Bill > SB339

This bill modifies how Medi-Cal (California's Medicaid program) reimburses providers for clinical laboratory and laboratory services. Currently, reimbursement cannot exceed certain thresholds, but this bill changes the language to require reimbursement to "equal" the lowest of those thresholds, which include the amount billed, the charge to the general public, 100% of the lowest Medicare rate, or an average of the lowest rates from other payers. For sexually transmitted infection (STI) testing services, the bill creates a special provision that will take effect on July 1, 2027, or when funding is appropriated, applying a similar reimbursement approach but excluding the average rate calculation. The bill also requires the California Department of Health Care Services to publicly release a deidentified dataset of laboratory service data from providers who reported more than 10 tests, which must be published alongside updated reimbursement rates. Additionally, the bill eliminates a previously existing 10% payment reduction for laboratory services. These changes aim to make laboratory service reimbursement more transparent and potentially more equitable, while ensuring that the new methodology complies with federal Medicaid requirements.

Budget and Finance, Health and Social Services, Justice

https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202520260SB339