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| 1 | + | Amended IN Senate August 17, 2018 Amended IN Senate July 03, 2018 Amended IN Senate June 14, 2018 Amended IN Assembly May 25, 2018 Amended IN Assembly April 24, 2018 Amended IN Assembly April 11, 2018 CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Assembly Bill No. 2122Introduced by Assembly Member Reyes(Principal coauthor: Assembly Member Arambula)(Principal coauthor: Senator Leyva)(Coauthor: Assembly Member Cristina Garcia)(Coauthors: Assembly Members Cristina Garcia and Santiago)(Coauthor: Senator Hueso)February 08, 2018 An act to add Section 105287 to the Health and Safety Code, and to amend Section 14197.05 of, and to add Sections 14087.42 and 14132.015 to to, the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGESTAB 2122, as amended, Reyes. Medi-Cal: blood lead screening tests.Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, 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 authorizes the department to enter contracts with managed care plans to provide Medi-Cal services. Under existing law, Medi-Cal covers early and periodic screening, diagnosis, and treatment for individuals under 21 years of age, consistent with federal law. Existing law requires the State Department of Public Health to adopt regulations establishing a standard of care under which a child is evaluated for risk of lead poisoning by health care providers during the childs periodic health assessment.This bill would require the State Department of Health Care Services to ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure, as described by the State Department of Public Health, and that a child 2 to 6 years of age, inclusive, receives a blood lead screening test if there is no record of a previous test for that child. The bill would require the department to report its progress toward blood lead screening tests for all enrolled children, as specified, in its annual External Accountability Set as part of the annual external quality review organization review, and annually on its Internet Web site, ensure Medi-Cal managed care plans make certain each enrolled child receives required blood lead screening tests, and ensure Medi-Cal managed care plans require health care providers to test enrolled children, as specified. The bill would further require the department to ensure a Medi-Cal managed care plan notifies a childs parent, parents, guardian, or other person charged with his or her support and maintenance, and the childs health care provider, with specified information, including when a child has missed a required blood lead screening test, as specified. The bill would require a contract between the department and a Medi-Cal managed care plan to ensure the plan and its contractors meet the standard of care for early and periodic screening when providing lead testing. This bill would require the State Department of Public Health to prepare provider training guidelines, curriculum, and resources to educate providers about childhood lead poisoning prevention, exposure risks, exposure health effects, and sources of exposure. The bill would require the State Department of Health Care Services to ensure a Medi-Cal managed care plan notifies and educates a contracted health care provider that, for 2 consecutive 12-month periods, fails to blood lead test at least 80% of the enrolled children, as specified, and to ensure that education reflects the training guidelines, curriculum, and resources developed by the State Department of Public Health. The bill would provide that it is the goal of the state that all children at risk of lead exposure receive blood lead screening tests. The bill would also make findings and declarations.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares the following:(a) Federal law and regulations require a state Medicaid plan, which in California is known as Medi-Cal, to provide Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program services to a person under 21 years of age who is eligible to receive assistance under the plan.(b) Federal law and regulations require EPSDT services to include blood lead risk assessments and blood lead tests as appropriate for age and risk factors.(c) Federal and state regulations require all Medi-Cal recipient children to be blood lead tested at 12 and 24 months of age. If a Medi-Cal recipient child is not blood lead tested by 24 months of age, the child is to be blood lead tested before six years of age.(d) Recent data provided to the Legislature by the State Department of Health Care Services indicate that the department can only verify that 28 percent of Medi-Cal recipient children are blood lead tested at 12 and 24 months of age.(e) According to the State Department of Public Health, 88 percent of children identified by the department as being lead poisoned are enrolled in Medi-Cal.(f) Multiple agencies, including the State Department of Public Health, the State Department of Health Care Services, local environmental health and public health departments, and other state agencies, share responsibilities related to ensuring that children are blood lead screened as required, and that they are treated for, and protected from, lead exposure.(g) Therefore, it is the intent of the Legislature to restate and reaffirm the responsibilities of these agencies to ensure that Medi-Cal recipient children, specifically children 12 months to six years of age, inclusive, receive required blood lead testing, as well as all necessary health care, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services.(h) It is also the intent of the Legislature to direct the State Department of Health Care Services to utilize all legally mandated financial resources to pay the costs associated with Medi-Cal recipient blood lead screening, treatment, and services, pursuant to the federal and state matching agreements outlined in the state Medicaid plan.SEC. 2. Section 105287 is added to the Health and Safety Code, to read:105287. The department shall prepare provider training guidelines, curriculum, and resources that shall be used to educate providers about childhood lead poisoning prevention, childhood lead exposure risks, childhood lead exposure health effects, and sources of childhood lead exposure at the state, regional, and local levels. The departments training guidelines, curriculum, and resources shall also explain and inform providers about the federal and state laws, regulations, and guidelines regarding childhood lead exposure screening and testing.SEC. 3. Section 14087.42 is added to the Welfare and Institutions Code, to read:14087.42. A contract between the department and a Medi-Cal managed care plan shall ensure that the Medi-Cal managed care plan and its contractors meet the standard of care for early and periodic screening when providing lead testing.SEC. 4. Section 14132.015 is added to the Welfare and Institutions Code, to read:14132.015. (a) (1) It is the goal of the state that all children at risk of lead exposure receive blood lead screening tests.(2) It is the goal of the state that all children eligible for Medi-Cal receive blood lead screening tests at 12 and 24 months of age.(3) It is the goal of the state that a child eligible for Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receive at least one blood lead screening test.(b) The department shall ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure.(c) The department shall ensure that a child enrolled in Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receives at least one blood lead screening test. The department shall also ensure that children are screened at any time at which they are identified as having a high risk of lead exposure.(d) To comply with the requirements of subdivisions (b) and (c), the department shall ensure contracted Medi-Cal managed care plans do all of the following:(1) Ensure each enrolled child receives required blood lead screening tests pursuant to state and federal law, regulations, and guidelines.(2) Require health care providers to test enrolled children pursuant to state and federal law, regulations, and guidelines.(3) At the time of a childs enrollment, and annually thereafter until a child receives all required tests or reaches six years of age, whichever occurs first, inform the childs parent, parents, guardian, or other person charged with his or her support and maintenance about all of the following:(A) The risks and effects of lead exposure.(B) The requirement for an enrolled child to receive blood lead screening tests.(C) The recommendation that a child receive a blood lead screening test if he or she is at risk of lead exposure.(D) The most common sources of lead exposure.(4) Provide coordination of care for each enrolled child, consistent with Medi-Cal managed care plans existing obligations under the Early and Periodic Screening, Diagnosis, and Treatment program, which program. This coordination of care shall ensure each enrolled child receives required blood lead screening tests and appropriate followup services if a childs blood test indicates an elevated blood lead level. services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code.(5) Ensure each enrolled child with an elevated blood lead level is connected to appropriate followup services, including, but not as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. Appropriate followup services include, but are not limited to, all of the following:(A) Environmental Appropriate environmental assessments and investigations, including onsite investigations of a childs home or primary residence, to determine the source or sources of lead.(B) Available remediation resources.(C) Assessments for iron deficiency and nutrition.(D) Any other health and behavioral health interventions to address the effects of blood lead poisoning, if appropriate.(E) Long-term monitoring for the effects of lead exposure.(F) Education and resources for the childs family members and caretakers.(G) Any additional testing and treatment as appropriate.(6) Notify a childs parent, parents, guardian, or other person charged with his or her support and maintenance, and the childs health care provider, when the child misses a required blood lead screening test. This notification shall be sent within 30 days of the missed test.(7) (A) Notify and educate a contracted health care provider that, for two consecutive 12-month periods, fails to blood lead test at least 80 percent of enrolled children pursuant to state and federal law, regulations, and guidelines. The Medi-Cal managed care plan shall only include in its calculation children with whom the provider had at least one encounter during the preceding 12 months.(B) To ensure compliance with this paragraph, the department shall ensure a Medi-Cal managed care plan notifies a noncompliant provider within 30 days of the end of the second 12-month period and educate noncompliant providers within three months of the second 12-month period. The department shall ensure the education of noncompliant providers reflects the training guidelines, curriculum, and resources developed by the State Department of Public Health pursuant to Section 105287 of the Health and Safety Code.(e) The department shall include blood lead screening tests as a performance measure in its annual external quality review organization (EQRO) review pursuant to Section 438.364 of Title 42 of the Code of Federal Regulations and Section 14197.05. This performance measure shall be reflected in the External Accountability Set. Set (EAS), effective for contract periods commencing on or after July 1, 2022. The EQRO entity shall annually review, survey, and report to the department the data and information required for the EAS and as identified in this subdivision. The department shall annually create a report detailing the departments progress toward the goals specified in subdivision (a) for children who were continuously enrolled for a three-month period and for children who were continuously enrolled for a 12-month period. The report shall be posted on the departments Internet Web site in a location that can be readily accessed by the general public. The report shall include all of the following:(1) The number of enrolled children in each county, divided by age, who have and have not received blood lead screening tests.(2) Screening results divided by blood-lead-level ranges.(3) The number of children referred to coordination of care services who received the following:(A) Followup health care.(B) Environmental assessment.(C) Educational screenings, nutrition education, and other resources.(4) The number of children identified as having lead poisoning and who received treatment for that lead poisoning.(5) Information about why a child identified with lead exposure or lead poisoning, who was connected to coordination of care services, did not receive one or more of the following:(A) Followup health care.(B) Environmental assessment.(C) Educational activities.(6) Information about the type and scope of educational activities provided.(f) As used in this section, elevated blood lead level shall be defined by the department in a way that is at least as stringent as the most recent federal Centers for Disease Control and Prevention screening guidelines. have the same meaning as the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code.SEC. 5. Section 14197.05 of the Welfare and Institutions Code is amended to read:14197.05. (a) As part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care plans in the annual detailed technical report required by Section 438.364 of Title 42 of the Code of Federal Regulations, effective for contract periods commencing on or after July 1, 2018, the EQRO entity designated by the department shall compile the data described in subdivision (b) by plan and by county for the purpose of informing the status of implementation of the requirements of Section 14197.(b) (1) The information compiled by the EQRO entity shall include all of the following:(A) Number of requests for alternative access standards in the plan service area for time and distance, categorized by all provider types, including specialists, and by adult and pediatric.(B) Number of allowable exceptions for the appointment time standard, if known, categorized by all provider types, including specialists, and by adult and pediatric.(C) Distance and driving time between the nearest network provider and ZIP Code of the beneficiary furthest from that provider for requests for alternative access standards.(D) Approximate number of beneficiaries impacted by alternative access standards or allowable exceptions.(E) Percentage of providers in the plan service area by provider and specialty type that are under a contract with a Medi-Cal managed care plan.(F) The number of requests for alternative access standards approved or denied by ZIP Code and provider and specialty type, and the reasons for the approval or denial of the request for alternative access standards.(G) The process of ensuring out-of-network access.(H) Descriptions of contracting efforts and explanation for why a contract was not executed.(I) Timeframe for approval or denial of a request for alternative access standards by the department.(J) Consumer complaints, if any.(2) The information described in paragraph (1) shall be presented in a chart format to enable comparison among counties, provider types, and plans.(c) The EQRO entity shall develop a methodology to assess information that will help inform the experience of individuals placed in a skilled nursing facility or intermediate care facility and the distance that they are placed from their place of residence. The EQRO entity shall report the results from the use of this methodology in the EQRO annual Medi-Cal managed care plan technical report.(d) Effective for contract periods commencing on or after July 1, 2022, the EQRO entity designated by the department shall review, survey, and report to the department the data and information relating to blood lead screening tests and performance measures as described in subdivision (e) of Section 14132.015.(d)(e) The department shall comply with the requirements of subsection (c) of Section 438.364 of Title 42 of the Code of Federal Regulations in making the information described in this section publicly available. | |
| 2 | 2 | ||
| 3 | - | ||
| 3 | + | Amended IN Senate August 17, 2018 Amended IN Senate July 03, 2018 Amended IN Senate June 14, 2018 Amended IN Assembly May 25, 2018 Amended IN Assembly April 24, 2018 Amended IN Assembly April 11, 2018 CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION Assembly Bill No. 2122Introduced by Assembly Member Reyes(Principal coauthor: Assembly Member Arambula)(Principal coauthor: Senator Leyva)(Coauthor: Assembly Member Cristina Garcia)(Coauthors: Assembly Members Cristina Garcia and Santiago)(Coauthor: Senator Hueso)February 08, 2018 An act to add Section 105287 to the Health and Safety Code, and to amend Section 14197.05 of, and to add Sections 14087.42 and 14132.015 to to, the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGESTAB 2122, as amended, Reyes. Medi-Cal: blood lead screening tests.Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, 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 authorizes the department to enter contracts with managed care plans to provide Medi-Cal services. Under existing law, Medi-Cal covers early and periodic screening, diagnosis, and treatment for individuals under 21 years of age, consistent with federal law. Existing law requires the State Department of Public Health to adopt regulations establishing a standard of care under which a child is evaluated for risk of lead poisoning by health care providers during the childs periodic health assessment.This bill would require the State Department of Health Care Services to ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure, as described by the State Department of Public Health, and that a child 2 to 6 years of age, inclusive, receives a blood lead screening test if there is no record of a previous test for that child. The bill would require the department to report its progress toward blood lead screening tests for all enrolled children, as specified, in its annual External Accountability Set as part of the annual external quality review organization review, and annually on its Internet Web site, ensure Medi-Cal managed care plans make certain each enrolled child receives required blood lead screening tests, and ensure Medi-Cal managed care plans require health care providers to test enrolled children, as specified. The bill would further require the department to ensure a Medi-Cal managed care plan notifies a childs parent, parents, guardian, or other person charged with his or her support and maintenance, and the childs health care provider, with specified information, including when a child has missed a required blood lead screening test, as specified. The bill would require a contract between the department and a Medi-Cal managed care plan to ensure the plan and its contractors meet the standard of care for early and periodic screening when providing lead testing. This bill would require the State Department of Public Health to prepare provider training guidelines, curriculum, and resources to educate providers about childhood lead poisoning prevention, exposure risks, exposure health effects, and sources of exposure. The bill would require the State Department of Health Care Services to ensure a Medi-Cal managed care plan notifies and educates a contracted health care provider that, for 2 consecutive 12-month periods, fails to blood lead test at least 80% of the enrolled children, as specified, and to ensure that education reflects the training guidelines, curriculum, and resources developed by the State Department of Public Health. The bill would provide that it is the goal of the state that all children at risk of lead exposure receive blood lead screening tests. The bill would also make findings and declarations.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO | |
