BILL NUMBER: AB 442 CHAPTERED
BILL TEXT
CHAPTER 1161
FILED WITH SECRETARY OF STATE SEPTEMBER 30, 2002
APPROVED BY GOVERNOR SEPTEMBER 30, 2002
PASSED THE ASSEMBLY SEPTEMBER 1, 2002
PASSED THE SENATE JUNE 29, 2002
AMENDED IN SENATE JUNE 24, 2002
AMENDED IN ASSEMBLY MAY 23, 2001
INTRODUCED BY Committee on Budget (Cardenas (Chair), Aroner,
Cardoza, Cedillo, Dutra, Firebaugh, Horton, Keeley, Nakano, Oropeza,
Pavley, Simitian, Steinberg, Vargas, and Wright)
FEBRUARY 20, 2001
An act to amend Section 4426 of, and to repeal Section 4427 of,
the Business and Professions Code, to amend Section 49557.2 of the
Education Code, to amend Sections 1356, 1797.199, 53300, 100171,
120955, 124030, 124040, 124120, and 124250 of, to add Sections 26157,
104188, 124033, 124977, 125190, and 127280.1 to, and to add Article
6 (commencing with Section 101315) to Chapter 3 of Part 3 of Division
101 of, the Health and Safety Code, to amend Sections 12693.17,
12693.43, 12693.45, 12693.70, and 12693.981 of, and to amend, repeal,
and add Section 12693.41 of, the Insurance Code, and to amend
Sections 4094.2, 4380, 4418.3, 4418.7, 4640.6, 4643, 4646.5, 5600.8,
5869, 5881, 5882, 5883, 14005.41, 14011.6, 14019.3, 14051, 14085.7,
14085.8, 14103.6, 14105.2, 14105.3, 14105.31, 14105.33, 14105.337,
14105.34, 14105.35, 14105.37, 14105.38, 14105.39, 14105.405,
14105.42, 14105.43, 14105.45, 14125, 14132, 14132.26, 14132.88,
14132.95, 14163, 14495.10, 16809, 16809.4, and 18925 of, to add
Sections 4418.2, 4418.25, 4781.5, 5767, 14000.03, 14000.5, 14011.7,
14011.8, 14011.9, 14105.18, 14105.332, 14105.46, 14105.47, 14105.8,
14105.85, 14132.73, and 14150 to, to add and repeal Sections 4631.5
and 14105.436 of, to repeal Sections 4847, 14105.65, 14105.91,
14105.915, and 14105.916 of, and to repeal and amend Sections 14105.4
and 14105.41 of, the Welfare and Institutions Code, relating to
health, making an appropriation therefor, and declaring the urgency
thereof, to take effect immediately.
LEGISLATIVE COUNSEL'S DIGEST
AB 442, Committee on Budget. Health: budget trailer.
Existing law provides for the Medi-Cal program, administered by
the State Department of Health Services, under which qualified
low-income persons are provided with health care services.
Existing law requires, as a condition of a pharmacy's
participation in the Medi-Cal program, the pharmacy to charge a price
that does not exceed the Medi-Cal reimbursement rate for
prescription medicines and an amount to cover electronic transmission
charges by Medicare beneficiaries. Existing law requires the
department to monitor pharmacy participation under these provisions,
conduct a study of the adequacy of the Medi-Cal pharmacy
reimbursement rates, and report the results of the study to the
Legislature by July 1, 2002. Under existing law, these provisions
are repealed as of January 1, 2003.
This bill would delete the repeal of these provisions, thereby
extending the operation of these provisions indefinitely. The bill
would delete the requirement of the department to report the results
of the study by July 1, 2002.
Existing law provides for a school lunch program under which
eligible pupils receive free or reduced price meals. Existing law,
effective July 1, 2002, authorizes the incorporation into the school
lunch program application packet, or notification of eligibility,
various notifications to parents and guardians, including those with
regard to the confidentiality of school lunch application information
and its use for purposes of the Medi-Cal program.
This bill would change the effective date of the above
notification provisions from July 1, 2002, to July 1, 2003. It would
also revise the notifications that may be incorporated under this
provision regarding the confidentiality of the school lunch
application information and its use for purposes of the Medi-Cal
program and would make related and technical changes.
