An act to amend Section 14132.25 of the Welfare and Institutions Code, relating to Medi-Cal.
Summary
AB 220 would amend the Medi-Cal subacute care statute to standardize and tighten the authorization process for both pediatric and adult subacute care services. The bill requires providers to submit specified DHCS forms with treatment authorization requests, including electronic requests, when seeking approval for subacute care. It also directs that Medi-Cal managed care plans may not use their own medical-necessity criteria beyond what is listed on the state forms, and it bars plans from requiring a new authorization when a patient returns to subacute care after an acute hospitalization bed hold.
The measure is aimed at making subacute care authorizations more uniform across managed care plans and reducing delays or denials for medically fragile patients who need long-term, technology-dependent care. It also authorizes the Department of Health Care Services to sanction managed care plans that violate these requirements. The bill does not create a new benefit, but it changes how existing Medi-Cal subacute care services are administered and enforced.
Impact
AB 220 would amend Welfare and Institutions Code Section 14132.25, affecting Medi-Cal subacute care rules for both pediatric and adult patients. It would require use of DHCS-prescribed authorization forms, limit managed care plans from imposing additional medical-necessity standards, and prohibit repeat authorization requests after a bed hold for acute hospitalization. The bill also gives DHCS explicit sanctioning authority over managed care plans for noncompliance, strengthening state oversight of utilization review and authorization practices in this area.
Sentiment
The bill appears to have broad support in the Legislature, with unanimous or near-unanimous votes at multiple stages and no recorded opposition in the provided voting history. The absence of committee transcript material limits insight into debate, but the vote pattern suggests the measure was viewed favorably as a technical and patient-access improvement to Medi-Cal administration. Its progression through both houses indicates general agreement that subacute care authorization should be more consistent and less burdensome.
Contention
The main policy tension is between standardizing authorization rules statewide and preserving managed care plans’ discretion to review medical necessity. AB 220 resolves that tension in favor of state-defined criteria by prohibiting plans from adding their own standards for pediatric and adult subacute care. A related point is the bed-hold provision, which prevents plans from forcing a new authorization after an acute hospitalization return; this likely benefits patients and providers but reduces plan control over reauthorization. No specific organized opposition is reflected in the available record, but the bill’s fiscal committee referral and suspense-file placement suggest there were at least administrative or fiscal considerations.
An act to add Chapter 10 (commencing with Section 8300) to Division 8 of Section 4755 to the Welfare and Institutions Code, relating to behavioral health. developmental services.
An act to add Section Sections 1371.143 and 128739 to, and to add Article 4 (commencing with Section 127480) to Chapter 2.5 of Part 2 of Division 107 of, the Health and Safety Code, and to add Section 10123.858 to the Insurance Code, relating to health care.