| 4 | 4 | ||
| 5 | - | ||
| 5 | + | Amended IN Senate August 17, 2018 Amended IN Senate July 03, 2018 Amended IN Senate June 14, 2018 Amended IN Assembly May 25, 2018 Amended IN Assembly April 24, 2018 Amended IN Assembly April 11, 2018 | |
| 6 | 6 | ||
| 7 | - | Enrolled September 04, 2018 | |
| 8 | - | Passed IN Senate August 23, 2018 | |
| 9 | - | Passed IN Assembly August 30, 2018 | |
| 10 | 7 | Amended IN Senate August 17, 2018 | |
| 11 | 8 | Amended IN Senate July 03, 2018 | |
| 12 | 9 | Amended IN Senate June 14, 2018 | |
| 13 | 10 | Amended IN Assembly May 25, 2018 | |
| 14 | 11 | Amended IN Assembly April 24, 2018 | |
| 15 | 12 | Amended IN Assembly April 11, 2018 | |
| 16 | 13 | ||
| 17 | 14 | CALIFORNIA LEGISLATURE 20172018 REGULAR SESSION | |
| 18 | 15 | ||
| 19 | 16 | Assembly Bill No. 2122 | |
| 20 | 17 | ||
| 21 | - | Introduced by Assembly Member Reyes(Principal coauthor: Assembly Member Arambula)(Principal coauthor: Senator Leyva)(Coauthors: Assembly Members Cristina Garcia and Santiago)(Coauthor: Senator Hueso)February 08, 2018 | |
| 18 | + | Introduced by Assembly Member Reyes(Principal coauthor: Assembly Member Arambula)(Principal coauthor: Senator Leyva)(Coauthor: Assembly Member Cristina Garcia)(Coauthors: Assembly Members Cristina Garcia and Santiago)(Coauthor: Senator Hueso)February 08, 2018 | |
| 22 | 19 | ||
| 23 | - | Introduced by Assembly Member Reyes(Principal coauthor: Assembly Member Arambula)(Principal coauthor: Senator Leyva)(Coauthors: Assembly Members Cristina Garcia and Santiago)(Coauthor: Senator Hueso) | |
| 20 | + | Introduced by Assembly Member Reyes(Principal coauthor: Assembly Member Arambula)(Principal coauthor: Senator Leyva)(Coauthor: Assembly Member Cristina Garcia)(Coauthors: Assembly Members Cristina Garcia and Santiago)(Coauthor: Senator Hueso) | |
| 24 | 21 | February 08, 2018 | |
| 25 | 22 | ||
| 26 | - | An act to add Section 105287 to the Health and Safety Code, and to amend Section 14197.05 of, and to add Sections 14087.42 and 14132.015 to, the Welfare and Institutions Code, relating to Medi-Cal. | |
| 23 | + | An act to add Section 105287 to the Health and Safety Code, and to amend Section 14197.05 of, and to add Sections 14087.42 and 14132.015 to to, the Welfare and Institutions Code, relating to Medi-Cal. | |
| 27 | 24 | ||
| 28 | 25 | LEGISLATIVE COUNSEL'S DIGEST | |
| 29 | 26 | ||
| 30 | 27 | ## LEGISLATIVE COUNSEL'S DIGEST | |
| 31 | 28 | ||
| 32 | - | AB 2122, Reyes. Medi-Cal: blood lead screening tests. | |
| 29 | + | AB 2122, as amended, Reyes. Medi-Cal: blood lead screening tests. | |
| 33 | 30 | ||
| 34 | - | Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, 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 authorizes the department to enter contracts with managed care plans to provide Medi-Cal services. Under existing law, Medi-Cal covers early and periodic screening, diagnosis, and treatment for individuals under 21 years of age, consistent with federal law. Existing law requires the State Department of Public Health to adopt regulations establishing a standard of care under which a child is evaluated for risk of lead poisoning by health care providers during the childs periodic health assessment.This bill would require the State Department of Health Care Services to ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure, as described by the State Department of Public Health, and that a child 2 to 6 years of age, inclusive, receives a blood lead screening test if there is no record of a previous test for that child. The bill would require the department to report its progress toward blood lead screening tests for all enrolled children, as specified, in its annual External Accountability Set as part of the annual external quality review organization review, and annually on its Internet Web site, | |
| 31 | + | Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, 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 authorizes the department to enter contracts with managed care plans to provide Medi-Cal services. Under existing law, Medi-Cal covers early and periodic screening, diagnosis, and treatment for individuals under 21 years of age, consistent with federal law. Existing law requires the State Department of Public Health to adopt regulations establishing a standard of care under which a child is evaluated for risk of lead poisoning by health care providers during the childs periodic health assessment.This bill would require the State Department of Health Care Services to ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure, as described by the State Department of Public Health, and that a child 2 to 6 years of age, inclusive, receives a blood lead screening test if there is no record of a previous test for that child. The bill would require the department to report its progress toward blood lead screening tests for all enrolled children, as specified, in its annual External Accountability Set as part of the annual external quality review organization review, and annually on its Internet Web site, ensure Medi-Cal managed care plans make certain each enrolled child receives required blood lead screening tests, and ensure Medi-Cal managed care plans require health care providers to test enrolled children, as specified. The bill would further require the department to ensure a Medi-Cal managed care plan notifies a childs parent, parents, guardian, or other person charged with his or her support and maintenance, and the childs health care provider, with specified information, including when a child has missed a required blood lead screening test, as specified. The bill would require a contract between the department and a Medi-Cal managed care plan to ensure the plan and its contractors meet the standard of care for early and periodic screening when providing lead testing. This bill would require the State Department of Public Health to prepare provider training guidelines, curriculum, and resources to educate providers about childhood lead poisoning prevention, exposure risks, exposure health effects, and sources of exposure. The bill would require the State Department of Health Care Services to ensure a Medi-Cal managed care plan notifies and educates a contracted health care provider that, for 2 consecutive 12-month periods, fails to blood lead test at least 80% of the enrolled children, as specified, and to ensure that education reflects the training guidelines, curriculum, and resources developed by the State Department of Public Health. The bill would provide that it is the goal of the state that all children at risk of lead exposure receive blood lead screening tests. The bill would also make findings and declarations. | |
| 35 | 32 | ||
| 36 | 33 | Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, 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 authorizes the department to enter contracts with managed care plans to provide Medi-Cal services. Under existing law, Medi-Cal covers early and periodic screening, diagnosis, and treatment for individuals under 21 years of age, consistent with federal law. Existing law requires the State Department of Public Health to adopt regulations establishing a standard of care under which a child is evaluated for risk of lead poisoning by health care providers during the childs periodic health assessment. | |
| 37 | 34 | ||
| 38 | - | This bill would require the State Department of Health Care Services to ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure, as described by the State Department of Public Health, and that a child 2 to 6 years of age, inclusive, receives a blood lead screening test if there is no record of a previous test for that child. The bill would require the department to report its progress toward blood lead screening tests for all enrolled children, as specified, in its annual External Accountability Set as part of the annual external quality review organization review, and annually on its Internet Web site, | |
| 35 | + | This bill would require the State Department of Health Care Services to ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure, as described by the State Department of Public Health, and that a child 2 to 6 years of age, inclusive, receives a blood lead screening test if there is no record of a previous test for that child. The bill would require the department to report its progress toward blood lead screening tests for all enrolled children, as specified, in its annual External Accountability Set as part of the annual external quality review organization review, and annually on its Internet Web site, ensure Medi-Cal managed care plans make certain each enrolled child receives required blood lead screening tests, and ensure Medi-Cal managed care plans require health care providers to test enrolled children, as specified. The bill would further require the department to ensure a Medi-Cal managed care plan notifies a childs parent, parents, guardian, or other person charged with his or her support and maintenance, and the childs health care provider, with specified information, including when a child has missed a required blood lead screening test, as specified. The bill would require a contract between the department and a Medi-Cal managed care plan to ensure the plan and its contractors meet the standard of care for early and periodic screening when providing lead testing. | |
| 39 | 36 | ||
| 40 | 37 | This bill would require the State Department of Public Health to prepare provider training guidelines, curriculum, and resources to educate providers about childhood lead poisoning prevention, exposure risks, exposure health effects, and sources of exposure. The bill would require the State Department of Health Care Services to ensure a Medi-Cal managed care plan notifies and educates a contracted health care provider that, for 2 consecutive 12-month periods, fails to blood lead test at least 80% of the enrolled children, as specified, and to ensure that education reflects the training guidelines, curriculum, and resources developed by the State Department of Public Health. The bill would provide that it is the goal of the state that all children at risk of lead exposure receive blood lead screening tests. The bill would also make findings and declarations. | |
| 41 | 38 | ||
| 42 | 39 | ## Digest Key | |
| 43 | 40 | ||
| 44 | 41 | ## Bill Text | |
| 45 | 42 | ||
| 46 | - | The people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares the following:(a) Federal law and regulations require a state Medicaid plan, which in California is known as Medi-Cal, to provide Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program services to a person under 21 years of age who is eligible to receive assistance under the plan.(b) Federal law and regulations require EPSDT services to include blood lead risk assessments and blood lead tests as appropriate for age and risk factors.(c) Federal and state regulations require all Medi-Cal recipient children to be blood lead tested at 12 and 24 months of age. If a Medi-Cal recipient child is not blood lead tested by 24 months of age, the child is to be blood lead tested before six years of age.(d) Recent data provided to the Legislature by the State Department of Health Care Services indicate that the department can only verify that 28 percent of Medi-Cal recipient children are blood lead tested at 12 and 24 months of age.(e) According to the State Department of Public Health, 88 percent of children identified by the department as being lead poisoned are enrolled in Medi-Cal.(f) Multiple agencies, including the State Department of Public Health, the State Department of Health Care Services, local environmental health and public health departments, and other state agencies, share responsibilities related to ensuring that children are blood lead screened as required, and that they are treated for, and protected from, lead exposure.(g) Therefore, it is the intent of the Legislature to restate and reaffirm the responsibilities of these agencies to ensure that Medi-Cal recipient children, specifically children 12 months to six years of age, inclusive, receive required blood lead testing, as well as all necessary health care, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services.(h) It is also the intent of the Legislature to direct the State Department of Health Care Services to utilize all legally mandated financial resources to pay the costs associated with Medi-Cal recipient blood lead screening, treatment, and services, pursuant to the federal and state matching agreements outlined in the state Medicaid plan.SEC. 2. Section 105287 is added to the Health and Safety Code, to read:105287. The department shall prepare provider training guidelines, curriculum, and resources that shall be used to educate providers about childhood lead poisoning prevention, childhood lead exposure risks, childhood lead exposure health effects, and sources of childhood lead exposure at the state, regional, and local levels. The departments training guidelines, curriculum, and resources shall also explain and inform providers about the federal and state laws, regulations, and guidelines regarding childhood lead exposure screening and testing.SEC. 3. Section 14087.42 is added to the Welfare and Institutions Code, to read:14087.42. A contract between the department and a Medi-Cal managed care plan shall ensure that the Medi-Cal managed care plan and its contractors meet the standard of care for early and periodic screening when providing lead testing.SEC. 4. Section 14132.015 is added to the Welfare and Institutions Code, to read:14132.015. (a) (1) It is the goal of the state that all children at risk of lead exposure receive blood lead screening tests.(2) It is the goal of the state that all children eligible for Medi-Cal receive blood lead screening tests at 12 and 24 months of age.(3) It is the goal of the state that a child eligible for Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receive at least one blood lead screening test.(b) The department shall ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure.(c) The department shall ensure that a child enrolled in Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receives at least one blood lead screening test. The department shall also ensure that children are screened at any time at which they are identified as having a high risk of lead exposure.(d) To comply with the requirements of subdivisions (b) and (c), the department shall ensure contracted Medi-Cal managed care plans do all of the following:(1) Ensure each enrolled child receives required blood lead screening tests pursuant to state and federal law, regulations, and guidelines.(2) Require health care providers to test enrolled children pursuant to state and federal law, regulations, and guidelines.(3) At the time of a childs enrollment, and annually thereafter until a child receives all required tests or reaches six years of age, whichever occurs first, inform the childs parent, parents, guardian, or other person charged with his or her support and maintenance about all of the following:(A) The risks and effects of lead exposure.(B) The requirement for an enrolled child to receive blood lead screening tests.(C) The recommendation that a child receive a blood lead screening test if he or she is at risk of lead exposure.(D) The most common sources of lead exposure.(4) Provide coordination of care for each enrolled child, consistent with Medi-Cal managed care plans existing obligations under the Early and Periodic Screening, Diagnosis, and Treatment program. This coordination of care shall ensure each enrolled child receives required blood lead screening tests and appropriate followup services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code.(5) Ensure each enrolled child with an elevated blood lead level is connected to appropriate followup services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. Appropriate followup services include, but are not limited to, all of the following:(A) Appropriate environmental assessments and investigations, including onsite investigations of a childs home or primary residence, to determine the source or sources of lead.(B) Available remediation resources.(C) Assessments for iron deficiency and nutrition.(D) Any other health and behavioral health interventions to address the effects of blood lead poisoning, if appropriate.(E) Long-term monitoring for the effects of lead exposure.(F) Education and resources for the childs family members and caretakers.(G) Any additional testing and treatment as appropriate.(6) Notify a childs parent, parents, guardian, or other person charged with his or her support and maintenance, and the childs health care provider, when the child misses a required blood lead screening test. This notification shall be sent within 30 days of the missed test.(7) (A) Notify and educate a contracted health care provider that, for two consecutive 12-month periods, fails to blood lead test at least 80 percent of enrolled children pursuant to state and federal law, regulations, and guidelines. The Medi-Cal managed care plan shall only include in its calculation children with whom the provider had at least one encounter during the preceding 12 months.(B) To ensure compliance with this paragraph, the department shall ensure a Medi-Cal managed care plan notifies a noncompliant provider within 30 days of the end of the second 12-month period and educate noncompliant providers within three months of the second 12-month period. The department shall ensure the education of noncompliant providers reflects the training guidelines, curriculum, and resources developed by the State Department of Public Health pursuant to Section 105287 of the Health and Safety Code.(e) The department shall include blood lead screening tests as a performance measure in its annual external quality review organization (EQRO) review pursuant to Section 438.364 of Title 42 of the Code of Federal Regulations and Section 14197.05. This performance measure shall be reflected in the External Accountability Set (EAS), effective for contract periods commencing on or after July 1, 2022. The EQRO entity shall annually review, survey, and report to the department the data and information required for the EAS and as identified in this subdivision. The department shall annually create a report detailing the departments progress toward the goals specified in subdivision (a) for children who were continuously enrolled for a three-month period and for children who were continuously enrolled for a 12-month period. The report shall be posted on the departments Internet Web site in a location that can be readily accessed by the general public. The report shall include all of the following:(1) The number of enrolled children in each county, divided by age, who have and have not received blood lead screening tests.