Existing law provides for the regulation and licensure of health
care service plans, administered by the Department of Managed Health
Care. Existing law requires a health care service plan to reimburse
the director for the actual cost of processing an application for
licensure as a health care service plan and for a health care service
plan's share of all costs and expenses reasonably incurred in the
administration of these regulatory provisions. In addition, existing
law authorizes the director, by notice on or before September 15,
2000, to require a health care service plan to pay an additional
assessment to provide the department with sufficient revenues to
support various costs and expenses for the 2000-01, 2001-02, and
2002-03 fiscal years.
This bill would require that notice for the additional assessment
be provided each year, rather than on or before September 15, 2000.
The bill would expressly require, if a health care plan fails to pay
the additional assessment for the 2001-02 fiscal year, the assessment
of the amount due for the 2001-02 fiscal year in the 2002-03 fiscal
year, in addition to the amount due in the 2002-03 fiscal year.
Existing law establishes the Trauma Care Fund, effective August
10, 2001, which is continuously appropriated to the Emergency Medical
Services Authority for purposes of allocating funds to local
emergency medical services (EMS) agencies for certain trauma centers.
Existing law requires the authority, within 30 days of the
effective date of the establishment of the fund and related
provisions, to request all local EMS agencies with an approved trauma
plan to submit specified information.
This bill, instead, would require the authority to request all
local EMS agencies to submit this information within 30 days of the
effective date of the enactment of an appropriation for purposes of
implementing provisions relating to the Trauma Care Fund.
Existing law establishes the Toxic Mold Protection Act of 2002,
which requires the State Department of Health Services to take
specified steps related to reducing toxic mold exposure. The act
declares that it shall be implemented only to the extent that the
department determines that funds are available for its purposes.
This bill would authorize the department to receive voluntary
contributions to support the department's activities pursuant to the
act. It would establish the Public Health Protection from Indoor
Mold Hazards Fund, a continuously appropriated fund, into which those
contributions would be deposited for use by the department in
implementing the act, thereby making an appropriation.
The existing California Statewide Supportive Housing Initiative
Act requires the State Department of Mental Health to award grants to
local government or private nonprofit agencies for services to a
target population. The act requires the department to make all grant
awards from funds allocated in the Budget Act of 2000 for the
supportive housing initiative no later than June 30, 2002, and to
expend the funds allocated for those grants no later than June 30,
2004.
This bill would revise this provision to require, instead, the
department to make all grant awards from funds allocated in the
Budget Act of 2001 for the supportive housing initiative no later
than June 30, 2002, and to expend the funds allocated for those
grants no later than June 30, 2005.
Existing law vests the State Department of Health Services with
various powers, functions, and duties with respect to the
administration and oversight of various health programs and
facilities. Existing law requires that any adjudicative hearing that
the department is authorized or required to conduct be conducted
pursuant to the Administrative Procedure Act. The staff assigned to
the hearing office of the State Department of Health Services is
authorized to determine the time and place of an administrative
adjudication hearing conducted pursuant to these procedures.
This bill would require that formal hearings requested by
institutional Medi-Cal providers and health facilities be held in
Sacramento and would authorize informal conferences concerning
appeals by those entities to be held in Sacramento or Los Angeles.
Existing law provides for the allocation of state aid to the
administrative bodies of qualifying local health departments
according to a specified formula.
This bill would establish procedures and requirements to govern
the allocation to, and expenditure by, local health jurisdictions of
federal funding received for the prevention of, and response to,
bioterrorist attacks and other public health emergencies.
The bill would provide that federal funding received by the State
Department of Health Services for bioterrorism preparedness and
emergency response is subject to appropriation in the annual Budget
Act.
Existing law requires the State Department of Health Services to
establish and administer the Cancer Research Program and authorizes
the department to award grants under the program.
This bill would establish a maximum indirect cost rate that may be
charged on any cancer research program grant awarded to any
institution under these provisions.
Existing law requires the Director of Health Services to develop a
list of drugs to be provided under a program for the treatment of
persons infected with the human immunodeficiency virus (HIV) and
requires manufacturers of drugs on the list to pay the department a
rebate that is equal to the rebate that would apply to the drug under
certain provisions of federal law.
This bill would require these manufacturers to pay an additional
rebate to be negotiated by each manufacturer with the department.
