AB 220: Medi-Cal: subacute care services.

The proposed Medi-Cal program change aims to improve the administration of subacute care services. A provider must submit a treatment authorization request, including an electronic form, when requesting authorization for subacute care services. This form should include a specified list of conditions to substantiate medical necessity for pediatric and adult subacute care. Medi-Cal managed care plans are prohibited from developing or using their own criteria for medical necessity that is not listed on the approved forms. Additionally, managed care plans are not allowed to require a new authorization request after a patient returns from a bed hold for acute hospitalization. The state department of health care services can impose sanctions on managed care plans that violate these provisions.