(2) Screening results divided by blood-lead-level ranges.(3) The number of children referred to coordination of care services who received the following:(A) Followup health care.(B) Environmental assessment.(C) Educational screenings, nutrition education, and other resources.(4) The number of children identified as having lead poisoning and who received treatment for that lead poisoning.(5) Information about why a child identified with lead exposure or lead poisoning, who was connected to coordination of care services, did not receive one or more of the following:(A) Followup health care.(B) Environmental assessment.(C) Educational activities.(6) Information about the type and scope of educational activities provided.(f) As used in this section, elevated blood lead level shall have the same meaning as the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code.SEC. 5. Section 14197.05 of the Welfare and Institutions Code is amended to read:14197.05. (a) As part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care plans in the annual detailed technical report required by Section 438.364 of Title 42 of the Code of Federal Regulations, effective for contract periods commencing on or after July 1, 2018, the EQRO entity designated by the department shall compile the data described in subdivision (b) by plan and by county for the purpose of informing the status of implementation of the requirements of Section 14197.(b) (1) The information compiled by the EQRO entity shall include all of the following:(A) Number of requests for alternative access standards in the plan service area for time and distance, categorized by all provider types, including specialists, and by adult and pediatric.(B) Number of allowable exceptions for the appointment time standard, if known, categorized by all provider types, including specialists, and by adult and pediatric.(C) Distance and driving time between the nearest network provider and ZIP Code of the beneficiary furthest from that provider for requests for alternative access standards.(D) Approximate number of beneficiaries impacted by alternative access standards or allowable exceptions.(E) Percentage of providers in the plan service area by provider and specialty type that are under a contract with a Medi-Cal managed care plan.(F) The number of requests for alternative access standards approved or denied by ZIP Code and provider and specialty type, and the reasons for the approval or denial of the request for alternative access standards.(G) The process of ensuring out-of-network access.(H) Descriptions of contracting efforts and explanation for why a contract was not executed.(I) Timeframe for approval or denial of a request for alternative access standards by the department.(J) Consumer complaints, if any.(2) The information described in paragraph (1) shall be presented in a chart format to enable comparison among counties, provider types, and plans.(c) The EQRO entity shall develop a methodology to assess information that will help inform the experience of individuals placed in a skilled nursing facility or intermediate care facility and the distance that they are placed from their place of residence. The EQRO entity shall report the results from the use of this methodology in the EQRO annual Medi-Cal managed care plan technical report.(d) Effective for contract periods commencing on or after July 1, 2022, the EQRO entity designated by the department shall review, survey, and report to the department the data and information relating to blood lead screening tests and performance measures as described in subdivision (e) of Section 14132.015.(e) The department shall comply with the requirements of subsection (c) of Section 438.364 of Title 42 of the Code of Federal Regulations in making the information described in this section publicly available. | |
| 43 | + | The people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares the following:(a) Federal law and regulations require a state Medicaid plan, which in California is known as Medi-Cal, to provide Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program services to a person under 21 years of age who is eligible to receive assistance under the plan.(b) Federal law and regulations require EPSDT services to include blood lead risk assessments and blood lead tests as appropriate for age and risk factors.(c) Federal and state regulations require all Medi-Cal recipient children to be blood lead tested at 12 and 24 months of age. If a Medi-Cal recipient child is not blood lead tested by 24 months of age, the child is to be blood lead tested before six years of age.(d) Recent data provided to the Legislature by the State Department of Health Care Services indicate that the department can only verify that 28 percent of Medi-Cal recipient children are blood lead tested at 12 and 24 months of age.(e) According to the State Department of Public Health, 88 percent of children identified by the department as being lead poisoned are enrolled in Medi-Cal.(f) Multiple agencies, including the State Department of Public Health, the State Department of Health Care Services, local environmental health and public health departments, and other state agencies, share responsibilities related to ensuring that children are blood lead screened as required, and that they are treated for, and protected from, lead exposure.(g) Therefore, it is the intent of the Legislature to restate and reaffirm the responsibilities of these agencies to ensure that Medi-Cal recipient children, specifically children 12 months to six years of age, inclusive, receive required blood lead testing, as well as all necessary health care, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services.(h) It is also the intent of the Legislature to direct the State Department of Health Care Services to utilize all legally mandated financial resources to pay the costs associated with Medi-Cal recipient blood lead screening, treatment, and services, pursuant to the federal and state matching agreements outlined in the state Medicaid plan.SEC. 2. Section 105287 is added to the Health and Safety Code, to read:105287. The department shall prepare provider training guidelines, curriculum, and resources that shall be used to educate providers about childhood lead poisoning prevention, childhood lead exposure risks, childhood lead exposure health effects, and sources of childhood lead exposure at the state, regional, and local levels. The departments training guidelines, curriculum, and resources shall also explain and inform providers about the federal and state laws, regulations, and guidelines regarding childhood lead exposure screening and testing.SEC. 3. Section 14087.42 is added to the Welfare and Institutions Code, to read:14087.42. A contract between the department and a Medi-Cal managed care plan shall ensure that the Medi-Cal managed care plan and its contractors meet the standard of care for early and periodic screening when providing lead testing.SEC. 4. Section 14132.015 is added to the Welfare and Institutions Code, to read:14132.015. (a) (1) It is the goal of the state that all children at risk of lead exposure receive blood lead screening tests.(2) It is the goal of the state that all children eligible for Medi-Cal receive blood lead screening tests at 12 and 24 months of age.(3) It is the goal of the state that a child eligible for Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receive at least one blood lead screening test.(b) The department shall ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure.(c) The department shall ensure that a child enrolled in Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receives at least one blood lead screening test. The department shall also ensure that children are screened at any time at which they are identified as having a high risk of lead exposure.(d) To comply with the requirements of subdivisions (b) and (c), the department shall ensure contracted Medi-Cal managed care plans do all of the following:(1) Ensure each enrolled child receives required blood lead screening tests pursuant to state and federal law, regulations, and guidelines.(2) Require health care providers to test enrolled children pursuant to state and federal law, regulations, and guidelines.(3) At the time of a childs enrollment, and annually thereafter until a child receives all required tests or reaches six years of age, whichever occurs first, inform the childs parent, parents, guardian, or other person charged with his or her support and maintenance about all of the following:(A) The risks and effects of lead exposure.(B) The requirement for an enrolled child to receive blood lead screening tests.(C) The recommendation that a child receive a blood lead screening test if he or she is at risk of lead exposure.(D) The most common sources of lead exposure.(4) Provide coordination of care for each enrolled child, consistent with Medi-Cal managed care plans existing obligations under the Early and Periodic Screening, Diagnosis, and Treatment program, which program. This coordination of care shall ensure each enrolled child receives required blood lead screening tests and appropriate followup services if a childs blood test indicates an elevated blood lead level. services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code.(5) Ensure each enrolled child with an elevated blood lead level is connected to appropriate followup services, including, but not as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. Appropriate followup services include, but are not limited to, all of the following:(A) Environmental Appropriate environmental assessments and investigations, including onsite investigations of a childs home or primary residence, to determine the source or sources of lead.(B) Available remediation resources.(C) Assessments for iron deficiency and nutrition.(D) Any other health and behavioral health interventions to address the effects of blood lead poisoning, if appropriate.(E) Long-term monitoring for the effects of lead exposure.(F) Education and resources for the childs family members and caretakers.(G) Any additional testing and treatment as appropriate.(6) Notify a childs parent, parents, guardian, or other person charged with his or her support and maintenance, and the childs health care provider, when the child misses a required blood lead screening test. This notification shall be sent within 30 days of the missed test.(7) (A) Notify and educate a contracted health care provider that, for two consecutive 12-month periods, fails to blood lead test at least 80 percent of enrolled children pursuant to state and federal law, regulations, and guidelines. The Medi-Cal managed care plan shall only include in its calculation children with whom the provider had at least one encounter during the preceding 12 months.(B) To ensure compliance with this paragraph, the department shall ensure a Medi-Cal managed care plan notifies a noncompliant provider within 30 days of the end of the second 12-month period and educate noncompliant providers within three months of the second 12-month period. The department shall ensure the education of noncompliant providers reflects the training guidelines, curriculum, and resources developed by the State Department of Public Health pursuant to Section 105287 of the Health and Safety Code.(e) The department shall include blood lead screening tests as a performance measure in its annual external quality review organization (EQRO) review pursuant to Section 438.364 of Title 42 of the Code of Federal Regulations and Section 14197.05. This performance measure shall be reflected in the External Accountability Set. Set (EAS), effective for contract periods commencing on or after July 1, 2022. The EQRO entity shall annually review, survey, and report to the department the data and information required for the EAS and as identified in this subdivision. The department shall annually create a report detailing the departments progress toward the goals specified in subdivision (a) for children who were continuously enrolled for a three-month period and for children who were continuously enrolled for a 12-month period. The report shall be posted on the departments Internet Web site in a location that can be readily accessed by the general public. The report shall include all of the following:(1) The number of enrolled children in each county, divided by age, who have and have not received blood lead screening tests.(2) Screening results divided by blood-lead-level ranges.(3) The number of children referred to coordination of care services who received the following:(A) Followup health care.(B) Environmental assessment.(C) Educational screenings, nutrition education, and other resources.(4) The number of children identified as having lead poisoning and who received treatment for that lead poisoning.(5) Information about why a child identified with lead exposure or lead poisoning, who was connected to coordination of care services, did not receive one or more of the following:(A) Followup health care.(B) Environmental assessment.(C) Educational activities.(6) Information about the type and scope of educational activities provided.(f) As used in this section, elevated blood lead level shall be defined by the department in a way that is at least as stringent as the most recent federal Centers for Disease Control and Prevention screening guidelines. have the same meaning as the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code.SEC. 5. Section 14197.05 of the Welfare and Institutions Code is amended to read:14197.05. (a) As part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care plans in the annual detailed technical report required by Section 438.364 of Title 42 of the Code of Federal Regulations, effective for contract periods commencing on or after July 1, 2018, the EQRO entity designated by the department shall compile the data described in subdivision (b) by plan and by county for the purpose of informing the status of implementation of the requirements of Section 14197.(b) (1) The information compiled by the EQRO entity shall include all of the following:(A) Number of requests for alternative access standards in the plan service area for time and distance, categorized by all provider types, including specialists, and by adult and pediatric.(B) Number of allowable exceptions for the appointment time standard, if known, categorized by all provider types, including specialists, and by adult and pediatric.(C) Distance and driving time between the nearest network provider and ZIP Code of the beneficiary furthest from that provider for requests for alternative access standards.(D) Approximate number of beneficiaries impacted by alternative access standards or allowable exceptions.(E) Percentage of providers in the plan service area by provider and specialty type that are under a contract with a Medi-Cal managed care plan.(F) The number of requests for alternative access standards approved or denied by ZIP Code and provider and specialty type, and the reasons for the approval or denial of the request for alternative access standards.(G) The process of ensuring out-of-network access.(H) Descriptions of contracting efforts and explanation for why a contract was not executed.(I) Timeframe for approval or denial of a request for alternative access standards by the department.(J) Consumer complaints, if any.(2) The information described in paragraph (1) shall be presented in a chart format to enable comparison among counties, provider types, and plans.(c) The EQRO entity shall develop a methodology to assess information that will help inform the experience of individuals placed in a skilled nursing facility or intermediate care facility and the distance that they are placed from their place of residence. The EQRO entity shall report the results from the use of this methodology in the EQRO annual Medi-Cal managed care plan technical report.(d) Effective for contract periods commencing on or after July 1, 2022, the EQRO entity designated by the department shall review, survey, and report to the department the data and information relating to blood lead screening tests and performance measures as described in subdivision (e) of Section 14132.015.(d)(e) The department shall comply with the requirements of subsection (c) of Section 438.364 of Title 42 of the Code of Federal Regulations in making the information described in this section publicly available. | |
| 47 | 44 | ||
| 48 | 45 | The people of the State of California do enact as follows: | |
| 49 | 46 | ||
| 50 | 47 | ## The people of the State of California do enact as follows: | |
| 51 | 48 | ||
| 52 | 49 | SECTION 1. The Legislature finds and declares the following:(a) Federal law and regulations require a state Medicaid plan, which in California is known as Medi-Cal, to provide Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program services to a person under 21 years of age who is eligible to receive assistance under the plan.(b) Federal law and regulations require EPSDT services to include blood lead risk assessments and blood lead tests as appropriate for age and risk factors.(c) Federal and state regulations require all Medi-Cal recipient children to be blood lead tested at 12 and 24 months of age. If a Medi-Cal recipient child is not blood lead tested by 24 months of age, the child is to be blood lead tested before six years of age.(d) Recent data provided to the Legislature by the State Department of Health Care Services indicate that the department can only verify that 28 percent of Medi-Cal recipient children are blood lead tested at 12 and 24 months of age.(e) According to the State Department of Public Health, 88 percent of children identified by the department as being lead poisoned are enrolled in Medi-Cal.(f) Multiple agencies, including the State Department of Public Health, the State Department of Health Care Services, local environmental health and public health departments, and other state agencies, share responsibilities related to ensuring that children are blood lead screened as required, and that they are treated for, and protected from, lead exposure.(g) Therefore, it is the intent of the Legislature to restate and reaffirm the responsibilities of these agencies to ensure that Medi-Cal recipient children, specifically children 12 months to six years of age, inclusive, receive required blood lead testing, as well as all necessary health care, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services.(h) It is also the intent of the Legislature to direct the State Department of Health Care Services to utilize all legally mandated financial resources to pay the costs associated with Medi-Cal recipient blood lead screening, treatment, and services, pursuant to the federal and state matching agreements outlined in the state Medicaid plan. | |
| 53 | 50 | ||