Under existing law, the governing body of each county is required
to establish a community child health and disability prevention
program for the purpose of providing early and periodic assessments
of the health status of children in the county.
This bill would require, commencing July 1, 2003, that all
applications for services under the child health and disability
prevention program be filed electronically as provided under the
bill. The bill would define "child health and disability prevention
provider" for purposes of the provisions concerning child health and
disability prevention programs, and would make related changes.
Existing law requires the State Department of Health Services to
conduct a community outreach and awareness campaign relative to a
specified newborn hearing screening program and the value of early
hearing testing.
This bill, instead, would authorize the department to conduct this
outreach and awareness campaign.
Existing law requires the Maternal and Child Health Branch of the
department to administer a comprehensive shelter-based services grant
program to battered women's shelters. In implementing the program,
the department is required to consult with a designated advisory
council that shall remain in existence until January 1, 2003.
This bill would provide that the advisory council shall remain in
existence until January 1, 2006.
Existing law requires the department to charge a fee to all payers
for any tests or activities performed pursuant to provisions
relating to genetic disorder prevention services, including the
Hereditary Disorders Act. Existing law requires that any fee charged
for screening and followup services provided to Medi-Cal eligible
persons, health care service plan enrollees, or persons covered by
disability insurance policies be paid directly to the Genetic Disease
Testing Fund, a continuously appropriated fund, to be used for
purposes of the Hereditary Disorders Act.
This bill, commencing July 1, 2002, would recast these provisions
to require, instead, the department to charge a fee to the hospital
of birth or to families of a newborn, for births not occurring in a
hospital, for newborn screening and followup services. The bill
would require that payments pursuant to this provision be made to the
Genetic Disease Testing Fund. The bill would prohibit the
department from charging or billing Medi-Cal beneficiaries for
services provided under these provisions relating to genetic disorder
prevention services.
Existing law requires the State Department of Health Services to
establish and administer a program for the medical care of persons
with genetically handicapping conditions.
This bill would provide that the department is considered to be
the purchaser, but not the dispenser or distributor, of blood factor
products, under the Genetically Handicapped Person's Program.
Existing law requires that all health facilities, except those
owned and operated by the state, be charged each year a designated
fee established, in accordance with certain requirements, by the
Office of Statewide Health Planning and Development to pay for
certain functions required to be performed by the office.
This bill would authorize the State Department of Health Services
to expend $200,000 of the fees collected pursuant to this provision
for use in the 2002-03 fiscal year for data collection on, analysis
of, and reporting on, maternal and perinatal outcomes, if funds are
appropriated in the Budget Act of 2002 for that purpose.
Existing law establishes the Healthy Families Program,
administered by the Managed Risk Medical Insurance Board, to arrange
for the provision of health services to eligible children, and
defines "family contribution sponsor" for purposes of these
provisions.
This bill would revise the definition of family contribution
sponsor.
Existing law provides for reimbursement to providers participating
in the Healthy Families Program for certain services provided up to
90 days prior to the effective date of coverage under the program.
This bill would repeal these reimbursement provisions and would
require instead, effective April 1, 2003, the board, in consultation
with the State Department of Health Services, to implement a
preenrollment program into the Healthy Families Program or the
Medi-Cal program. The bill would authorize the board to adopt
emergency regulations to implement this preenrollment program. The
bill would make various other changes in program requirements related
to family contributions, disenrollment, and eligibility to
participate in the program.
Existing law establishes the Healthy Families-to-Medi-Cal Bridge
Benefits Program to provide any person enrolled for coverage under
the Healthy Families Program who meets certain criteria with a two
calendar-month period of health care benefits in order to provide the
person with the opportunity to apply for Medi-Cal. Existing law
authorizes the implementation of this program only if a specified
State Children's Health Insurance Program waiver is approved, and at
the time the waiver is implemented.
This bill would delete this waiver restriction on implementation
of the Healthy Families-to-Medi-Cal Bridge Benefits Program.
Existing law requires the State Department of Social Services to
establish a foster care rate for each community treatment facility
program, and requires for the 2001-02 fiscal year that a community
treatment facility program be paid a community treatment facility
supplemental rate. Subject to the availability of funds, this
payment is required to be shared by the state and the counties.
This bill would extend to the 2002-03 fiscal year the requirement
that the supplemental rate be paid.
