Adult day health care services: eligibility criteria: Medi-Cal reimbursement methodology and limit.

Existing law establishes the Medi-Cal program, administered by the State Department of Health Care Services, under which basic health care services are provided to qualified low-income persons. The Adult Day Health Medi-Cal Law establishes adult day health care services as a Medi-Cal benefit for Medi-Cal beneficiaries who meet certain criteria, including, beneficiaries who meet the skilled nursing facility level of care, as specified. This bill would modify the aforementioned criteria to, instead, provide that a beneficiary shall be eligible for adult day health care services as a Medi-Cal benefit if he or she meets a specified level of care. Under existing law, participation in an adult day health care program requires prior authorization by the department. Existing law requires the department, effective August 1, 2010, to establish a reimbursement methodology and a reimbursement limit for adult day health care services on a prospective cost basis for services that are provided to each participant, pursuant to his or her individual plan of care, as specified. Existing law requires that these provisions be implemented only to the extent that federal financial participation is available. This bill would, instead, provide that the requirement that the department establish a reimbursement methodology and reimbursement limit be effective August 1, 2012, and would make other conforming changes. This bill would also make a technical, nonsubstantive change relating to adult day health care services.