Medi-Cal: laboratory rates.

Senator Cabaldon's Medi-Cal laboratory reimbursement legislation modifies how California pays for clinical laboratory services, with distinct provisions for sexually transmitted infection (STI) testing. The bill removes the existing 10% payment reduction for laboratory services while establishing separate reimbursement frameworks for STI-related and non-STI laboratory work.

For non-STI laboratory services, reimbursement remains capped at the lowest of: the billed amount, public charge rate, Medicare maximum allowance, or average of other payers' rates. STI-related laboratory services would follow a modified structure excluding the other-payer average requirement. The legislation also exempts STI testing from data reporting mandates that apply to other laboratory services.

The Department of Health Care Services must publish deidentified payment data from laboratories reporting more than 10 tests during collection periods, including procedure codes, third-party rates, and test volumes. This data will be released concurrent with updated reimbursement rates, which are set every three years. The department retains authority to modify rates to maintain federal Medicaid compliance, with notification to the Joint Legislative Budget Committee required 10 days before any compliance-driven rate changes.