Medi-Cal: laboratory rates.

Senator Cabaldon's proposal to modify Medi-Cal laboratory reimbursement rates carves out new payment criteria for sexually transmitted infection (STI) testing while increasing transparency in laboratory payment data. The legislation alters how California determines Medi-Cal payments for clinical laboratory services, particularly by establishing separate reimbursement standards for STI-related testing starting July 2027.

The bill creates distinct payment calculations for STI laboratory services by removing the requirement to consider rates paid by other payers and state Medicaid programs. For these services, Medi-Cal would pay the lowest of: the amount billed, the public charge, or Medicare's maximum allowance. The legislation also eliminates the existing 10% payment reduction currently applied to clinical laboratory services.

Under the proposal, the Department of Health Care Services must publish deidentified laboratory payment data from providers performing more than 10 tests during each collection period. This dataset would include procedure codes, third-party payment rates, and test volumes, released concurrent with updated Medi-Cal reimbursement rates. The bill maintains existing confidentiality protections for raw provider data while creating this new public reporting requirement. Implementation timing depends on funding availability, with provisions taking effect no later than July 2027.