Existing law requires the Director of Mental Health to award
matching grants to local educational agencies to pay the state share
of the costs of providing programs that provide school-based early
mental health intervention and prevention services to eligible pupils
at schoolsites of eligible pupils, based on certain priorities and
specifications.
This bill would revise these priorities and specifications.
Existing law states the intent of the Legislature relating to the
transition process of persons with developmental disabilities from a
developmental center to a community living arrangement through the
development of an individual program plan process.
This bill would require the State Department of Developmental
Services to establish policies and procedures for the development by
regional centers of an annual community placement plan, would require
the department to review the plans, and would authorize the
department to make allocations to regional centers to develop the
plans. It would also require, until July 1, 2004, a regional center
to take specified actions upon the department's determination of the
amount of unallocated reduction in the regional center's purchase of
service budget.
The bill also would specify additional requirements for the State
Department of Developmental Services, developmental centers, and
regional resource development projects pertaining to the coordination
of efforts among those entities, the provision of services to
consumers, and the collection and availability of data.
Existing law provides for the provision of services to persons
with developmental disabilities by regional centers, pursuant to
contracts with the State Department of Developmental Services.
Existing law imposes various requirements on the department and the
regional centers with respect to these contracts.
The bill would provide that any contract between the department
and a regional center entered into on and after January 1, 2003,
shall require that all employment contracts entered into with
regional center staff or contractors be available to the public for
review, except with respect to the social security number of the
contracting party. It would also prohibit any employment contract,
or portion thereof, from being deemed confidential or unavailable for
public review.
Existing law requires that a regional center perform initial
intake, including deciding whether to provide assessment, within 15
days following a request for assistance. Existing law requires that
if assessment is needed, the assessment shall be performed within 60
days following the initial intake.
This bill, instead, would require, before July 1, 2003, that the
assessment be performed within 120 days following initial intake, and
on or after July 1, 2003, that the time limit for performing the
assessment be within 60 days following initial intake.
Existing law requires the development of an individual program
plan for an individual with developmental disabilities eligible for
regional center services. Existing law requires the State Department
of Developmental Services to annually review a random sample of
individual program plans at each regional center.
This bill, instead, would require a biennial review by the
department pursuant to this provision.
The bill, with certain exceptions, would prohibit, for the 2002-03
fiscal year only, a regional center from expending any purchase of
service funds for the startup of any new program unless certain
conditions exist.
Existing law requires the State Department of Developmental
Services to coordinate, or require each regional center to
coordinate, a meeting within each regional center catchment area
between the regional center, the local health facility providers, the
State Department of Health Services representatives from the local
district office, and the State Department of Developmental Services
center staff for purposes of better coordinating services and
supports provided to regional center consumers in licensed health
facilities.
This bill would repeal this requirement.
Existing law authorizes the State Department of Developmental
Services to allocate funds appropriated in a specified item of the
Budget Act of 2000 to county mental health programs that meet
programmatic goals and model adult system of care programs to the
satisfaction of the department or for Children's System of Care
programming.
This bill, instead, would authorize the department to allocate
funds appropriated in a specified item of the annual Budget Act for
these purposes.
Under the Children's Mental Health Services Act, the State
Department of Mental Health is authorized to enter into annual
performance contracts with participating counties, known as system of
care counties, for the delivery of mental health services to
seriously emotionally disturbed children. Existing law requires the
department to provide participating counties with a contract with an
independent evaluator to measure performance outcomes and provide
technical assistance to the state and counties and provide training,
consultation, and technical assistance for county applicants and
participants.
This bill would eliminate the requirement that the department
provide the above-described independent evaluator and the training,
consultation, and technical assistance, and would require instead
that the department provide technical assistance related to system
evaluation. The bill would make related changes.
Existing federal law requires that California's state plan for
medical assistance under the medicaid program, known as the Medi-Cal
program, provide for entering into cooperative arrangements with the
state agencies responsible for the administration of health services
and vocational rehabilitation services in the state looking toward
maximum utilization of these services in the provision of medical
assistance under the plan.
This bill would provide, notwithstanding any other provision of
law, upon additional funds being appropriated and budgeted for the
support of the services identified within the scope of work of an
agreement of the type specified under federal law and previously
entered into by the State Department of Health Services, the amount
of the encumbrance in such an agreement shall be amended, by
operation of law, to reflect the newly appropriated and budgeted
funds. It would also provide that once an agreement is entered into
by the department, the agreement shall continue in effect
indefinitely and need not be amended unless the department changes
the scope of work to be provided under the agreement.
