Overview

Assembly Bill X3 5 (Evans, Chapter 20, Statutes of 2009), the budget trailer bill for the recently signed budget bill, added Section 14131.10 of the Welfare and Institutions Code (W&I Code) to exclude several optional benefits categories from coverage under the Medi-Cal program, and was implemented on July 1, 2009.

Accordingly, the following optional benefits are excluded from coverage under the Medi-Cal program:

• Acupuncture services
• Adult dental services
• Audiology services
• Chiropractic services
• Incontinence creams and washes products
• Dispensing Optician services, including services provided by a fabricating optical laboratory
• Podiatric services
• Psychology services
• Speech therapy services

Important details to this policy, including information about exemptions to the excluded benefits, are explained in the “What’s New” list below, the FAQs, and the Optional Benefits Exclusion section of the Part 2 provider manual.

What's New?

• Optional Benefits Exclusion Updates for FQHCs and RHCs
• Court Injunction Impacts FQHC and RHC Claims
• Optometry Services Reinstated – Provider References
• Beneficiary Reimbursement Process for Optometry Services
• Optometry Services Reinstated
• Optometry Services Reinstated as Medi-Cal Covered Benefit
• OBE Policy Updates for ICF-DD Residents and Audiology/Speech Therapy
• Federally Qualified Health Centers (FQHC), Rural Health Centers (RHC) and Indian Health Services (IHS) – Optional Benefits Exclusion of Adult Dental Services
• Optional Benefits Exclusion Policy: Additional Billing Information for FQHCs, RHCs and IHS
• Medi-Cal Beneficiary Optional Benefits Reduction Notice
• New RAD Code for Optional Benefits
• Optional Benefits Exclusion Policy Update
• Optional Benefits Excluded from Medi-Cal Coverage