Reimbursement for pharmacist services.

The term 'advanced practice pharmacist' is replaced with 'pharmacist practitioner' or 'advanced pharmacist practitioner' throughout the bill, including in the Medi-Cal fee schedule provision (Section 14132.968(a)(4)) and the MTM reimbursement provisions (Sections 14132.969(a) and (c)(1)).

A new subdivision (e)(1) in Section 14132.968 now explicitly states that advanced pharmacist practitioners shall be recognized as health care providers at federally qualified health centers and rural health clinics for Medi-Cal reimbursement purposes. The prior version only required the department to seek federal approval for this recognition without mandating it.

The new subdivision (e)(2) adds a condition that recognition of advanced pharmacist practitioners as providers at FQHCs and rural health clinics is subject to an appropriation made by the Legislature in the annual Budget Act or another statute, in addition to federal approval and federal financial participation.

The reimbursement rate language in Section 14132.968(a)(4) is changed from 'the same as no less than 85 percent of the fee schedule for physician services' to simply 'no less than 85 percent of the fee schedule for physician services,' removing redundant phrasing while maintaining the same minimum rate floor.

The reimbursement rate for advanced practice pharmacist services under Medi-Cal was reduced from 100% of the physician fee schedule to no less than 85% of the physician fee schedule, including MTM pharmacist services.

References to 'advanced practice pharmacist' were changed to simply 'pharmacist' in the insurance code provisions (Sections 1 and 2), broadening the payment mandate to cover all licensed pharmacists rather than only those with advanced practice status.

A new exemption was added to Section 1368.5 of the Health and Safety Code stating that the requirement for health care service plans to pay or reimburse pharmacists does not apply to Medi-Cal managed care plans that contract with the Department of Health Care Services under Chapters 7 and 8 of Part 3 of Division 9 of the Welfare and Institutions Code.

A typo was corrected in Section 14132.969, changing 'pharmacies pharmacies' to 'pharmacies'.

New definitions added to Sections 1 and 2 (Health and Safety Code 1368.5 and Insurance Code 10125.1) clarifying that 'pharmacist' includes pharmacists providing services at federally qualified health centers or rural health clinics, as defined in federal law (42 U.S.C. 1396d(l)).

In Section 3 (Welfare and Institutions Code 14132.968), the federal approval requirement in subdivision (e) is expanded from recognizing pharmacists at 'federally qualified health centers' to also include 'rural health clinics.'

In Section 4 (Welfare and Institutions Code 14132.969), MTM reimbursement eligibility is expanded to include 'pharmacies, including those operating at federally qualified health centers or rural health clinics,' and the phrase 'dispensing use of qualified specialty drugs' is shortened to 'use of qualified specialty drugs,' decoupling MTM services from the act of dispensing.

In Sections 1 and 2, the term 'advanced practice pharmacist enrolled as a provider' is replaced with 'a pharmacist enrolled as a provider,' removing the advanced practice requirement and allowing any licensed pharmacist to be reimbursed under these provisions.

In Sections 1 and 2, the condition that coverage must provide reimbursement for 'identical services performed by other licensed health care providers' is changed to 'similar services,' lowering the threshold a plan must meet before it is required to pay pharmacist claims.

Minor language cleanups throughout: 'neither restricts nor prohibits any' changed to 'does not restrict or prohibit,' removal of 'but not limited to' and redundant 'or' in references to existing law, and page number corrections from 99 to 98.