Opinion No. (2003)

BILL LOCKYER Attorney General ANTHONY S. DA VIGO Deputy Attorney General THE HONORABLE JOSEPH L. DUNN, MEMBER OF THE STATE SENATE, has requested an opinion on the following question: In providing or arranging for the provision of health care services under the California Medical Assistance program, is a county organized health system that has contracted with the California Medical Assistance Commission subject to the statutory requirement that a request for treatment "be reviewed for medical necessity only"? CONCLUSION In providing or arranging for the provision of health care services under the California Medical Assistance program, a county organized health system that has contracted with the California Medical Assistance Commission is not subject to the statutory requirement that a request for treatment "be reviewed for medical necessity only" unless such requirement is a term of its contract. ANALYSIS The California Medical Assistance (Medi-Cal) program (Welf. Inst. Code, §§ 14000 - 14198.2 ) 1 implements the federal Medicaid program, established under title XIX of the Social Security Act ( 42 U.S.C. § 1396 et seq.), authorizing "the payment of federal funds to…