Medi-Cal: subacute care program.

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 requires the department to establish a subacute care program in health facilities in order to more effectively use limited Medi-Cal dollars while ensuring needed services for patients who meet subacute care criteria, as established by the department. Existing law provides that, for the purposes of this program, subacute care may be provided by any facility designated by the Director of Health Care Services as meeting subacute care criteria and that has an approved provider participation agreement with the department. Existing law also provides that subacute patient care shall be defined by the department based on the results of a specified study. This bill would delete the requirement that the department define subacute patient care based on the results of the study. This bill would require, for the purposes of the subacute care program, medical necessity for pediatric subacute care services, as defined, to be substantiated in one of 5 ways. This bill would also make technical, nonsubstantive changes to these provisions.