| 54 | 51 | SECTION 1. The Legislature finds and declares the following:(a) Federal law and regulations require a state Medicaid plan, which in California is known as Medi-Cal, to provide Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program services to a person under 21 years of age who is eligible to receive assistance under the plan.(b) Federal law and regulations require EPSDT services to include blood lead risk assessments and blood lead tests as appropriate for age and risk factors.(c) Federal and state regulations require all Medi-Cal recipient children to be blood lead tested at 12 and 24 months of age. If a Medi-Cal recipient child is not blood lead tested by 24 months of age, the child is to be blood lead tested before six years of age.(d) Recent data provided to the Legislature by the State Department of Health Care Services indicate that the department can only verify that 28 percent of Medi-Cal recipient children are blood lead tested at 12 and 24 months of age.(e) According to the State Department of Public Health, 88 percent of children identified by the department as being lead poisoned are enrolled in Medi-Cal.(f) Multiple agencies, including the State Department of Public Health, the State Department of Health Care Services, local environmental health and public health departments, and other state agencies, share responsibilities related to ensuring that children are blood lead screened as required, and that they are treated for, and protected from, lead exposure.(g) Therefore, it is the intent of the Legislature to restate and reaffirm the responsibilities of these agencies to ensure that Medi-Cal recipient children, specifically children 12 months to six years of age, inclusive, receive required blood lead testing, as well as all necessary health care, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services.(h) It is also the intent of the Legislature to direct the State Department of Health Care Services to utilize all legally mandated financial resources to pay the costs associated with Medi-Cal recipient blood lead screening, treatment, and services, pursuant to the federal and state matching agreements outlined in the state Medicaid plan. | |
| 55 | 52 | ||
| 56 | 53 | SECTION 1. The Legislature finds and declares the following: | |
| 57 | 54 | ||
| 58 | 55 | ### SECTION 1. | |
| 59 | 56 | ||
| 60 | 57 | (a) Federal law and regulations require a state Medicaid plan, which in California is known as Medi-Cal, to provide Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program services to a person under 21 years of age who is eligible to receive assistance under the plan. | |
| 61 | 58 | ||
| 62 | 59 | (b) Federal law and regulations require EPSDT services to include blood lead risk assessments and blood lead tests as appropriate for age and risk factors. | |
| 63 | 60 | ||
| 64 | 61 | (c) Federal and state regulations require all Medi-Cal recipient children to be blood lead tested at 12 and 24 months of age. If a Medi-Cal recipient child is not blood lead tested by 24 months of age, the child is to be blood lead tested before six years of age. | |
| 65 | 62 | ||
| 66 | 63 | (d) Recent data provided to the Legislature by the State Department of Health Care Services indicate that the department can only verify that 28 percent of Medi-Cal recipient children are blood lead tested at 12 and 24 months of age. | |
| 67 | 64 | ||
| 68 | 65 | (e) According to the State Department of Public Health, 88 percent of children identified by the department as being lead poisoned are enrolled in Medi-Cal. | |
| 69 | 66 | ||
| 70 | 67 | (f) Multiple agencies, including the State Department of Public Health, the State Department of Health Care Services, local environmental health and public health departments, and other state agencies, share responsibilities related to ensuring that children are blood lead screened as required, and that they are treated for, and protected from, lead exposure. | |
| 71 | 68 | ||
| 72 | 69 | (g) Therefore, it is the intent of the Legislature to restate and reaffirm the responsibilities of these agencies to ensure that Medi-Cal recipient children, specifically children 12 months to six years of age, inclusive, receive required blood lead testing, as well as all necessary health care, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services. | |
| 73 | 70 | ||
| 74 | 71 | (h) It is also the intent of the Legislature to direct the State Department of Health Care Services to utilize all legally mandated financial resources to pay the costs associated with Medi-Cal recipient blood lead screening, treatment, and services, pursuant to the federal and state matching agreements outlined in the state Medicaid plan. | |
| 75 | 72 | ||
| 76 | 73 | SEC. 2. Section 105287 is added to the Health and Safety Code, to read:105287. The department shall prepare provider training guidelines, curriculum, and resources that shall be used to educate providers about childhood lead poisoning prevention, childhood lead exposure risks, childhood lead exposure health effects, and sources of childhood lead exposure at the state, regional, and local levels. The departments training guidelines, curriculum, and resources shall also explain and inform providers about the federal and state laws, regulations, and guidelines regarding childhood lead exposure screening and testing. | |
| 77 | 74 | ||
| 78 | 75 | SEC. 2. Section 105287 is added to the Health and Safety Code, to read: | |
| 79 | 76 | ||
| 80 | 77 | ### SEC. 2. | |
| 81 | 78 | ||
| 82 | 79 | 105287. The department shall prepare provider training guidelines, curriculum, and resources that shall be used to educate providers about childhood lead poisoning prevention, childhood lead exposure risks, childhood lead exposure health effects, and sources of childhood lead exposure at the state, regional, and local levels. The departments training guidelines, curriculum, and resources shall also explain and inform providers about the federal and state laws, regulations, and guidelines regarding childhood lead exposure screening and testing. | |
| 83 | 80 | ||
| 84 | 81 | 105287. The department shall prepare provider training guidelines, curriculum, and resources that shall be used to educate providers about childhood lead poisoning prevention, childhood lead exposure risks, childhood lead exposure health effects, and sources of childhood lead exposure at the state, regional, and local levels. The departments training guidelines, curriculum, and resources shall also explain and inform providers about the federal and state laws, regulations, and guidelines regarding childhood lead exposure screening and testing. | |
| 85 | 82 | ||
| 86 | 83 | 105287. The department shall prepare provider training guidelines, curriculum, and resources that shall be used to educate providers about childhood lead poisoning prevention, childhood lead exposure risks, childhood lead exposure health effects, and sources of childhood lead exposure at the state, regional, and local levels. The departments training guidelines, curriculum, and resources shall also explain and inform providers about the federal and state laws, regulations, and guidelines regarding childhood lead exposure screening and testing. | |
| 87 | 84 | ||
| 88 | 85 | ||
| 89 | 86 | ||
| 90 | 87 | 105287. The department shall prepare provider training guidelines, curriculum, and resources that shall be used to educate providers about childhood lead poisoning prevention, childhood lead exposure risks, childhood lead exposure health effects, and sources of childhood lead exposure at the state, regional, and local levels. The departments training guidelines, curriculum, and resources shall also explain and inform providers about the federal and state laws, regulations, and guidelines regarding childhood lead exposure screening and testing. | |
| 91 | 88 | ||
| 92 | 89 | SEC. 3. Section 14087.42 is added to the Welfare and Institutions Code, to read:14087.42. A contract between the department and a Medi-Cal managed care plan shall ensure that the Medi-Cal managed care plan and its contractors meet the standard of care for early and periodic screening when providing lead testing. | |
| 93 | 90 | ||
| 94 | 91 | SEC. 3. Section 14087.42 is added to the Welfare and Institutions Code, to read: | |
| 95 | 92 | ||
| 96 | 93 | ### SEC. 3. | |
| 97 | 94 | ||
| 98 | 95 | 14087.42. A contract between the department and a Medi-Cal managed care plan shall ensure that the Medi-Cal managed care plan and its contractors meet the standard of care for early and periodic screening when providing lead testing. | |
| 99 | 96 | ||
| 100 | 97 | 14087.42. A contract between the department and a Medi-Cal managed care plan shall ensure that the Medi-Cal managed care plan and its contractors meet the standard of care for early and periodic screening when providing lead testing. | |
| 101 | 98 | ||
| 102 | 99 | 14087.42. A contract between the department and a Medi-Cal managed care plan shall ensure that the Medi-Cal managed care plan and its contractors meet the standard of care for early and periodic screening when providing lead testing. | |
| 103 | 100 | ||
| 104 | 101 | ||
| 105 | 102 | ||
| 106 | 103 | 14087.42. A contract between the department and a Medi-Cal managed care plan shall ensure that the Medi-Cal managed care plan and its contractors meet the standard of care for early and periodic screening when providing lead testing. | |
| 107 | 104 | ||
| 108 | - | SEC. 4. Section 14132.015 is added to the Welfare and Institutions Code, to read:14132.015. (a) (1) It is the goal of the state that all children at risk of lead exposure receive blood lead screening tests.(2) It is the goal of the state that all children eligible for Medi-Cal receive blood lead screening tests at 12 and 24 months of age.(3) It is the goal of the state that a child eligible for Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receive at least one blood lead screening test.(b) The department shall ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure.(c) The department shall ensure that a child enrolled in Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receives at least one blood lead screening test. The department shall also ensure that children are screened at any time at which they are identified as having a high risk of lead exposure.(d) To comply with the requirements of subdivisions (b) and (c), the department shall ensure contracted Medi-Cal managed care plans do all of the following:(1) Ensure each enrolled child receives required blood lead screening tests pursuant to state and federal law, regulations, and guidelines.(2) Require health care providers to test enrolled children pursuant to state and federal law, regulations, and guidelines.(3) At the time of a childs enrollment, and annually thereafter until a child receives all required tests or reaches six years of age, whichever occurs first, inform the childs parent, parents, guardian, or other person charged with his or her support and maintenance about all of the following:(A) The risks and effects of lead exposure.(B) The requirement for an enrolled child to receive blood lead screening tests.(C) The recommendation that a child receive a blood lead screening test if he or she is at risk of lead exposure.(D) The most common sources of lead exposure.(4) Provide coordination of care for each enrolled child, consistent with Medi-Cal managed care plans existing obligations under the Early and Periodic Screening, Diagnosis, and Treatment program. This coordination of care shall ensure each enrolled child receives required blood lead screening tests and appropriate followup services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code.(5) Ensure each enrolled child with an elevated blood lead level is connected to appropriate followup services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. Appropriate followup services include, but are not limited to, all of the following:(A) Appropriate environmental assessments and investigations, including onsite investigations of a childs home or primary residence, to determine the source or sources of lead.(B) Available remediation resources.(C) Assessments for iron deficiency and nutrition.(D) Any other health and behavioral health interventions to address the effects of blood lead poisoning, if appropriate.(E) Long-term monitoring for the effects of lead exposure.(F) Education and resources for the childs family members and caretakers.(G) Any additional testing and treatment as appropriate.(6) Notify a childs parent, parents, guardian, or other person charged with his or her support and maintenance, and the childs health care provider, when the child misses a required blood lead screening test. This notification shall be sent within 30 days of the missed test.(7) (A) Notify and educate a contracted health care provider that, for two consecutive 12-month periods, fails to blood lead test at least 80 percent of enrolled children pursuant to state and federal law, regulations, and guidelines. The Medi-Cal managed care plan shall only include in its calculation children with whom the provider had at least one encounter during the preceding 12 months.(B) To ensure compliance with this paragraph, the department shall ensure a Medi-Cal managed care plan notifies a noncompliant provider within 30 days of the end of the second 12-month period and educate noncompliant providers within three months of the second 12-month period. The department shall ensure the education of noncompliant providers reflects the training guidelines, curriculum, and resources developed by the State Department of Public Health pursuant to Section 105287 of the Health and Safety Code.(e) The department shall include blood lead screening tests as a performance measure in its annual external quality review organization (EQRO) review pursuant to Section 438.364 of Title 42 of the Code of Federal Regulations and Section 14197.05. This performance measure shall be reflected in the External Accountability Set (EAS), effective for contract periods commencing on or after July 1, 2022. The EQRO entity shall annually review, survey, and report to the department the data and information required for the EAS and as identified in this subdivision. The department shall annually create a report detailing the departments progress toward the goals specified in subdivision (a) for children who were continuously enrolled for a three-month period and for children who were continuously enrolled for a 12-month period. The report shall be posted on the departments Internet Web site in a location that can be readily accessed by the general public. The report shall include all of the following:(1) The number of enrolled children in each county, divided by age, who have and have not received blood lead screening tests.(2) Screening results divided by blood-lead-level ranges.(3) The number of children referred to coordination of care services who received the following:(A) Followup health care.(B) Environmental assessment.(C) Educational screenings, nutrition education, and other resources.(4) The number of children identified as having lead poisoning and who received treatment for that lead poisoning.(5) Information about why a child identified with lead exposure or lead poisoning, who was connected to coordination of care services, did not receive one or more of the following:(A) Followup health care.(B) Environmental assessment.(C) Educational activities.(6) Information about the type and scope of educational activities provided.(f) As used in this section, elevated blood lead level shall have the same meaning as the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. | |
| 105 | + | SEC. 4. Section 14132.015 is added to the Welfare and Institutions Code, to read:14132.015. (a) (1) It is the goal of the state that all children at risk of lead exposure receive blood lead screening tests.(2) It is the goal of the state that all children eligible for Medi-Cal receive blood lead screening tests at 12 and 24 months of age.(3) It is the goal of the state that a child eligible for Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receive at least one blood lead screening test.(b) The department shall ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure.(c) The department shall ensure that a child enrolled in Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receives at least one blood lead screening test. The department shall also ensure that children are screened at any time at which they are identified as having a high risk of lead exposure.(d) To comply with the requirements of subdivisions (b) and (c), the department shall ensure contracted Medi-Cal managed care plans do all of the following:(1) Ensure each enrolled child receives required blood lead screening tests pursuant to state and federal law, regulations, and guidelines.(2) Require health care providers to test enrolled children pursuant to state and federal law, regulations, and guidelines.(3) At the time of a childs enrollment, and annually thereafter until a child receives all required tests or reaches six years of age, whichever occurs first, inform the childs parent, parents, guardian, or other person charged with his or her support and maintenance about all of the following:(A) The risks and effects of lead exposure.(B) The requirement for an enrolled child to receive blood lead screening tests.(C) The recommendation that a child receive a blood lead screening test if he or she is at risk of lead exposure.(D) The most common sources of lead exposure.(4) Provide coordination of care for each enrolled child, consistent with Medi-Cal managed care plans existing obligations under the Early and Periodic Screening, Diagnosis, and Treatment program, which program. This coordination of care shall ensure each enrolled child receives required blood lead screening tests and appropriate followup services if a childs blood test indicates an elevated blood lead level. services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code.(5) Ensure each enrolled child with an elevated blood lead level is connected to appropriate followup services, including, but not as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. Appropriate followup services include, but are not limited to, all of the following:(A) Environmental Appropriate environmental assessments and investigations, including onsite investigations of a childs home or primary residence, to determine the source or sources of lead.(B) Available remediation resources.(C) Assessments for iron deficiency and nutrition.(D) Any other health and behavioral health interventions to address the effects of blood lead poisoning, if appropriate.(E) Long-term monitoring for the effects of lead exposure.(F) Education and resources for the childs family members and caretakers.(G) Any additional testing and treatment as appropriate.(6) Notify a childs parent, parents, guardian, or other person charged with his or her support and maintenance, and the childs health care provider, when the child misses a required blood lead screening test. This notification shall be sent within 30 days of the missed test.(7) (A) Notify and educate a contracted health care provider that, for two consecutive 12-month periods, fails to blood lead test at least 80 percent of enrolled children pursuant to state and federal law, regulations, and guidelines. The Medi-Cal managed care plan shall only include in its calculation children with whom the provider had at least one encounter during the preceding 12 months.(B) To ensure compliance with this paragraph, the department shall ensure a Medi-Cal managed care plan notifies a noncompliant provider within 30 days of the end of the second 12-month period and educate noncompliant providers within three months of the second 12-month period. The department shall ensure the education of noncompliant providers reflects the training guidelines, curriculum, and resources developed by the State Department of Public Health pursuant to Section 105287 of the Health and Safety Code.(e) The department shall include blood lead screening tests as a performance measure in its annual external quality review organization (EQRO) review pursuant to Section 438.364 of Title 42 of the Code of Federal Regulations and Section 14197.05. This performance measure shall be reflected in the External Accountability Set. Set (EAS), effective for contract periods commencing on or after July 1, 2022. The EQRO entity shall annually review, survey, and report to the department the data and information required for the EAS and as identified in this subdivision. The department shall annually create a report detailing the departments progress toward the goals specified in subdivision (a) for children who were continuously enrolled for a three-month period and for children who were continuously enrolled for a 12-month period. The report shall be posted on the departments Internet Web site in a location that can be readily accessed by the general public. The report shall include all of the following:(1) The number of enrolled children in each county, divided by age, who have and have not received blood lead screening tests.(2) Screening results divided by blood-lead-level ranges.(3) The number of children referred to coordination of care services who received the following:(A) Followup health care.(B) Environmental assessment.(C) Educational screenings, nutrition education, and other resources.(4) The number of children identified as having lead poisoning and who received treatment for that lead poisoning.(5) Information about why a child identified with lead exposure or lead poisoning, who was connected to coordination of care services, did not receive one or more of the following:(A) Followup health care.(B) Environmental assessment.(C) Educational activities.(6) Information about the type and scope of educational activities provided.(f) As used in this section, elevated blood lead level shall be defined by the department in a way that is at least as stringent as the most recent federal Centers for Disease Control and Prevention screening guidelines. have the same meaning as the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. | |