Under existing law, the Medi-Cal program is administered by the
State Department of Health Services.
This bill would authorize the Director of Health Services, on a
regional pilot project basis, to enter into contracts with one or
more nonprofit organizations to perform the functions of the
department's Office of the Ombudsman, with services provided by the
ombudsman to be made available to any person who may be eligible for,
or who is receiving, benefits under the Medi-Cal program.
Existing law provides that any child who is less than 6 years of
age and who has been determined to be eligible for free meals under
the National School Lunch Program has met the income eligibility
requirements for participation in the Medi-Cal program, without a
share of cost.
This bill would revise this provision to replace the reference to
income eligibility requirements with income documentation
requirements and would make conforming changes.
Existing law, effective July 1, 2002, requires each county to
participate in a statewide pilot project to grant Medi-Cal program
eligibility to, and enroll in the Medi-Cal program, any child under 6
years of age enrolled in school and eligible for free meals under
the National School Lunch Program.
This bill would change the effective date of this and related
provisions from July 1, 2002, to July 1, 2003. It would also revise
this provision to require each county, instead, to determine Medi-Cal
program eligibility for any child described above, and would
authorize the department to exercise a specified federal option for
eligibility determinations.
Existing law requires the State Department of Health Services to
exercise certain options provided under federal law to implement a
program for accelerated enrollment of children in the Medi-Cal
program.
This bill would require a county, upon receipt of an application
for a child who has accelerated enrollment coverage under this
program, to determine whether the child is eligible for Medi-Cal
benefits and to report this finding to the medical eligibility data
system. The bill would provide that this provision shall become
operative on July 1, 2002, or the date that the program of
accelerated enrollment coverage for children takes effect, whichever
is later.
This bill would require the State Department of Health Services
and the Managed Risk Medical Insurance Board to exercise certain
options provided under federal law to implement a program for
preenrollment of children into the Medi-Cal program and the Healthy
Families Program. The bill would require the department to develop
an electronic application before July 1, 2003, to serve as the
application for preenrollment into the Medi-Cal program or the
Healthy Families Program and to also serve as an application for the
Child Health and Disability Prevention program. The bill would
specify requirements for the processing of the electronic
application.
The bill would provide for the termination within a designated
time of benefits provided to an individual pursuant to a preliminary
determination under Medi-Cal as described under federal law, unless
an application for medical assistance under the state plan is filed.
The bill would require the State Department of Health Services, on
or before October 1, 2002, to issue instructions to all counties to
establish an automated system for tracking the status of applications
received by county welfare departments from the centralized
processing entity, which screens applications for eligibility
benefits under the Medi-Cal program and forwards the applications to
the appropriate county.
Existing law provides that a beneficiary or any person on behalf
of the beneficiary who has paid for health care services otherwise
covered by the Medi-Cal program received by the beneficiary shall be
entitled to a return from the provider of any part of the payment
that meets specified requirements. Existing law also provides for
the Medi-Cal reimbursement of a provider upon submission of proof of
eligibility.
This bill would require the State Department of Health Services,
to the extent permitted by federal law, to waive overpayments made to
a pharmacy provider that would otherwise be reimbursable to the
department for prescription drugs returned to the pharmacy provider
from a nursing facility upon discontinuation of the drug therapy or
death of the beneficiary.
Under existing law, for purposes of the Medi-Cal program,
"medically needy person" is defined to include, among other described
persons, until October 1, 2002, a child who is eligible to receive
Medi-Cal benefits under an interstate agreement for adoption
assistance and related services and benefits to the extent federal
financial participation is available.
This bill would delete reference to October 1, 2002, and thereby
include the above-described child within the definition of a
medically needy person indefinitely.
Existing law requires the county in which a person resides to
determine a person's eligibility for Medi-Cal benefits and continued
eligibility.
To the extent this bill would increase the counties'
responsibilities for eligibility determination, it would impose a
state-mandated local program.
