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<ns0:Id>20250AB__171799INT</ns0:Id>
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<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2026-02-04</ns0:ActionDate>
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<ns0:SessionYear>2025</ns0:SessionYear>
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<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Castillo</ns0:AuthorText>
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<ns0:Name>Castillo</ns0:Name>
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<ns0:Title> An act to add Section 14132.87 to the Welfare and Institutions Code, relating to Medi-Cal.</ns0:Title>
<ns0:RelatingClause>Medi-Cal</ns0:RelatingClause>
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<ns0:Subject>Medi-Cal dental reimbursement: house/extended care facility call.</ns0:Subject>
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<html:p>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, including certain dental services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.</html:p>
<html:p>Under the Medi-Cal Dental Provider Handbook, the maximum allowance for a house/extended care facility call under a specified billing code is $20.</html:p>
<html:p>This bill would require the department to increase the Medi-Cal reimbursement base rate for a house/extended care facility call in order to reflect the reasonable travel costs for purposes of delivering dental services in the patient’s private residence or applicable facility instead of the location of the dental provider. The bill would
require that the rate be adjusted to a minimum of $120 per patient per date of service, with subsequent readjustments every 2 years to account for inflation and provider cost data.</html:p>
<html:p>The bill would require the department, every 2 years, to report to the Legislature about the impact of the rate adjustments on access, utilization, and reductions in emergency department visits for dental conditions.</html:p>
<html:p>The bill would condition implementation of these provisions on an appropriation, receipt of any necessary federal approvals, and the availability of federal financial participation.</html:p>
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<ns0:FiscalCommittee>YES</ns0:FiscalCommittee>
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<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
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<ns0:Num>SECTION 1.</ns0:Num>
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Section 14132.87 is added to the
<ns0:DocName>Welfare and Institutions Code</ns0:DocName>
, to read:
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<ns0:Num>14132.87.</ns0:Num>
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(a)
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The department shall increase the Medi-Cal reimbursement base rate, as described in subdivision (b), for a house/extended care facility call under Current Dental Terminology (CDT) Code D9410 or its successor, in order to reflect the reasonable travel costs for purposes of delivering dental services in the patient’s private residence or applicable facility instead of the location of the dental provider.
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(b)
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(1)
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As soon as possible, subject to the implementation timeline under subdivision (e), the reimbursement base rate described in subdivision (a) shall be adjusted to a minimum of one hundred twenty dollars ($120) per patient per date of service.
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(2)
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The
reimbursement base rate shall thereafter be readjusted every two years to account for inflation and provider cost data, while not falling below the minimum threshold described in paragraph (1).
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(c)
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(1)
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Every two years, the department shall report to the Legislature about the impact of the rate adjustments described in subdivision (b) on access, utilization, and reductions in emergency department visits for dental conditions.
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(2)
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A report submitted pursuant to paragraph (1) shall be submitted in accordance with Section 9795 of the Government Code.
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(d)
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Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of provider bulletins, plan
letters, or other similar instructions, without taking regulatory action.
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(e)
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(1)
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This section shall be implemented subject to an appropriation made by the Legislature.
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(2)
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This section shall be implemented only to the extent that any necessary federal approvals are obtained and that federal financial participation is available and is not otherwise jeopardized.
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