Welfare and Institutions Code section 14199.110

Specialty Care Account

(a)

Moneys in the Specialty Care Account shall be used for the purpose of increasing Medi-Cal patient access to specialty care services as set forth in this section.

(b)

The department shall, subject to the stakeholder input requirements of Section 14199.121, establish and implement one or more payment methodologies that meet federal requirements and that require each Medi-Cal managed care plan or its subcontracted entities to expand beneficiary access to Medi-Cal covered specialty care services. The payment methodology or methodologies developed by the department shall address the following objectives:

(1)

Increase the number of Medi-Cal managed care plan-contracting specialists.

(2)

Retain existing Medi-Cal managed care plan-contracting specialists within the plan’s network of contracting providers.

(3)

Increase the number of Medi-Cal patients an existing Medi-Cal managed care plan-contracting specialist serves.

(4)

Provide expanded specialist appointment availability for Medi-Cal patients.

(5)

Support specialists in coordinating and overseeing the care of patients as part of a multidisciplinary care team.

(c)

A Medi-Cal managed care plan or a subcontracted entity shall provide payments to specialists consistent with the payment methodologies developed by the department pursuant to this section.