Medi-Cal: department-approved chronic disease self-management programs.

Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which basic health care services are provided to qualified low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing law requires the department to submit an application to the federal Centers for Medicare and Medicaid Services (CMS) for a waiver or demonstration project that would implement specified objectives. Existing law requires the waiver or demonstration project to include designated restructuring proposals for the organization and delivery of services under the Medi-Cal program. Existing law provides that the restructuring proposals may include, but are not limited to, better care coordination for, among other persons, seniors and persons with disabilities, and requires better care coordination to include the establishment of organized delivery systems that incorporate a medical home system of care and disease management. This bill would require the department to include reimbursement under the Medi-Cal program for services provided through a department-approved chronic disease self-management program, as defined, as part of the above-described restructuring proposals. The bill would provide that if the department includes better care coordination as part of the above-described restructuring proposals, reimbursement for services provided through a department-approved chronic disease self-management program be implemented as part of the department's implementation of better care coordination.