CA SB1287

Revises the definition of "medically necessary" for Medi-Cal coverage of individuals under 21 years of age to incorporate federal EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) standards set forth in 42 U.S.C. Section 1396d(r)(5).

Maintains the existing definition of "medically necessary" for individuals 21 years and older as services reasonable and necessary to protect life, prevent significant illness or disability, or alleviate severe pain.

Requires the State Department of Health Care Services and contractors to update model evidence of coverage documents, beneficiary handbooks, and related materials to reflect the correct medical necessity standard for individuals under 21.

Authorizes the department to implement these provisions through all-county letters and similar instructions without formal rulemaking until regulations are adopted by July 1, 2022.

Clarifies that prior authorization requests must include fully documented medical justification that services are medically necessary as defined in the revised section.