20250AB__224098AMD INTRODUCED 2026-02-19 AMENDED_ASSEMBLY 2026-04-16 2025 AB AMD Introduced by Assembly Member Stefani LEAD_AUTHOR ASSEMBLY Stefani

An act to add

Section 14149.96 to the Welfare and Institutions Code, relating to Medi-Cal. Medi-Cal Medi-Cal: private duty nursing. Existing law provides for the licensure of private duty nursing agencies and home health agencies by the State Department of Public Health.

Existing law defines “private duty nursing services” as skilled nursing services provided on a shift basis for patients who require individual and continuous nursing care in the patient’s temporary or permanent place of residence or other community-based setting, as specified.</xhtml:p>"?> Existing law, the Medi-Cal Act, establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services.

Under existing law, early and periodic screening, diagnostic, and treatment (EPSDT) services, including private duty nursing services, are covered under Medi-Cal for an individual under years of age in accordance with certain federal provisions. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions. Under this bill, private duty nursing services, provided to a child under years of age by a home health agency, would be considered specialty care for purposes of Medi-Cal reimbursement under the provisions of the Medi-Cal Act.

The bill would not apply this designation for purposes of Medi-Cal reimbursement under the provisions of the Protect Access to Health Care Act of 2024, an initiative measure enacted by Proposition 35, as approved by the voters at the November 5, 2024, statewide general election.</xhtml:p>"?> This bill would require the department to measure and assess whether private duty nursing services provided as part of the EPSDT benefit are in compliance with federal Medicaid requirements, as specified.

The bill would require the assessment to include a comparison of the hours of EPSDT private duty nursing services authorized by the Medi-Cal program to the hours actually provided to eligible beneficiary children and a determination of whether the reimbursement rates for those services are sufficient to ensure that all authorized hours are able to be provided. The bill would require the department to prepare and submit a report to the Legislature on the findings of the assessment by no later than March 1, 2027. MAJORITY NO YES NO NO NO NO NO NO NO NO The people of the State of California do enact as follows:

SECTION

Section 14149.96 is added to the Welfare and Institutions Code , to read: 14149.96. (

a) The department shall measure and assess whether private duty nursing services provided as part of the early periodic screening, diagnostic, and treatment (EPSDT) benefit are in compliance with federal Medicaid requirements for the provision of private duty nursing services to children under years of age. The assessment shall include, but is not limited to, both of the following:

(1) A comparison of the number of hours of EPSDT private duty nursing services authorized by the Medi-Cal program to the hours actually provided to eligible beneficiary children.

(2) A determination of whether the reimbursement rates for EPSDT private duty nursing services are sufficient to ensure that all authorized hours are able to be provided to eligible beneficiary children. (

b) By no later than March 1, 2027, the department shall prepare and submit a report to the Legislature on the findings of the assessment described in subdivision (

a) in compliance with

Section of the Government Code. <caml:Num>SECTION 1.</caml:Num><caml:ActionLine action="IS_AMENDED" xlink:href="urn:caml:codes:HSC:caml#xpointer(%2Fcaml%3ALawDoc%2Fcaml%3ACode%2Fcaml%3ALawHeading%5B%40type%3D'DIVISION'%20and%20caml%3ANum%3D'2.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'CHAPTER'%20and%20caml%3ANum%3D'8.3.'%5D%2Fcaml%3ALawSection%5Bcaml%3ANum%3D'1743.2.'%5D)" xlink:label="fractionType: LAW_SECTION" xlink:type="locator">Section 1743.2 of the <caml:DocName>Health and Safety Code</caml:DocName> is amended to read:</caml:ActionLine><caml:Fragment><caml:LawSection id="id_A024CEEB-2F49-46C9-8500-30A8D6F075F7"><caml:Num>1743.2.</caml:Num><caml:LawSectionVersion id="id_E59CE879-B8A8-45FA-AEF4-CA29657BCD33"><caml:Content><xhtml:p>(a) <xhtml:span class="EnSpace"/>“Private duty nursing agency” means a private or public organization, including, but not limited to, any partnership, corporation, political subdivision of the state, or other government agency within the state, that provides, or arranges for the provision of, private duty nursing services, as described in

Section 1743.3.</xhtml:p><xhtml:p>(b) <xhtml:span class="EnSpace"/>“Private duty nursing services” means skilled nursing services provided on a shift basis for patients who require individual and continuous nursing care, and that meets all of the following requirements:</xhtml:p><xhtml:p>(1) <xhtml:span class="EnSpace"/>Is provided by a registered nurse or a licensed vocational nurse, except that any person accepted for service whose care requires medical orders shall be under the care of a physician, dentist, podiatrist, or other licensed practitioner within their scope of practice.</xhtml:p><xhtml:p>(2) <xhtml:span class="EnSpace"/>Is provided to the patient in their temporary or permanent place of residence or other community-based setting and includes, one or both of the following locations:</xhtml:p><xhtml:p>(A) <xhtml:span class="EnSpace"/>The patient’s home.</xhtml:p><xhtml:p>(B) <xhtml:span class="EnSpace"/>Outside of the patient’s home, as necessitated by normal life activities.</xhtml:p><xhtml:p>(c)<xhtml:span class="EnSpace"/>Private duty nursing services, provided to a child under years of age by a home health agency, as defined in

Section 1727, shall be considered specialty care for purposes of Medi-Cal reimbursement under

Chapter 7 (commencing with

Section 14000) of, but not

Chapter 7.5 (commencing with

Section 14199.100) of, Part of Division of the Welfare and Institutions Code.</xhtml:p></caml:Content></caml:LawSectionVersion></caml:LawSection></caml:Fragment></caml:BillSection>"?>