Medical care: electronic treatment authorization requests.

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 benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law also requires the department to administer various health programs, including the California Children's Services Program and the Genetically Handicapped Person's Program. This bill would, by July 1, 2016, or a subsequent date determined by the department, require requests for authorization for treatment or services under those programs, excluding those submitted by dental providers enrolled in the Medi-Cal Dental program, to be submitted in an electronic format determined by the department via the department's Internet Web site or other electronic means. The bill would require the department to designate an alternate format for submitting requests for authorization for treatment or services when the department's Internet Web site or other electronic means are unavailable due to a system disruption. The bill would also require the department to consider the capacity of small and rural Medi-Cal providers to comply with these requirements, and to implement the process in a manner that offers these providers reasonable time to establish the infrastructure necessary for the generation of electronic treatment authorization requests and an opportunity to participate in training offered by the department. The bill would authorize the department to implement these provisions in phases and by means of all-county letters, plan letters, provider bulletins, or similar instructions, but would require the department to adopt regulations by July 1, 2017.