Medi-Cal: comprehensive medication management.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and 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 establishes a schedule of benefits under the Medi-Cal program, which includes outpatient prescription drugs, subject to utilization controls and the Medi-Cal list of contract drugs. This bill would provide that comprehensive medication management (CMM) services, as defined, are covered under the Medi-Cal program, and would require CMM services to include, among other specified functions, the development of a care plan in collaboration with the beneficiary and the beneficiary's health care providers to address identified medication therapy problems. The bill would require CMM services to be offered to a beneficiary who is referred by a physician and surgeon as having a medical condition that could benefit from the provision of CMM services and who meets one or more of specified criteria, including being prescribed 8 or more prescription drugs or biologics, collectively by multiple prescribers, to treat or prevent 2 or more chronic medical conditions. The bill would require the department to establish reimbursement rates and rate billing codes for CMM services provided by a licensed pharmacist. The bill would require a pharmacist who initiates, adjusts, or discontinues medication in the course of providing CMM services to do so pursuant to established policies, procedures, or protocols described in existing provisions regulating pharmacists.