Medi-Cal: emergency medical conditions.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law provides for a schedule of benefits under the Medi-Cal program, which includes inpatient hospital services subject to utilization controls. Existing federal law requires a hospital to provide appropriate medical screening or treatment to determine whether an emergency medical condition exists if any individual comes to the emergency department and requires an examination or treatment for a medical condition, as specified. This bill would, for Medi-Cal fee-for-service beneficiaries, add emergency services and care that are necessary for the treatment of an emergency medical condition and medical care directly related to the emergency medical condition to the schedule of benefits. This bill would provide that specified definitions shall apply for the purposes of this provision and that this provision shall not be construed to change the obligation of Medi-Cal managed care plans to provide emergency services and care.