| 109 | 106 | ||
| 110 | 107 | SEC. 4. Section 14132.015 is added to the Welfare and Institutions Code, to read: | |
| 111 | 108 | ||
| 112 | 109 | ### SEC. 4. | |
| 113 | 110 | ||
| 114 | - | 14132.015. (a) (1) It is the goal of the state that all children at risk of lead exposure receive blood lead screening tests.(2) It is the goal of the state that all children eligible for Medi-Cal receive blood lead screening tests at 12 and 24 months of age.(3) It is the goal of the state that a child eligible for Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receive at least one blood lead screening test.(b) The department shall ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure.(c) The department shall ensure that a child enrolled in Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receives at least one blood lead screening test. The department shall also ensure that children are screened at any time at which they are identified as having a high risk of lead exposure.(d) To comply with the requirements of subdivisions (b) and (c), the department shall ensure contracted Medi-Cal managed care plans do all of the following:(1) Ensure each enrolled child receives required blood lead screening tests pursuant to state and federal law, regulations, and guidelines.(2) Require health care providers to test enrolled children pursuant to state and federal law, regulations, and guidelines.(3) At the time of a childs enrollment, and annually thereafter until a child receives all required tests or reaches six years of age, whichever occurs first, inform the childs parent, parents, guardian, or other person charged with his or her support and maintenance about all of the following:(A) The risks and effects of lead exposure.(B) The requirement for an enrolled child to receive blood lead screening tests.(C) The recommendation that a child receive a blood lead screening test if he or she is at risk of lead exposure.(D) The most common sources of lead exposure.(4) Provide coordination of care for each enrolled child, consistent with Medi-Cal managed care plans existing obligations under the Early and Periodic Screening, Diagnosis, and Treatment program. This coordination of care shall ensure each enrolled child receives required blood lead screening tests and appropriate followup services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code.(5) Ensure each enrolled child with an elevated blood lead level is connected to appropriate followup services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. Appropriate followup services include, but are not limited to, all of the following:(A) Appropriate environmental assessments and investigations, including onsite investigations of a childs home or primary residence, to determine the source or sources of lead.(B) Available remediation resources.(C) Assessments for iron deficiency and nutrition.(D) Any other health and behavioral health interventions to address the effects of blood lead poisoning, if appropriate.(E) Long-term monitoring for the effects of lead exposure.(F) Education and resources for the childs family members and caretakers.(G) Any additional testing and treatment as appropriate.(6) Notify a childs parent, parents, guardian, or other person charged with his or her support and maintenance, and the childs health care provider, when the child misses a required blood lead screening test. This notification shall be sent within 30 days of the missed test.(7) (A) Notify and educate a contracted health care provider that, for two consecutive 12-month periods, fails to blood lead test at least 80 percent of enrolled children pursuant to state and federal law, regulations, and guidelines. The Medi-Cal managed care plan shall only include in its calculation children with whom the provider had at least one encounter during the preceding 12 months.(B) To ensure compliance with this paragraph, the department shall ensure a Medi-Cal managed care plan notifies a noncompliant provider within 30 days of the end of the second 12-month period and educate noncompliant providers within three months of the second 12-month period. The department shall ensure the education of noncompliant providers reflects the training guidelines, curriculum, and resources developed by the State Department of Public Health pursuant to Section 105287 of the Health and Safety Code.(e) The department shall include blood lead screening tests as a performance measure in its annual external quality review organization (EQRO) review pursuant to Section 438.364 of Title 42 of the Code of Federal Regulations and Section 14197.05. This performance measure shall be reflected in the External Accountability Set (EAS), effective for contract periods commencing on or after July 1, 2022. The EQRO entity shall annually review, survey, and report to the department the data and information required for the EAS and as identified in this subdivision. The department shall annually create a report detailing the departments progress toward the goals specified in subdivision (a) for children who were continuously enrolled for a three-month period and for children who were continuously enrolled for a 12-month period. The report shall be posted on the departments Internet Web site in a location that can be readily accessed by the general public. The report shall include all of the following:(1) The number of enrolled children in each county, divided by age, who have and have not received blood lead screening tests.(2) Screening results divided by blood-lead-level ranges.(3) The number of children referred to coordination of care services who received the following:(A) Followup health care.(B) Environmental assessment.(C) Educational screenings, nutrition education, and other resources.(4) The number of children identified as having lead poisoning and who received treatment for that lead poisoning.(5) Information about why a child identified with lead exposure or lead poisoning, who was connected to coordination of care services, did not receive one or more of the following:(A) Followup health care.(B) Environmental assessment.(C) Educational activities.(6) Information about the type and scope of educational activities provided.(f) As used in this section, elevated blood lead level shall have the same meaning as the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. | |
| 111 | + | 14132.015. (a) (1) It is the goal of the state that all children at risk of lead exposure receive blood lead screening tests.(2) It is the goal of the state that all children eligible for Medi-Cal receive blood lead screening tests at 12 and 24 months of age.(3) It is the goal of the state that a child eligible for Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receive at least one blood lead screening test.(b) The department shall ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure.(c) The department shall ensure that a child enrolled in Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receives at least one blood lead screening test. The department shall also ensure that children are screened at any time at which they are identified as having a high risk of lead exposure.(d) To comply with the requirements of subdivisions (b) and (c), the department shall ensure contracted Medi-Cal managed care plans do all of the following:(1) Ensure each enrolled child receives required blood lead screening tests pursuant to state and federal law, regulations, and guidelines.(2) Require health care providers to test enrolled children pursuant to state and federal law, regulations, and guidelines.(3) At the time of a childs enrollment, and annually thereafter until a child receives all required tests or reaches six years of age, whichever occurs first, inform the childs parent, parents, guardian, or other person charged with his or her support and maintenance about all of the following:(A) The risks and effects of lead exposure.(B) The requirement for an enrolled child to receive blood lead screening tests.(C) The recommendation that a child receive a blood lead screening test if he or she is at risk of lead exposure.(D) The most common sources of lead exposure.(4) Provide coordination of care for each enrolled child, consistent with Medi-Cal managed care plans existing obligations under the Early and Periodic Screening, Diagnosis, and Treatment program, which program. This coordination of care shall ensure each enrolled child receives required blood lead screening tests and appropriate followup services if a childs blood test indicates an elevated blood lead level. services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code.(5) Ensure each enrolled child with an elevated blood lead level is connected to appropriate followup services, including, but not as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. Appropriate followup services include, but are not limited to, all of the following:(A) Environmental Appropriate environmental assessments and investigations, including onsite investigations of a childs home or primary residence, to determine the source or sources of lead.(B) Available remediation resources.(C) Assessments for iron deficiency and nutrition.(D) Any other health and behavioral health interventions to address the effects of blood lead poisoning, if appropriate.(E) Long-term monitoring for the effects of lead exposure.(F) Education and resources for the childs family members and caretakers.(G) Any additional testing and treatment as appropriate.(6) Notify a childs parent, parents, guardian, or other person charged with his or her support and maintenance, and the childs health care provider, when the child misses a required blood lead screening test. This notification shall be sent within 30 days of the missed test.(7) (A) Notify and educate a contracted health care provider that, for two consecutive 12-month periods, fails to blood lead test at least 80 percent of enrolled children pursuant to state and federal law, regulations, and guidelines. The Medi-Cal managed care plan shall only include in its calculation children with whom the provider had at least one encounter during the preceding 12 months.(B) To ensure compliance with this paragraph, the department shall ensure a Medi-Cal managed care plan notifies a noncompliant provider within 30 days of the end of the second 12-month period and educate noncompliant providers within three months of the second 12-month period. The department shall ensure the education of noncompliant providers reflects the training guidelines, curriculum, and resources developed by the State Department of Public Health pursuant to Section 105287 of the Health and Safety Code.(e) The department shall include blood lead screening tests as a performance measure in its annual external quality review organization (EQRO) review pursuant to Section 438.364 of Title 42 of the Code of Federal Regulations and Section 14197.05. This performance measure shall be reflected in the External Accountability Set. Set (EAS), effective for contract periods commencing on or after July 1, 2022. The EQRO entity shall annually review, survey, and report to the department the data and information required for the EAS and as identified in this subdivision. The department shall annually create a report detailing the departments progress toward the goals specified in subdivision (a) for children who were continuously enrolled for a three-month period and for children who were continuously enrolled for a 12-month period. The report shall be posted on the departments Internet Web site in a location that can be readily accessed by the general public. The report shall include all of the following:(1) The number of enrolled children in each county, divided by age, who have and have not received blood lead screening tests.(2) Screening results divided by blood-lead-level ranges.(3) The number of children referred to coordination of care services who received the following:(A) Followup health care.(B) Environmental assessment.(C) Educational screenings, nutrition education, and other resources.(4) The number of children identified as having lead poisoning and who received treatment for that lead poisoning.(5) Information about why a child identified with lead exposure or lead poisoning, who was connected to coordination of care services, did not receive one or more of the following:(A) Followup health care.(B) Environmental assessment.(C) Educational activities.(6) Information about the type and scope of educational activities provided.(f) As used in this section, elevated blood lead level shall be defined by the department in a way that is at least as stringent as the most recent federal Centers for Disease Control and Prevention screening guidelines. have the same meaning as the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. | |
| 115 | 112 | ||
| 116 | - | 14132.015. (a) (1) It is the goal of the state that all children at risk of lead exposure receive blood lead screening tests.(2) It is the goal of the state that all children eligible for Medi-Cal receive blood lead screening tests at 12 and 24 months of age.(3) It is the goal of the state that a child eligible for Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receive at least one blood lead screening test.(b) The department shall ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure.(c) The department shall ensure that a child enrolled in Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receives at least one blood lead screening test. The department shall also ensure that children are screened at any time at which they are identified as having a high risk of lead exposure.(d) To comply with the requirements of subdivisions (b) and (c), the department shall ensure contracted Medi-Cal managed care plans do all of the following:(1) Ensure each enrolled child receives required blood lead screening tests pursuant to state and federal law, regulations, and guidelines.(2) Require health care providers to test enrolled children pursuant to state and federal law, regulations, and guidelines.(3) At the time of a childs enrollment, and annually thereafter until a child receives all required tests or reaches six years of age, whichever occurs first, inform the childs parent, parents, guardian, or other person charged with his or her support and maintenance about all of the following:(A) The risks and effects of lead exposure.(B) The requirement for an enrolled child to receive blood lead screening tests.(C) The recommendation that a child receive a blood lead screening test if he or she is at risk of lead exposure.(D) The most common sources of lead exposure.(4) Provide coordination of care for each enrolled child, consistent with Medi-Cal managed care plans existing obligations under the Early and Periodic Screening, Diagnosis, and Treatment program. This coordination of care shall ensure each enrolled child receives required blood lead screening tests and appropriate followup services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code.(5) Ensure each enrolled child with an elevated blood lead level is connected to appropriate followup services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. Appropriate followup services include, but are not limited to, all of the following:(A) Appropriate environmental assessments and investigations, including onsite investigations of a childs home or primary residence, to determine the source or sources of lead.(B) Available remediation resources.(C) Assessments for iron deficiency and nutrition.(D) Any other health and behavioral health interventions to address the effects of blood lead poisoning, if appropriate.(E) Long-term monitoring for the effects of lead exposure.(F) Education and resources for the childs family members and caretakers.(G) Any additional testing and treatment as appropriate.(6) Notify a childs parent, parents, guardian, or other person charged with his or her support and maintenance, and the childs health care provider, when the child misses a required blood lead screening test. This notification shall be sent within 30 days of the missed test.(7) (A) Notify and educate a contracted health care provider that, for two consecutive 12-month periods, fails to blood lead test at least 80 percent of enrolled children pursuant to state and federal law, regulations, and guidelines. The Medi-Cal managed care plan shall only include in its calculation children with whom the provider had at least one encounter during the preceding 12 months.(B) To ensure compliance with this paragraph, the department shall ensure a Medi-Cal managed care plan notifies a noncompliant provider within 30 days of the end of the second 12-month period and educate noncompliant providers within three months of the second 12-month period. The department shall ensure the education of noncompliant providers reflects the training guidelines, curriculum, and resources developed by the State Department of Public Health pursuant to Section 105287 of the Health and Safety Code.(e) The department shall include blood lead screening tests as a performance measure in its annual external quality review organization (EQRO) review pursuant to Section 438.364 of Title 42 of the Code of Federal Regulations and Section 14197.05. This performance measure shall be reflected in the External Accountability Set (EAS), effective for contract periods commencing on or after July 1, 2022. The EQRO entity shall annually review, survey, and report to the department the data and information required for the EAS and as identified in this subdivision. The department shall annually create a report detailing the departments progress toward the goals specified in subdivision (a) for children who were continuously enrolled for a three-month period and for children who were continuously enrolled for a 12-month period. The report shall be posted on the departments Internet Web site in a location that can be readily accessed by the general public. The report shall include all of the following:(1) The number of enrolled children in each county, divided by age, who have and have not received blood lead screening tests.(2) Screening results divided by blood-lead-level ranges.(3) The number of children referred to coordination of care services who received the following:(A) Followup health care.(B) Environmental assessment.(C) Educational screenings, nutrition education, and other resources.(4) The number of children identified as having lead poisoning and who received treatment for that lead poisoning.(5) Information about why a child identified with lead exposure or lead poisoning, who was connected to coordination of care services, did not receive one or more of the following:(A) Followup health care.(B) Environmental assessment.(C) Educational activities.(6) Information about the type and scope of educational activities provided.(f) As used in this section, elevated blood lead level shall have the same meaning as the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. | |
