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California Code, Welfare and Institutions Code - WIC § 14132.171

Current as of January 01, 2025 | Updated by Findlaw Staff

(a)(1) An annual cognitive health assessment for Medi-Cal beneficiaries who are 65 years of age or older is a covered benefit if they are otherwise ineligible for a similar assessment as part of an annual wellness visit under the Medicare Program. Subject to paragraph (3), the department shall provide reimbursement to a Medi-Cal provider who renders this service.

(2) The payment for the cognitive health assessment developed pursuant to paragraph (1) shall only be available upon appropriation by the Legislature for these purposes.

(3)(A) A Medi-Cal provider shall only be eligible to receive the payment for the benefit specified in paragraph (1) if the provider complies with both of the following requirements:

(i) Completes cognitive health assessment training, as specified and approved by the department.

(ii) Conducts the cognitive health assessment using validated tools, as recommended by the department.

(B)(i) The department shall determine the cognitive health assessment training and validated tools, as described in subparagraph (A), in consultation with the State Department of Public Health's Alzheimer's Disease Program (Article 4 (commencing with Section 125275) of Chapter 2 of Part 5 of Division 106 of the Health and Safety Code), that program's 10 California Alzheimer's Disease Centers, representatives of primary care physician specialties, including, but not limited to, family medicine, and the Alzheimer's Disease and Related Disorders Advisory Committee of the California Health and Human Services Agency (Chapter 3.1 (commencing with Section 1568.15) of Division 2 of the Health and Safety Code).

(ii) With respect to the validated tools, the department shall select multiple tools. To improve overall accessibility of these tools and minimize access barriers, at least one of those tools shall not carry any restrictions on copyright or trademark.

(b) An annual cognitive health assessment shall identify signs of Alzheimer's disease or dementia, consistent with the standards for detecting cognitive impairment under the federal Centers for Medicare and Medicaid Services and the recommendations by the American Academy of Neurology.

(c) By January 1, 2024, and every two years thereafter, the department shall do both of the following:

(1) Consolidate and analyze the data on the administration of the cognitive health assessment in the Medi-Cal managed care and fee-for-service delivery systems.

(2) Post information on the utilization of, and payment for, this benefit on its internet website.

(d) 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 this section, in whole or in part, by means of all-plan letters, provider bulletins, or similar instructions, without taking any further regulatory action.

(e) This section shall be implemented only to the extent any necessary federal approvals are obtained and federal financial participation is available.

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Cite this article: FindLaw.com - California Code, Welfare and Institutions Code - WIC § 14132.171 - last updated January 01, 2025 | https://codes.findlaw.com/ca/welfare-and-institutions-code/wic-sect-14132-171/

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