Bill > AB220

This bill amends the existing Medi-Cal (California's Medicaid) program to provide clearer guidelines for subacute care services for both pediatric and adult patients. Specifically, the bill requires providers seeking authorization for subacute care to submit a standardized form (DHCS 6200 for pediatric services and DHCS 6200A for adult services) with their treatment authorization request. The bill prohibits Medi-Cal managed care plans from creating their own criteria for determining medical necessity that goes beyond the standards outlined in these forms, ensuring a more consistent and uniform approach to evaluating subacute care needs. Additionally, the bill prevents managed care plans from requiring a new treatment authorization request when a patient returns from a short-term acute hospitalization (known as a "bed hold"). The legislation also empowers the State Department of Health Care Services to impose sanctions on managed care plans that violate these provisions. Subacute care is a specialized level of medical service for patients who require ongoing medical technology or intensive nursing care but do not need the full acute hospital level of treatment, typically serving patients with complex medical conditions who need continuous professional medical supervision.

Budget and Finance, Health and Social Services

https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202520260AB220