| 113 | + | 14132.015. (a) (1) It is the goal of the state that all children at risk of lead exposure receive blood lead screening tests.(2) It is the goal of the state that all children eligible for Medi-Cal receive blood lead screening tests at 12 and 24 months of age.(3) It is the goal of the state that a child eligible for Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receive at least one blood lead screening test.(b) The department shall ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure.(c) The department shall ensure that a child enrolled in Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receives at least one blood lead screening test. The department shall also ensure that children are screened at any time at which they are identified as having a high risk of lead exposure.(d) To comply with the requirements of subdivisions (b) and (c), the department shall ensure contracted Medi-Cal managed care plans do all of the following:(1) Ensure each enrolled child receives required blood lead screening tests pursuant to state and federal law, regulations, and guidelines.(2) Require health care providers to test enrolled children pursuant to state and federal law, regulations, and guidelines.(3) At the time of a childs enrollment, and annually thereafter until a child receives all required tests or reaches six years of age, whichever occurs first, inform the childs parent, parents, guardian, or other person charged with his or her support and maintenance about all of the following:(A) The risks and effects of lead exposure.(B) The requirement for an enrolled child to receive blood lead screening tests.(C) The recommendation that a child receive a blood lead screening test if he or she is at risk of lead exposure.(D) The most common sources of lead exposure.(4) Provide coordination of care for each enrolled child, consistent with Medi-Cal managed care plans existing obligations under the Early and Periodic Screening, Diagnosis, and Treatment program, which program. This coordination of care shall ensure each enrolled child receives required blood lead screening tests and appropriate followup services if a childs blood test indicates an elevated blood lead level. services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code.(5) Ensure each enrolled child with an elevated blood lead level is connected to appropriate followup services, including, but not as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. Appropriate followup services include, but are not limited to, all of the following:(A) Environmental Appropriate environmental assessments and investigations, including onsite investigations of a childs home or primary residence, to determine the source or sources of lead.(B) Available remediation resources.(C) Assessments for iron deficiency and nutrition.(D) Any other health and behavioral health interventions to address the effects of blood lead poisoning, if appropriate.(E) Long-term monitoring for the effects of lead exposure.(F) Education and resources for the childs family members and caretakers.(G) Any additional testing and treatment as appropriate.(6) Notify a childs parent, parents, guardian, or other person charged with his or her support and maintenance, and the childs health care provider, when the child misses a required blood lead screening test. This notification shall be sent within 30 days of the missed test.(7) (A) Notify and educate a contracted health care provider that, for two consecutive 12-month periods, fails to blood lead test at least 80 percent of enrolled children pursuant to state and federal law, regulations, and guidelines. The Medi-Cal managed care plan shall only include in its calculation children with whom the provider had at least one encounter during the preceding 12 months.(B) To ensure compliance with this paragraph, the department shall ensure a Medi-Cal managed care plan notifies a noncompliant provider within 30 days of the end of the second 12-month period and educate noncompliant providers within three months of the second 12-month period. The department shall ensure the education of noncompliant providers reflects the training guidelines, curriculum, and resources developed by the State Department of Public Health pursuant to Section 105287 of the Health and Safety Code.(e) The department shall include blood lead screening tests as a performance measure in its annual external quality review organization (EQRO) review pursuant to Section 438.364 of Title 42 of the Code of Federal Regulations and Section 14197.05. This performance measure shall be reflected in the External Accountability Set. Set (EAS), effective for contract periods commencing on or after July 1, 2022. The EQRO entity shall annually review, survey, and report to the department the data and information required for the EAS and as identified in this subdivision. The department shall annually create a report detailing the departments progress toward the goals specified in subdivision (a) for children who were continuously enrolled for a three-month period and for children who were continuously enrolled for a 12-month period. The report shall be posted on the departments Internet Web site in a location that can be readily accessed by the general public. The report shall include all of the following:(1) The number of enrolled children in each county, divided by age, who have and have not received blood lead screening tests.(2) Screening results divided by blood-lead-level ranges.(3) The number of children referred to coordination of care services who received the following:(A) Followup health care.(B) Environmental assessment.(C) Educational screenings, nutrition education, and other resources.(4) The number of children identified as having lead poisoning and who received treatment for that lead poisoning.(5) Information about why a child identified with lead exposure or lead poisoning, who was connected to coordination of care services, did not receive one or more of the following:(A) Followup health care.(B) Environmental assessment.(C) Educational activities.(6) Information about the type and scope of educational activities provided.(f) As used in this section, elevated blood lead level shall be defined by the department in a way that is at least as stringent as the most recent federal Centers for Disease Control and Prevention screening guidelines. have the same meaning as the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. | |
| 117 | 114 | ||
| 118 | - | 14132.015. (a) (1) It is the goal of the state that all children at risk of lead exposure receive blood lead screening tests.(2) It is the goal of the state that all children eligible for Medi-Cal receive blood lead screening tests at 12 and 24 months of age.(3) It is the goal of the state that a child eligible for Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receive at least one blood lead screening test.(b) The department shall ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure.(c) The department shall ensure that a child enrolled in Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receives at least one blood lead screening test. The department shall also ensure that children are screened at any time at which they are identified as having a high risk of lead exposure.(d) To comply with the requirements of subdivisions (b) and (c), the department shall ensure contracted Medi-Cal managed care plans do all of the following:(1) Ensure each enrolled child receives required blood lead screening tests pursuant to state and federal law, regulations, and guidelines.(2) Require health care providers to test enrolled children pursuant to state and federal law, regulations, and guidelines.(3) At the time of a childs enrollment, and annually thereafter until a child receives all required tests or reaches six years of age, whichever occurs first, inform the childs parent, parents, guardian, or other person charged with his or her support and maintenance about all of the following:(A) The risks and effects of lead exposure.(B) The requirement for an enrolled child to receive blood lead screening tests.(C) The recommendation that a child receive a blood lead screening test if he or she is at risk of lead exposure.(D) The most common sources of lead exposure.(4) Provide coordination of care for each enrolled child, consistent with Medi-Cal managed care plans existing obligations under the Early and Periodic Screening, Diagnosis, and Treatment program. This coordination of care shall ensure each enrolled child receives required blood lead screening tests and appropriate followup services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code.(5) Ensure each enrolled child with an elevated blood lead level is connected to appropriate followup services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. Appropriate followup services include, but are not limited to, all of the following:(A) Appropriate environmental assessments and investigations, including onsite investigations of a childs home or primary residence, to determine the source or sources of lead.(B) Available remediation resources.(C) Assessments for iron deficiency and nutrition.(D) Any other health and behavioral health interventions to address the effects of blood lead poisoning, if appropriate.(E) Long-term monitoring for the effects of lead exposure.(F) Education and resources for the childs family members and caretakers.(G) Any additional testing and treatment as appropriate.(6) Notify a childs parent, parents, guardian, or other person charged with his or her support and maintenance, and the childs health care provider, when the child misses a required blood lead screening test. This notification shall be sent within 30 days of the missed test.(7) (A) Notify and educate a contracted health care provider that, for two consecutive 12-month periods, fails to blood lead test at least 80 percent of enrolled children pursuant to state and federal law, regulations, and guidelines. The Medi-Cal managed care plan shall only include in its calculation children with whom the provider had at least one encounter during the preceding 12 months.(B) To ensure compliance with this paragraph, the department shall ensure a Medi-Cal managed care plan notifies a noncompliant provider within 30 days of the end of the second 12-month period and educate noncompliant providers within three months of the second 12-month period. The department shall ensure the education of noncompliant providers reflects the training guidelines, curriculum, and resources developed by the State Department of Public Health pursuant to Section 105287 of the Health and Safety Code.(e) The department shall include blood lead screening tests as a performance measure in its annual external quality review organization (EQRO) review pursuant to Section 438.364 of Title 42 of the Code of Federal Regulations and Section 14197.05. This performance measure shall be reflected in the External Accountability Set (EAS), effective for contract periods commencing on or after July 1, 2022. The EQRO entity shall annually review, survey, and report to the department the data and information required for the EAS and as identified in this subdivision. The department shall annually create a report detailing the departments progress toward the goals specified in subdivision (a) for children who were continuously enrolled for a three-month period and for children who were continuously enrolled for a 12-month period. The report shall be posted on the departments Internet Web site in a location that can be readily accessed by the general public. The report shall include all of the following:(1) The number of enrolled children in each county, divided by age, who have and have not received blood lead screening tests.(2) Screening results divided by blood-lead-level ranges.(3) The number of children referred to coordination of care services who received the following:(A) Followup health care.(B) Environmental assessment.(C) Educational screenings, nutrition education, and other resources.(4) The number of children identified as having lead poisoning and who received treatment for that lead poisoning.(5) Information about why a child identified with lead exposure or lead poisoning, who was connected to coordination of care services, did not receive one or more of the following:(A) Followup health care.(B) Environmental assessment.(C) Educational activities.(6) Information about the type and scope of educational activities provided.(f) As used in this section, elevated blood lead level shall have the same meaning as the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. | |
| 115 | + | 14132.015. (a) (1) It is the goal of the state that all children at risk of lead exposure receive blood lead screening tests.(2) It is the goal of the state that all children eligible for Medi-Cal receive blood lead screening tests at 12 and 24 months of age.(3) It is the goal of the state that a child eligible for Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receive at least one blood lead screening test.(b) The department shall ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure.(c) The department shall ensure that a child enrolled in Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receives at least one blood lead screening test. The department shall also ensure that children are screened at any time at which they are identified as having a high risk of lead exposure.(d) To comply with the requirements of subdivisions (b) and (c), the department shall ensure contracted Medi-Cal managed care plans do all of the following:(1) Ensure each enrolled child receives required blood lead screening tests pursuant to state and federal law, regulations, and guidelines.(2) Require health care providers to test enrolled children pursuant to state and federal law, regulations, and guidelines.(3) At the time of a childs enrollment, and annually thereafter until a child receives all required tests or reaches six years of age, whichever occurs first, inform the childs parent, parents, guardian, or other person charged with his or her support and maintenance about all of the following:(A) The risks and effects of lead exposure.(B) The requirement for an enrolled child to receive blood lead screening tests.(C) The recommendation that a child receive a blood lead screening test if he or she is at risk of lead exposure.(D) The most common sources of lead exposure.(4) Provide coordination of care for each enrolled child, consistent with Medi-Cal managed care plans existing obligations under the Early and Periodic Screening, Diagnosis, and Treatment program, which program. This coordination of care shall ensure each enrolled child receives required blood lead screening tests and appropriate followup services if a childs blood test indicates an elevated blood lead level. services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code.(5) Ensure each enrolled child with an elevated blood lead level is connected to appropriate followup services, including, but not as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. Appropriate followup services include, but are not limited to, all of the following:(A) Environmental Appropriate environmental assessments and investigations, including onsite investigations of a childs home or primary residence, to determine the source or sources of lead.(B) Available remediation resources.(C) Assessments for iron deficiency and nutrition.(D) Any other health and behavioral health interventions to address the effects of blood lead poisoning, if appropriate.(E) Long-term monitoring for the effects of lead exposure.(F) Education and resources for the childs family members and caretakers.(G) Any additional testing and treatment as appropriate.(6) Notify a childs parent, parents, guardian, or other person charged with his or her support and maintenance, and the childs health care provider, when the child misses a required blood lead screening test. This notification shall be sent within 30 days of the missed test.(7) (A) Notify and educate a contracted health care provider that, for two consecutive 12-month periods, fails to blood lead test at least 80 percent of enrolled children pursuant to state and federal law, regulations, and guidelines. The Medi-Cal managed care plan shall only include in its calculation children with whom the provider had at least one encounter during the preceding 12 months.(B) To ensure compliance with this paragraph, the department shall ensure a Medi-Cal managed care plan notifies a noncompliant provider within 30 days of the end of the second 12-month period and educate noncompliant providers within three months of the second 12-month period. The department shall ensure the education of noncompliant providers reflects the training guidelines, curriculum, and resources developed by the State Department of Public Health pursuant to Section 105287 of the Health and Safety Code.(e) The department shall include blood lead screening tests as a performance measure in its annual external quality review organization (EQRO) review pursuant to Section 438.364 of Title 42 of the Code of Federal Regulations and Section 14197.05. This performance measure shall be reflected in the External Accountability Set. Set (EAS), effective for contract periods commencing on or after July 1, 2022. The EQRO entity shall annually review, survey, and report to the department the data and information required for the EAS and as identified in this subdivision. The department shall annually create a report detailing the departments progress toward the goals specified in subdivision (a) for children who were continuously enrolled for a three-month period and for children who were continuously enrolled for a 12-month period. The report shall be posted on the departments Internet Web site in a location that can be readily accessed by the general public. The report shall include all of the following:(1) The number of enrolled children in each county, divided by age, who have and have not received blood lead screening tests.(2) Screening results divided by blood-lead-level ranges.(3) The number of children referred to coordination of care services who received the following:(A) Followup health care.(B) Environmental assessment.(C) Educational screenings, nutrition education, and other resources.(4) The number of children identified as having lead poisoning and who received treatment for that lead poisoning.(5) Information about why a child identified with lead exposure or lead poisoning, who was connected to coordination of care services, did not receive one or more of the following:(A) Followup health care.(B) Environmental assessment.(C) Educational activities.(6) Information about the type and scope of educational activities provided.(f) As used in this section, elevated blood lead level shall be defined by the department in a way that is at least as stringent as the most recent federal Centers for Disease Control and Prevention screening guidelines. have the same meaning as the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. | |
