Medi-Cal: contracts.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. 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 authorizes the department to enter into various types of contracts for the provision of services to beneficiaries, including contracts with managed care systems and prepaid health plans. Existing federal law provides for the federal Medicare Program, which is a public health insurance program for persons 65 years of age and older and specified persons with disabilities who are under 65 years of age. This bill would require a health care service plan that coordinates services for patients eligible for both Medi-Cal and Medicare to report to the State Department of Health Care Services and the appropriate budget and policy committees of the Legislature if the actual use of services differs, as specified, from the anticipated use of services assumed in the plan's capitation agreement with the department.