Existing law provides for the Medi-Cal program, 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 and provides for various services, including comprehensive perinatal services and federally qualified health center (FQHC) and rural health clinic (RHC) services, that are rendered by Medi-Cal enrolled providers. Under existing law, FQHCs and RHCs receive a per-visit prospective payment system (PPS) rate for each visit.

Existing law establishes the Comprehensive Perinatal Services Program, the goals of which are to decrease and maintain the decreased level of perinatal, maternal, and infant mortality and morbidity in the State of California and to support methods of providing comprehensive prenatal care that prevent prematurity and the incidence of low birth weight infants. Under the program, the State Department of Public Health is required to develop and maintain a statewide comprehensive community-based perinatal services program and enter into contracts, grants, or agreements with health care providers to deliver these services in a coordinated effort. Existing law also requires the department to monitor the delivery of services under those contracts, grants, and agreements through a uniform health data collection system that utilizes epidemiologic methodology.

This bill would instead require the State Department of Health Care Services to oversee a statewide comprehensive community-based perinatal services program and enroll health care providers to deliver these services to Medi-Cal members and make conforming changes, but would maintain the State Department of Public Health’s role with related contracts, grants, and agreements. The bill would specify that any participation by the State Department of Public Health does not change the State Department of Health Care Services’ authority to implement comprehensive community-based perinatal services for purposes of the Medi-Cal program. By January 1, 2028, the bill would require the State Department of Health Care Services, in consultation with the State Department of Public Health, to clarify each department’s roles and responsibilities regarding comprehensive perinatal services by regulation. The bill would, among other things, require the State Department of Health Care Services to develop a training on administering the comprehensive perinatal services, require all perinatal providers providing perinatal care to Medi-Cal members to attend the training, and require all Medi-Cal managed care plans to ensure providers receive the training. The bill would require the State Department of Health Care Services, no later than July 15, 2027, to submit to the Assembly Committee on Health and the Senate Committee on Health, and post on its internet website, a report that identifies the number of pregnant and postpartum individuals that received comprehensive perinatal services from January 1, 2022, to January 1, 2025, inclusive. The bill would also require the State Department of Health Care Services, commencing January 1, 2028, and every 3 years thereafter, to submit to those committees, and post on its internet website, a report that identify the number of pregnant and postpartum individuals that received and were offered comprehensive perinatal services during the previous 3 years.

This bill would require a Medi-Cal provider providing pregnancy care to inform each Medi-Cal member treated during the perinatal period regarding the availability of and access to comprehensive perinatal services. On an effective date designated by the State Department of Health Care Services that is no sooner than January 1, 2027, the bill would prohibit a PPS billable visit from including an encounter with a comprehensive perinatal practitioner who is not otherwise a PPS billable health professional. The bill would authorize the department to implement an alternative payment methodology for FQHCs and RHCs to obtain reimbursement for encounters with community health workers at no less than the applicable Medi-Cal fee-for-service rate when provided either on the same day or different day as a PPS billable visit.