§ 14131.10
657 words·~3 min read·
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(a)Notwithstanding this chapter, Chapter 8 (commencing with Section 14200), or Chapter 8.75 (commencing with Section 14591), in order to implement changes in the level of funding for health care services, specific optional benefits are excluded from coverage under the Medi-Cal program.
(1)The following optional benefits are excluded from coverage under the Medi-Cal program:
(A)Adult dental services, except as specified in paragraph (2).
(i)This exclusion shall be in effect only through December 31, 2017, and adult dental services shall be covered under the Medi-Cal program as of January 1, 2018, or the effective date of any necessary federal approvals, whichever is later.
(ii)The restoration of adult dental services pursuant to clause
(i)shall be effective only to the extent any necessary federal approvals are obtained as required by subdivision (f).
(B)Audiology services and speech therapy services.
(C)Chiropractic services.
(D)Optometric and optician services, including services provided by a fabricating optical laboratory, except as provided in subdivision (g).
(E)Podiatric services.
(F)Incontinence creams and washes.
(A)Medical and surgical services provided by a doctor of dental medicine or dental surgery, which, if provided by a physician, would be considered physician services, and which services may be provided by either a physician or a dentist in this state, are covered.
(B)Emergency procedures are also covered in the categories of service specified in subparagraph (A). The director may adopt regulations for any of the services specified in subparagraph (A).
(C)Effective May 1, 2014, or the effective date of any necessary federal approvals as required by subdivision (f), whichever is later, for persons 21 years of age or older, adult dental benefits, subject to utilization controls, are limited to all the following medically necessary services:
(i)Examinations, radiographs/photographic images, prophylaxis, and fluoride treatments.
(ii)Amalgam and composite restorations.
(iii)Stainless steel, resin, and resin window crowns.
(iv)Anterior root canal therapy.
(v)Complete dentures, including immediate dentures.
(vi)Complete denture adjustments, repairs, and relines.
(D)Services specified in this paragraph shall be included as a covered medical benefit under the Medi-Cal program pursuant to Section 14132.89.
(3)Pregnancy-related services and services for the treatment of other conditions that might complicate the pregnancy are not excluded from coverage under this section.
(c)The optional benefit exclusions do not apply to either of the following:
(1)Beneficiaries under the Early and Periodic Screening, Diagnostic, and Treatment Program.
(2)Beneficiaries receiving long-term care in a nursing facility that is both:
(A)A skilled nursing facility or intermediate care facility as defined in subdivisions
(c)and
(d)of Section 1250 of the Health and Safety Code.
(B)Licensed pursuant to subdivision
(k)of Section 1250 of the Health and Safety Code.
(d)This section shall only be implemented to the extent permitted by federal law.
(e)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement the provisions of this section by means of all-county letters, provider bulletins, or similar instructions, without taking further regulatory action.
(f)This section shall be implemented only to the extent that federal financial participation is available and any necessary federal approvals have been obtained.
(1)Effective no sooner than January 1, 2020, or January 1 of the subsequent calendar year following the legislative action pursuant to paragraph (2), whichever is later, and subject to paragraph
(2)and subdivision (f), optometric and optician services, including services provided by a fabricating optical laboratory, shall be covered benefits under the Medi-Cal program.
(2)The restoration of optometric and optician services pursuant to this subdivision is contingent upon the Legislature including funding for these services in the state budget process.
(h)Effective no sooner than January 1, 2020, all of the following optional benefits shall be covered benefits under the Medi-Cal program:
(1)Audiology services and speech therapy services.
(2)Podiatric services.
(3)Incontinence creams and washes.