Medi-Cal: beneficiaries with HIV or AIDS: managed care plans: reimbursement rates.

Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services and under which health care services are provided to qualified, low-income persons. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Under existing law, one of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed care plans. Existing law requires the department to determine rates of payment for services provided under this chapter for Medi-Cal beneficiaries enrolled in these plans, as specified. This bill would authorize the department to determine either a separate reimbursement rate for each stage of HIV disease, or a blended rate that covers a person at any stage of the disease. Existing law authorizes the Board of Supervisors of the County of Los Angeles to establish a commission for the provision, or arrangement for the provision, of health care services under the Medi-Cal program in all or a portion of the geographic area of the county, on a coordinated managed care basis. This bill would make a beneficiary with HIV disease who is required to enroll in a Medi-Cal managed care plan in the County of Los Angeles eligible to enroll in a plan that provides comprehensive services to persons with HIV disease in the county. This bill would define "HIV disease" to include any stage of HIV infection, as identified by the federal Centers for Disease Control and Prevention.