Bill > AB1126

This bill aims to streamline billing processes for healthcare providers serving individuals enrolled in both Medi-Cal managed care plans and other health insurance. Specifically, it requires that providers who are not contracted with a Medi-Cal managed care plan and are billing that plan for costs not covered by the enrollee's other insurance should not face administrative burdens significantly greater than those encountered when billing Medi-Cal's fee-for-service system. This means that, in most cases, providers will not need to become in-network with a Medi-Cal managed care plan to bill them for services rendered to dual-eligible enrollees, as long as Medi-Cal is the payer of last resort. However, Medi-Cal managed care plans can require agreements for services needing prior authorization or services not covered by the enrollee's other insurance. The bill also mandates that the State Department of Health Care Services clarify billing conditions, offer educational resources to enrollees about coordinating their coverage, and report annually on implementation effectiveness. Additionally, the California Health and Human Services Agency (CalHHS) will convene a workgroup to study functional, hormonal, integrative, and metabolic health. The implementation of these provisions is contingent on federal approvals and funding.

Budget and Finance, Health and Social Services

https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202520260AB1126