| 119 | 116 | ||
| 120 | 117 | ||
| 121 | 118 | ||
| 122 | 119 | 14132.015. (a) (1) It is the goal of the state that all children at risk of lead exposure receive blood lead screening tests. | |
| 123 | 120 | ||
| 124 | 121 | (2) It is the goal of the state that all children eligible for Medi-Cal receive blood lead screening tests at 12 and 24 months of age. | |
| 125 | 122 | ||
| 126 | 123 | (3) It is the goal of the state that a child eligible for Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receive at least one blood lead screening test. | |
| 127 | 124 | ||
| 128 | 125 | (b) The department shall ensure that a child enrolled in Medi-Cal receives blood lead screening tests at 12 and 24 months of age, or at any time at which the child is identified as having a high risk of lead exposure. | |
| 129 | 126 | ||
| 130 | 127 | (c) The department shall ensure that a child enrolled in Medi-Cal between two and six years of age, inclusive, for whom there is no record of a previous blood lead screening test, receives at least one blood lead screening test. The department shall also ensure that children are screened at any time at which they are identified as having a high risk of lead exposure. | |
| 131 | 128 | ||
| 132 | 129 | (d) To comply with the requirements of subdivisions (b) and (c), the department shall ensure contracted Medi-Cal managed care plans do all of the following: | |
| 133 | 130 | ||
| 134 | 131 | (1) Ensure each enrolled child receives required blood lead screening tests pursuant to state and federal law, regulations, and guidelines. | |
| 135 | 132 | ||
| 136 | 133 | (2) Require health care providers to test enrolled children pursuant to state and federal law, regulations, and guidelines. | |
| 137 | 134 | ||
| 138 | 135 | (3) At the time of a childs enrollment, and annually thereafter until a child receives all required tests or reaches six years of age, whichever occurs first, inform the childs parent, parents, guardian, or other person charged with his or her support and maintenance about all of the following: | |
| 139 | 136 | ||
| 140 | 137 | (A) The risks and effects of lead exposure. | |
| 141 | 138 | ||
| 142 | 139 | (B) The requirement for an enrolled child to receive blood lead screening tests. | |
| 143 | 140 | ||
| 144 | 141 | (C) The recommendation that a child receive a blood lead screening test if he or she is at risk of lead exposure. | |
| 145 | 142 | ||
| 146 | 143 | (D) The most common sources of lead exposure. | |
| 147 | 144 | ||
| 148 | - | (4) Provide coordination of care for each enrolled child, consistent with Medi-Cal managed care plans existing obligations under the Early and Periodic Screening, Diagnosis, and Treatment program. This coordination of care shall ensure each enrolled child receives required blood lead screening tests and appropriate followup services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. | |
| 145 | + | (4) Provide coordination of care for each enrolled child, consistent with Medi-Cal managed care plans existing obligations under the Early and Periodic Screening, Diagnosis, and Treatment program, which program. This coordination of care shall ensure each enrolled child receives required blood lead screening tests and appropriate followup services if a childs blood test indicates an elevated blood lead level. services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. | |
| 149 | 146 | ||
| 150 | - | (5) Ensure each enrolled child with an elevated blood lead level is connected to appropriate followup services, as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. Appropriate followup services include, but are not limited to, all of the following: | |
| 147 | + | (5) Ensure each enrolled child with an elevated blood lead level is connected to appropriate followup services, including, but not as set forth in the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. Appropriate followup services include, but are not limited to, all of the following: | |
| 151 | 148 | ||
| 152 | - | (A) Appropriate environmental assessments and investigations, including onsite investigations of a childs home or primary residence, to determine the source or sources of lead. | |
| 149 | + | (A) Environmental Appropriate environmental assessments and investigations, including onsite investigations of a childs home or primary residence, to determine the source or sources of lead. | |
| 153 | 150 | ||
| 154 | 151 | (B) Available remediation resources. | |
| 155 | 152 | ||
| 156 | 153 | (C) Assessments for iron deficiency and nutrition. | |
| 157 | 154 | ||
| 158 | 155 | (D) Any other health and behavioral health interventions to address the effects of blood lead poisoning, if appropriate. | |
| 159 | 156 | ||
| 160 | 157 | (E) Long-term monitoring for the effects of lead exposure. | |
| 161 | 158 | ||
| 162 | 159 | (F) Education and resources for the childs family members and caretakers. | |
| 163 | 160 | ||
| 164 | 161 | (G) Any additional testing and treatment as appropriate. | |
| 165 | 162 | ||
| 166 | 163 | (6) Notify a childs parent, parents, guardian, or other person charged with his or her support and maintenance, and the childs health care provider, when the child misses a required blood lead screening test. This notification shall be sent within 30 days of the missed test. | |
| 167 | 164 | ||
| 168 | 165 | (7) (A) Notify and educate a contracted health care provider that, for two consecutive 12-month periods, fails to blood lead test at least 80 percent of enrolled children pursuant to state and federal law, regulations, and guidelines. The Medi-Cal managed care plan shall only include in its calculation children with whom the provider had at least one encounter during the preceding 12 months. | |
| 169 | 166 | ||
| 170 | 167 | (B) To ensure compliance with this paragraph, the department shall ensure a Medi-Cal managed care plan notifies a noncompliant provider within 30 days of the end of the second 12-month period and educate noncompliant providers within three months of the second 12-month period. The department shall ensure the education of noncompliant providers reflects the training guidelines, curriculum, and resources developed by the State Department of Public Health pursuant to Section 105287 of the Health and Safety Code. | |
| 171 | 168 | ||
| 172 | - | (e) The department shall include blood lead screening tests as a performance measure in its annual external quality review organization (EQRO) review pursuant to Section 438.364 of Title 42 of the Code of Federal Regulations and Section 14197.05. This performance measure shall be reflected in the External Accountability Set (EAS), effective for contract periods commencing on or after July 1, 2022. The EQRO entity shall annually review, survey, and report to the department the data and information required for the EAS and as identified in this subdivision. The department shall annually create a report detailing the departments progress toward the goals specified in subdivision (a) for children who were continuously enrolled for a three-month period and for children who were continuously enrolled for a 12-month period. The report shall be posted on the departments Internet Web site in a location that can be readily accessed by the general public. The report shall include all of the following: | |
| 169 | + | (e) The department shall include blood lead screening tests as a performance measure in its annual external quality review organization (EQRO) review pursuant to Section 438.364 of Title 42 of the Code of Federal Regulations and Section 14197.05. This performance measure shall be reflected in the External Accountability Set. Set (EAS), effective for contract periods commencing on or after July 1, 2022. The EQRO entity shall annually review, survey, and report to the department the data and information required for the EAS and as identified in this subdivision. The department shall annually create a report detailing the departments progress toward the goals specified in subdivision (a) for children who were continuously enrolled for a three-month period and for children who were continuously enrolled for a 12-month period. The report shall be posted on the departments Internet Web site in a location that can be readily accessed by the general public. The report shall include all of the following: | |
| 173 | 170 | ||
| 174 | 171 | (1) The number of enrolled children in each county, divided by age, who have and have not received blood lead screening tests. | |
| 175 | 172 | ||
| 176 | 173 | (2) Screening results divided by blood-lead-level ranges. | |
| 177 | 174 | ||
| 178 | 175 | (3) The number of children referred to coordination of care services who received the following: | |
| 179 | 176 | ||
| 180 | 177 | (A) Followup health care. | |
| 181 | 178 | ||
| 182 | 179 | (B) Environmental assessment. | |
| 183 | 180 | ||
| 184 | 181 | (C) Educational screenings, nutrition education, and other resources. | |
| 185 | 182 | ||
| 186 | 183 | (4) The number of children identified as having lead poisoning and who received treatment for that lead poisoning. | |
| 187 | 184 | ||
| 188 | 185 | (5) Information about why a child identified with lead exposure or lead poisoning, who was connected to coordination of care services, did not receive one or more of the following: | |
| 189 | 186 | ||
| 190 | 187 | (A) Followup health care. | |
| 191 | 188 | ||
| 192 | 189 | (B) Environmental assessment. | |
| 193 | 190 | ||
| 194 | 191 | (C) Educational activities. | |
| 195 | 192 | ||
| 196 | 193 | (6) Information about the type and scope of educational activities provided. | |
| 197 | 194 | ||
| 198 | - | (f) As used in this section, elevated blood lead level shall have the same meaning as the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. | |
| 195 | + | (f) As used in this section, elevated blood lead level shall be defined by the department in a way that is at least as stringent as the most recent federal Centers for Disease Control and Prevention screening guidelines. have the same meaning as the State Department of Public Healths standard of care policies, promulgated regulations, and published guidelines established in accordance with Section 105285 of the Health and Safety Code. | |
| 199 | 196 | ||
| 200 | - | SEC. 5. Section 14197.05 of the Welfare and Institutions Code is amended to read:14197.05. (a) As part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care plans in the annual detailed technical report required by Section 438.364 of Title 42 of the Code of Federal Regulations, effective for contract periods commencing on or after July 1, 2018, the EQRO entity designated by the department shall compile the data described in subdivision (b) by plan and by county for the purpose of informing the status of implementation of the requirements of Section 14197.(b) (1) The information compiled by the EQRO entity shall include all of the following:(A) Number of requests for alternative access standards in the plan service area for time and distance, categorized by all provider types, including specialists, and by adult and pediatric.(B) Number of allowable exceptions for the appointment time standard, if known, categorized by all provider types, including specialists, and by adult and pediatric.(C) Distance and driving time between the nearest network provider and ZIP Code of the beneficiary furthest from that provider for requests for alternative access standards.(D) Approximate number of beneficiaries impacted by alternative access standards or allowable exceptions.(E) Percentage of providers in the plan service area by provider and specialty type that are under a contract with a Medi-Cal managed care plan.(F) The number of requests for alternative access standards approved or denied by ZIP Code and provider and specialty type, and the reasons for the approval or denial of the request for alternative access standards.(G) The process of ensuring out-of-network access.(H) Descriptions of contracting efforts and explanation for why a contract was not executed.(I) Timeframe for approval or denial of a request for alternative access standards by the department.(J) Consumer complaints, if any.(2) The information described in paragraph (1) shall be presented in a chart format to enable comparison among counties, provider types, and plans.(c) The EQRO entity shall develop a methodology to assess information that will help inform the experience of individuals placed in a skilled nursing facility or intermediate care facility and the distance that they are placed from their place of residence. The EQRO entity shall report the results from the use of this methodology in the EQRO annual Medi-Cal managed care plan technical report.(d) Effective for contract periods commencing on or after July 1, 2022, the EQRO entity designated by the department shall review, survey, and report to the department the data and information relating to blood lead screening tests and performance measures as described in subdivision (e) of Section 14132.015.(e) The department shall comply with the requirements of subsection (c) of Section 438.364 of Title 42 of the Code of Federal Regulations in making the information described in this section publicly available. | |
| 197 | + | SEC. 5. Section 14197.05 of the Welfare and Institutions Code is amended to read:14197.05. (a) As part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care plans in the annual detailed technical report required by Section 438.364 of Title 42 of the Code of Federal Regulations, effective for contract periods commencing on or after July 1, 2018, the EQRO entity designated by the department shall compile the data described in subdivision (b) by plan and by county for the purpose of informing the status of implementation of the requirements of Section 14197.(b) (1) The information compiled by the EQRO entity shall include all of the following:(A) Number of requests for alternative access standards in the plan service area for time and distance, categorized by all provider types, including specialists, and by adult and pediatric.(B) Number of allowable exceptions for the appointment time standard, if known, categorized by all provider types, including specialists, and by adult and pediatric.(C) Distance and driving time between the nearest network provider and ZIP Code of the beneficiary furthest from that provider for requests for alternative access standards.(D) Approximate number of beneficiaries impacted by alternative access standards or allowable exceptions.(E) Percentage of providers in the plan service area by provider and specialty type that are under a contract with a Medi-Cal managed care plan.(F) The number of requests for alternative access standards approved or denied by ZIP Code and provider and specialty type, and the reasons for the approval or denial of the request for alternative access standards.(G) The process of ensuring out-of-network access.(H) Descriptions of contracting efforts and explanation for why a contract was not executed.(I) Timeframe for approval or denial of a request for alternative access standards by the department.(J) Consumer complaints, if any.(2) The information described in paragraph (1) shall be presented in a chart format to enable comparison among counties, provider types, and plans.(c) The EQRO entity shall develop a methodology to assess information that will help inform the experience of individuals placed in a skilled nursing facility or intermediate care facility and the distance that they are placed from their place of residence. The EQRO entity shall report the results from the use of this methodology in the EQRO annual Medi-Cal managed care plan technical report.(d) Effective for contract periods commencing on or after July 1, 2022, the EQRO entity designated by the department shall review, survey, and report to the department the data and information relating to blood lead screening tests and performance measures as described in subdivision (e) of Section 14132.015.(d)(e) The department shall comply with the requirements of subsection (c) of Section 438.364 of Title 42 of the Code of Federal Regulations in making the information described in this section publicly available. | |
| 201 | 198 | ||
| 202 | 199 | SEC. 5. Section 14197.05 of the Welfare and Institutions Code is amended to read: | |
| 203 | 200 | ||
| 204 | 201 | ### SEC. 5. | |
| 205 | 202 | ||
| 206 | - | 14197.05. (a) As part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care plans in the annual detailed technical report required by Section 438.364 of Title 42 of the Code of Federal Regulations, effective for contract periods commencing on or after July 1, 2018, the EQRO entity designated by the department shall compile the data described in subdivision (b) by plan and by county for the purpose of informing the status of implementation of the requirements of Section 14197.(b) (1) The information compiled by the EQRO entity shall include all of the following:(A) Number of requests for alternative access standards in the plan service area for time and distance, categorized by all provider types, including specialists, and by adult and pediatric.(B) Number of allowable exceptions for the appointment time standard, if known, categorized by all provider types, including specialists, and by adult and pediatric.(C) Distance and driving time between the nearest network provider and ZIP Code of the beneficiary furthest from that provider for requests for alternative access standards.(D) Approximate number of beneficiaries impacted by alternative access standards or allowable exceptions.(E) Percentage of providers in the plan service area by provider and specialty type that are under a contract with a Medi-Cal managed care plan.(F) The number of requests for alternative access standards approved or denied by ZIP Code and provider and specialty type, and the reasons for the approval or denial of the request for alternative access standards.(G) The process of ensuring out-of-network access.(H) Descriptions of contracting efforts and explanation for why a contract was not executed.(I) Timeframe for approval or denial of a request for alternative access standards by the department.(J) Consumer complaints, if any.(2) The information described in paragraph (1) shall be presented in a chart format to enable comparison among counties, provider types, and plans.(c) The EQRO entity shall develop a methodology to assess information that will help inform the experience of individuals placed in a skilled nursing facility or intermediate care facility and the distance that they are placed from their place of residence. The EQRO entity shall report the results from the use of this methodology in the EQRO annual Medi-Cal managed care plan technical report.(d) Effective for contract periods commencing on or after July 1, 2022, the EQRO entity designated by the department shall review, survey, and report to the department the data and information relating to blood lead screening tests and performance measures as described in subdivision (e) of Section 14132.015.(e) The department shall comply with the requirements of subsection (c) of Section 438.364 of Title 42 of the Code of Federal Regulations in making the information described in this section publicly available. | |
