Medi-Cal: subacute care services.

Assembly Member Jackson's Medi-Cal legislation establishes standardized authorization procedures for subacute care services, requiring healthcare providers to submit specific state forms when requesting approval for both pediatric and adult care. The measure addresses authorization processes within California's Medi-Cal program, which provides health coverage for low-income residents.

Under the new requirements, providers must include form DHCS 6200 for pediatric subacute care requests and form DHCS 6200A for adult services. The legislation prohibits Medi-Cal managed care plans from developing or applying medical necessity criteria beyond those enumerated in these standardized forms. Additionally, plans cannot require new authorization requests when patients return from acute hospitalization bed holds.

The Department of Health Care Services maintains authority to impose sanctions on managed care plans that violate these provisions. These changes apply to the existing Medi-Cal subacute care program, which serves patients who meet specific medical criteria and receive care in designated health facilities.