AB 1126: Medi-Cal managed care plans: enrollees with other health care coverage.

The bill aims to simplify the process for Medi-Cal managed care plans and their providers when dealing with enrollees who have other health care coverage. Enrollees with other health care coverage are considered the "payer of last resort," and the Medi-Cal program is required to follow specific guidelines when billing providers. The bill allows providers to bill the Medi-Cal plan for allowable costs without having to contract as an in-network provider. However, in certain situations, such as when a service requires prior authorization or is not covered by the other health care coverage, the Medi-Cal plan may require a letter of agreement. To help enrollees understand their options, the state department of health care services will provide educational resources. The department will also provide clarification on the conditions for billing plans to providers and update the legislative heal…