Medi-Cal: subacute care services.
The amendments aim to prevent Medi-Cal managed care plans from using their own criteria to determine medical necessity for subacute care services, thereby standardizing the authority of care across the state. This change is intended to result in a more equitable access to healthcare services for patients who qualify for subacute care, ensuring that all providers adhere to uniform standards established by the Department of Health Care Services. The bill represents a significant adjustment in how Medi-Cal plans interact with healthcare providers and patients, potentially impacting the treatment landscape for vulnerable populations who depend on these services.
Assembly Bill 220, introduced by Assembly Member Jackson, seeks to amend Section 14132.25 of the Welfare and Institutions Code related to the provision of Medi-Cal subacute care services. This legislation is pivotal in establishing a more structured framework for managing authorizations for subacute care, particularly focusing on patients with serious medical needs, including pediatric and adult patients requiring specialized care. The proposed amendments specify the necessary documentation and processes health facilities must follow when submitting treatment authorization requests, thereby enhancing the efficiency of care delivery under the Medi-Cal program.
Notable points of contention surrounding AB 220 could involve concerns regarding the limitations imposed on Managed Care Plans, which may argue that more flexibility is necessary to manage patient care effectively based on their unique circumstances. Critics may also raise concerns about the adequacy of state funding to meet the projected demands of an expanded subacute care program, questioning whether the reimbursement rates set forth in the bill would be sustainable. Additionally, there may be apprehensions about the effectiveness of the oversight procedures that the Department of Health Care Services is mandated to implement, especially in terms of ensuring compliance from various providers.