Currrent as of February 4, 2022

Senate Bill No. 48

CHAPTER 484

An act to add Section 14132.171 to the Welfare and Institutions Code, relating to Medi-Cal.

[ Approved by Governor October 04, 2021. Filed with Secretary of State October 04, 2021. ]

LEGISLATIVE COUNSEL’S DIGEST

SB 48, Limón. Medi-Cal: annual cognitive health assessment.

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 pursuant to a schedule of benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Subject to an appropriation by the Legislature for this purpose, this bill would expand the schedule of benefits to include an annual cognitive health assessment for Medi-Cal beneficiaries who are 65 years of age or older if they are otherwise ineligible for a similar assessment as part of an annual wellness visit under the Medicare Program. The bill would make a Medi-Cal provider eligible to receive the payment for this benefit only if they comply with certain requirements, including completing cognitive health assessment training. The bill would require the department to determine specified training and validated tools in consultation with prescribed entities, including the State Department of Public Health’s Alzheimer’s Disease Program. By January 1, 2024, and every 2 years thereafter, the bill would require the department to consolidate and analyze data related to the benefit, and to post information on the utilization of, and payment for, the benefit on its internet website. The bill would authorize the department to implement these provisions by various means, including all-plan letters, without taking regulatory action, and would condition the implementation of these provisions to the extent federal approvals are obtained and federal financial participation is available.

Vote: majority Appropriation: no Fiscal Committee: yes Local Program: no

THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

SECTION 1.

Section 14132.171 is added to the Welfare and Institutions Code, to read:

14132.171.

(a) (1) An annual cognitive health assessment for Medi-Cal beneficiaries who are 65 years of age or older is a covered benefit if they are otherwise ineligible for a similar assessment as part of an annual wellness visit under the Medicare Program. Subject to paragraph (3), the department shall provide reimbursement to a Medi-Cal provider who renders this service.

(2) The payment for the cognitive health assessment developed pursuant to paragraph (1) shall only be available upon appropriation by the Legislature for these purposes.

(3) (A) A Medi-Cal provider shall only be eligible to receive the payment for the benefit specified in paragraph (1) if the provider complies with both of the following requirements:

(i) Completes cognitive health assessment training, as specified and approved by the department.

(ii) Conducts the cognitive health assessment using validated tools, as recommended by the department.

(B) (i) The department shall determine the cognitive health assessment training and validated tools, as described in subparagraph (A), in consultation with the State Department of Public Health’s Alzheimer’s Disease Program (Article 4 (commencing with Section 125275) of Chapter 2 of Part 5 of Division 106 of the Health and Safety Code), that program’s 10 California Alzheimer’s Disease Centers, representatives of primary care physician specialties, including, but not limited to, family medicine, and the Alzheimer’s Disease and Related Disorders Advisory Committee of the California Health and Human Services Agency (Chapter 3.1 (commencing with Section 1568.15) of Division 2 of the Health and Safety Code).

(ii) With respect to the validated tools, the department shall select multiple tools. To improve overall accessibility of these tools and minimize access barriers, at least one of those tools shall not carry any restrictions on copyright or trademark.

(b) An annual cognitive health assessment shall identify signs of Alzheimer’s disease or dementia, consistent with the standards for detecting cognitive impairment under the federal Centers for Medicare and Medicaid Services and the recommendations by the American Academy of Neurology.

(1) Consolidate and analyze the data on the administration of the cognitive health assessment in the Medi-Cal managed care and fee-for-service delivery systems.

(2) Post information on the utilization of, and payment for, this benefit on its internet website.

(d) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement this section, in whole or in part, by means of all-plan letters, provider bulletins, or similar instructions, without taking any further regulatory action.

(e) This section shall be implemented only to the extent any necessary federal approvals are obtained and federal financial participation is available.

SB 48