Medi-Cal: subacute care services.
What changed between versions
New provision (f)(2) states that if a provider substantiates a patient meets any of the specified criteria for pediatric subacute care, a Medi-Cal managed care plan shall not impose or require the patient to meet any additional criteria. This closes a gap where plans could add their own requirements on top of the statutory list.
New subdivision (h) requires that if DHCS develops a standard form for authorization and reauthorization of pediatric or adult subacute care services, a Medi-Cal managed care plan must deem it sufficient and accept it from providers, and is prohibited from creating or requiring submission of a separate form created by the plan or any other entity.
The medical necessity criteria in subdivision (f) were restructured from a flat numbered list into a nested format with paragraph (1) containing subparagraphs (A) through (E) and clauses (i) through (vi), to accommodate the new paragraph (2) about additional criteria. The substantive criteria themselves are unchanged.
The sanctions provision was updated to reference the relettered subdivisions, now citing violations of subdivisions (h) and (i) rather than the prior (h), (i), and (j) references, reflecting the new structure of the section.