| 203 | + | 14197.05. (a) As part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care plans in the annual detailed technical report required by Section 438.364 of Title 42 of the Code of Federal Regulations, effective for contract periods commencing on or after July 1, 2018, the EQRO entity designated by the department shall compile the data described in subdivision (b) by plan and by county for the purpose of informing the status of implementation of the requirements of Section 14197.(b) (1) The information compiled by the EQRO entity shall include all of the following:(A) Number of requests for alternative access standards in the plan service area for time and distance, categorized by all provider types, including specialists, and by adult and pediatric.(B) Number of allowable exceptions for the appointment time standard, if known, categorized by all provider types, including specialists, and by adult and pediatric.(C) Distance and driving time between the nearest network provider and ZIP Code of the beneficiary furthest from that provider for requests for alternative access standards.(D) Approximate number of beneficiaries impacted by alternative access standards or allowable exceptions.(E) Percentage of providers in the plan service area by provider and specialty type that are under a contract with a Medi-Cal managed care plan.(F) The number of requests for alternative access standards approved or denied by ZIP Code and provider and specialty type, and the reasons for the approval or denial of the request for alternative access standards.(G) The process of ensuring out-of-network access.(H) Descriptions of contracting efforts and explanation for why a contract was not executed.(I) Timeframe for approval or denial of a request for alternative access standards by the department.(J) Consumer complaints, if any.(2) The information described in paragraph (1) shall be presented in a chart format to enable comparison among counties, provider types, and plans.(c) The EQRO entity shall develop a methodology to assess information that will help inform the experience of individuals placed in a skilled nursing facility or intermediate care facility and the distance that they are placed from their place of residence. The EQRO entity shall report the results from the use of this methodology in the EQRO annual Medi-Cal managed care plan technical report.(d) Effective for contract periods commencing on or after July 1, 2022, the EQRO entity designated by the department shall review, survey, and report to the department the data and information relating to blood lead screening tests and performance measures as described in subdivision (e) of Section 14132.015.(d)(e) The department shall comply with the requirements of subsection (c) of Section 438.364 of Title 42 of the Code of Federal Regulations in making the information described in this section publicly available. | |
| 207 | 204 | ||
| 208 | - | 14197.05. (a) As part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care plans in the annual detailed technical report required by Section 438.364 of Title 42 of the Code of Federal Regulations, effective for contract periods commencing on or after July 1, 2018, the EQRO entity designated by the department shall compile the data described in subdivision (b) by plan and by county for the purpose of informing the status of implementation of the requirements of Section 14197.(b) (1) The information compiled by the EQRO entity shall include all of the following:(A) Number of requests for alternative access standards in the plan service area for time and distance, categorized by all provider types, including specialists, and by adult and pediatric.(B) Number of allowable exceptions for the appointment time standard, if known, categorized by all provider types, including specialists, and by adult and pediatric.(C) Distance and driving time between the nearest network provider and ZIP Code of the beneficiary furthest from that provider for requests for alternative access standards.(D) Approximate number of beneficiaries impacted by alternative access standards or allowable exceptions.(E) Percentage of providers in the plan service area by provider and specialty type that are under a contract with a Medi-Cal managed care plan.(F) The number of requests for alternative access standards approved or denied by ZIP Code and provider and specialty type, and the reasons for the approval or denial of the request for alternative access standards.(G) The process of ensuring out-of-network access.(H) Descriptions of contracting efforts and explanation for why a contract was not executed.(I) Timeframe for approval or denial of a request for alternative access standards by the department.(J) Consumer complaints, if any.(2) The information described in paragraph (1) shall be presented in a chart format to enable comparison among counties, provider types, and plans.(c) The EQRO entity shall develop a methodology to assess information that will help inform the experience of individuals placed in a skilled nursing facility or intermediate care facility and the distance that they are placed from their place of residence. The EQRO entity shall report the results from the use of this methodology in the EQRO annual Medi-Cal managed care plan technical report.(d) Effective for contract periods commencing on or after July 1, 2022, the EQRO entity designated by the department shall review, survey, and report to the department the data and information relating to blood lead screening tests and performance measures as described in subdivision (e) of Section 14132.015.(e) The department shall comply with the requirements of subsection (c) of Section 438.364 of Title 42 of the Code of Federal Regulations in making the information described in this section publicly available. | |
| 205 | + | 14197.05. (a) As part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care plans in the annual detailed technical report required by Section 438.364 of Title 42 of the Code of Federal Regulations, effective for contract periods commencing on or after July 1, 2018, the EQRO entity designated by the department shall compile the data described in subdivision (b) by plan and by county for the purpose of informing the status of implementation of the requirements of Section 14197.(b) (1) The information compiled by the EQRO entity shall include all of the following:(A) Number of requests for alternative access standards in the plan service area for time and distance, categorized by all provider types, including specialists, and by adult and pediatric.(B) Number of allowable exceptions for the appointment time standard, if known, categorized by all provider types, including specialists, and by adult and pediatric.(C) Distance and driving time between the nearest network provider and ZIP Code of the beneficiary furthest from that provider for requests for alternative access standards.(D) Approximate number of beneficiaries impacted by alternative access standards or allowable exceptions.(E) Percentage of providers in the plan service area by provider and specialty type that are under a contract with a Medi-Cal managed care plan.(F) The number of requests for alternative access standards approved or denied by ZIP Code and provider and specialty type, and the reasons for the approval or denial of the request for alternative access standards.(G) The process of ensuring out-of-network access.(H) Descriptions of contracting efforts and explanation for why a contract was not executed.(I) Timeframe for approval or denial of a request for alternative access standards by the department.(J) Consumer complaints, if any.(2) The information described in paragraph (1) shall be presented in a chart format to enable comparison among counties, provider types, and plans.(c) The EQRO entity shall develop a methodology to assess information that will help inform the experience of individuals placed in a skilled nursing facility or intermediate care facility and the distance that they are placed from their place of residence. The EQRO entity shall report the results from the use of this methodology in the EQRO annual Medi-Cal managed care plan technical report.(d) Effective for contract periods commencing on or after July 1, 2022, the EQRO entity designated by the department shall review, survey, and report to the department the data and information relating to blood lead screening tests and performance measures as described in subdivision (e) of Section 14132.015.(d)(e) The department shall comply with the requirements of subsection (c) of Section 438.364 of Title 42 of the Code of Federal Regulations in making the information described in this section publicly available. | |
| 209 | 206 | ||
| 210 | - | 14197.05. (a) As part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care plans in the annual detailed technical report required by Section 438.364 of Title 42 of the Code of Federal Regulations, effective for contract periods commencing on or after July 1, 2018, the EQRO entity designated by the department shall compile the data described in subdivision (b) by plan and by county for the purpose of informing the status of implementation of the requirements of Section 14197.(b) (1) The information compiled by the EQRO entity shall include all of the following:(A) Number of requests for alternative access standards in the plan service area for time and distance, categorized by all provider types, including specialists, and by adult and pediatric.(B) Number of allowable exceptions for the appointment time standard, if known, categorized by all provider types, including specialists, and by adult and pediatric.(C) Distance and driving time between the nearest network provider and ZIP Code of the beneficiary furthest from that provider for requests for alternative access standards.(D) Approximate number of beneficiaries impacted by alternative access standards or allowable exceptions.(E) Percentage of providers in the plan service area by provider and specialty type that are under a contract with a Medi-Cal managed care plan.(F) The number of requests for alternative access standards approved or denied by ZIP Code and provider and specialty type, and the reasons for the approval or denial of the request for alternative access standards.(G) The process of ensuring out-of-network access.(H) Descriptions of contracting efforts and explanation for why a contract was not executed.(I) Timeframe for approval or denial of a request for alternative access standards by the department.(J) Consumer complaints, if any.(2) The information described in paragraph (1) shall be presented in a chart format to enable comparison among counties, provider types, and plans.(c) The EQRO entity shall develop a methodology to assess information that will help inform the experience of individuals placed in a skilled nursing facility or intermediate care facility and the distance that they are placed from their place of residence. The EQRO entity shall report the results from the use of this methodology in the EQRO annual Medi-Cal managed care plan technical report.(d) Effective for contract periods commencing on or after July 1, 2022, the EQRO entity designated by the department shall review, survey, and report to the department the data and information relating to blood lead screening tests and performance measures as described in subdivision (e) of Section 14132.015.(e) The department shall comply with the requirements of subsection (c) of Section 438.364 of Title 42 of the Code of Federal Regulations in making the information described in this section publicly available. | |
| 207 | + | 14197.05. (a) As part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care plans in the annual detailed technical report required by Section 438.364 of Title 42 of the Code of Federal Regulations, effective for contract periods commencing on or after July 1, 2018, the EQRO entity designated by the department shall compile the data described in subdivision (b) by plan and by county for the purpose of informing the status of implementation of the requirements of Section 14197.(b) (1) The information compiled by the EQRO entity shall include all of the following:(A) Number of requests for alternative access standards in the plan service area for time and distance, categorized by all provider types, including specialists, and by adult and pediatric.(B) Number of allowable exceptions for the appointment time standard, if known, categorized by all provider types, including specialists, and by adult and pediatric.(C) Distance and driving time between the nearest network provider and ZIP Code of the beneficiary furthest from that provider for requests for alternative access standards.(D) Approximate number of beneficiaries impacted by alternative access standards or allowable exceptions.(E) Percentage of providers in the plan service area by provider and specialty type that are under a contract with a Medi-Cal managed care plan.(F) The number of requests for alternative access standards approved or denied by ZIP Code and provider and specialty type, and the reasons for the approval or denial of the request for alternative access standards.(G) The process of ensuring out-of-network access.(H) Descriptions of contracting efforts and explanation for why a contract was not executed.(I) Timeframe for approval or denial of a request for alternative access standards by the department.(J) Consumer complaints, if any.(2) The information described in paragraph (1) shall be presented in a chart format to enable comparison among counties, provider types, and plans.(c) The EQRO entity shall develop a methodology to assess information that will help inform the experience of individuals placed in a skilled nursing facility or intermediate care facility and the distance that they are placed from their place of residence. The EQRO entity shall report the results from the use of this methodology in the EQRO annual Medi-Cal managed care plan technical report.(d) Effective for contract periods commencing on or after July 1, 2022, the EQRO entity designated by the department shall review, survey, and report to the department the data and information relating to blood lead screening tests and performance measures as described in subdivision (e) of Section 14132.015.(d)(e) The department shall comply with the requirements of subsection (c) of Section 438.364 of Title 42 of the Code of Federal Regulations in making the information described in this section publicly available. | |
| 211 | 208 | ||
| 212 | 209 | ||
| 213 | 210 | ||
| 214 | 211 | 14197.05. (a) As part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care plans in the annual detailed technical report required by Section 438.364 of Title 42 of the Code of Federal Regulations, effective for contract periods commencing on or after July 1, 2018, the EQRO entity designated by the department shall compile the data described in subdivision (b) by plan and by county for the purpose of informing the status of implementation of the requirements of Section 14197. | |
| 215 | 212 | ||
| 216 | 213 | (b) (1) The information compiled by the EQRO entity shall include all of the following: | |
| 217 | 214 | ||
| 218 | 215 | (A) Number of requests for alternative access standards in the plan service area for time and distance, categorized by all provider types, including specialists, and by adult and pediatric. | |
| 219 | 216 | ||
| 220 | 217 | (B) Number of allowable exceptions for the appointment time standard, if known, categorized by all provider types, including specialists, and by adult and pediatric. | |
| 221 | 218 | ||
| 222 | 219 | (C) Distance and driving time between the nearest network provider and ZIP Code of the beneficiary furthest from that provider for requests for alternative access standards. | |
| 223 | 220 | ||
| 224 | 221 | (D) Approximate number of beneficiaries impacted by alternative access standards or allowable exceptions. | |
| 225 | 222 | ||
| 226 | 223 | (E) Percentage of providers in the plan service area by provider and specialty type that are under a contract with a Medi-Cal managed care plan. | |
| 227 | 224 | ||
| 228 | 225 | (F) The number of requests for alternative access standards approved or denied by ZIP Code and provider and specialty type, and the reasons for the approval or denial of the request for alternative access standards. | |
| 229 | 226 | ||
| 230 | 227 | (G) The process of ensuring out-of-network access. | |
| 231 | 228 | ||
| 232 | 229 | (H) Descriptions of contracting efforts and explanation for why a contract was not executed. | |
| 233 | 230 | ||
| 234 | 231 | (I) Timeframe for approval or denial of a request for alternative access standards by the department. | |
| 235 | 232 | ||
| 236 | 233 | (J) Consumer complaints, if any. | |
| 237 | 234 | ||
| 238 | 235 | (2) The information described in paragraph (1) shall be presented in a chart format to enable comparison among counties, provider types, and plans. | |
| 239 | 236 | ||
| 240 | 237 | (c) The EQRO entity shall develop a methodology to assess information that will help inform the experience of individuals placed in a skilled nursing facility or intermediate care facility and the distance that they are placed from their place of residence. The EQRO entity shall report the results from the use of this methodology in the EQRO annual Medi-Cal managed care plan technical report. | |
| 241 | 238 | ||
| 242 | 239 | (d) Effective for contract periods commencing on or after July 1, 2022, the EQRO entity designated by the department shall review, survey, and report to the department the data and information relating to blood lead screening tests and performance measures as described in subdivision (e) of Section 14132.015. | |
| 243 | 240 | ||
| 241 | + | (d) | |
| 242 | + | ||
| 243 | + | ||
| 244 | + | ||
| 244 | 245 | (e) The department shall comply with the requirements of subsection (c) of Section 438.364 of Title 42 of the Code of Federal Regulations in making the information described in this section publicly available. |