Existing law creates the Medi-Cal Medical Education Supplemental
Payment Fund, and the Large Teaching Emphasis Hospital and Children's
Hospital Medi-Cal Medical Education Supplemental Payment Fund, in
the State Treasury as continuously appropriated funds, which consist
of various moneys for use by public agencies for health care programs
or purposes. Under existing law, these provisions become
inoperative on July 1, 2002, and as of January 1, 2003, are repealed.
This bill would extend the inoperative dates to July 1, 2004, and
the repeal dates to January 1, 2005. By extending the operation of
continuously appropriated funds, this bill would result in an
appropriation.
Existing law authorizes the State Department of Health Services to
require that a provider receive prior authorization before providing
Medi-Cal services when it is determined that the provider has been
rendering unnecessary services.
This bill would authorize the department to contract for staff to
accomplish treatment authorization request reviews and to carry out
contracting activity with manufacturers of single-source drugs.
Existing law requires the State Department of Health Services to
administer various health programs, including the California Children'
s Services Program, Genetically Handicapped Person's Program, Breast
and Cervical Cancer Early Detection Program, State-Only Family
Planning Program, and Family Planning, Access, Care, and Treatment
(Family PACT) Waiver
Program.
This bill would require that provider rates of payment for
services rendered in all of these programs be identical to the rates
of payment for the same service performed by the same provider type
pursuant to the Medi-Cal program, would authorize the director to
identify, by regulation, other programs that would be subject to this
requirement, and would authorize reimbursement at rates greater than
the Medi-Cal rate if provided by regulation of the director.
Existing law under the Medi-Cal program prohibits the allowable
markup payable for the dispensing of medical supplies by assistive
device and sickroom supply dealers and pharmacies from exceeding 25%
of the cost of the item dispensed, as defined by the department.
This bill would prohibit the allowable markup payable for these
supplies from exceeding 23% of the cost of the item dispensed. It
would also prohibit payment for diabetic testing supplies from
exceeding the cost of the item dispensed, as defined by the
department, plus a fee equal to the maximum professional fee
component used in the payment for legend generic drug types.
Existing law provides that certain contracts entered into by the
department on a bid or negotiated basis for drugs, product-type
health services, and clinical laboratory services under the Medi-Cal
program have no force and effect unless approved by the Department of
Finance. Existing law exempts these contracts from certain
requirements under the Public Contract Code, including a requirement
of approval by the Department of General Services.
This bill would delete the requirement that these contracts be
approved by the Department of Finance, would provide for additional
exemptions from various requirements under the Public Contract Code
and the Government Code, and would make related changes.
Existing law authorizes the State Department of Health Services to
contract with less than all manufacturers or clinical laboratories
including only one manufacturer or clinical laboratory, on a bid or
nonbid basis.
This bill would delete this authorization and would require the
department to take specified actions for purposes of implementing
certain contracting provisions.
Existing law authorizes the State Department of Health Services to
enter into contracts with manufacturers of single-source and
multiple-source drugs on a bid or nonbid basis pursuant to specified
procedures and to maintain a list of contract drugs. Under existing
law, these provisions are repealed as of January 1, 2003, and
replaced with alternative provisions implementing the Medi-Cal drug
formulary program.
This bill would delete the repeal of these provisions, thereby
extending the authority of the department to enter into the
above-described contracts indefinitely. The bill would repeal the
alternative provisions related to the implementation of the Medi-Cal
drug formulary program.
Existing law provides for various increases to the reimbursement
to pharmacists for all drug prescription claims reimbursed through
the Medi-Cal program.
This bill, until July 1, 2004, would require the department to
reduce reimbursement to pharmacists in the amount reimbursement was
increased pursuant to these provisions with respect to pharmacy
services rendered on and after the date that this bill is enacted,
and would exempt claims submitted by pharmacists for beneficiaries in
a nursing facility.
Existing law provides that if certain conditions are met, a new
drug designated as having an important therapeutic gain and approved
for marketing by the federal Food and Drug Administration shall be
immediately included on the list of contract drugs for 3 years.
This bill would delete this provision.
Existing law permits any drug suspended from the list of contract
drugs for at least 12 months to be deleted from the list of contract
drugs.
This bill would remove the 12-month time period as a condition
prior to deletion of a drug from the list of contract drugs. It
would also establish a list of preferred prior authorization drugs as
a subset of the list of contract drugs and would permit a
manufacturer of a drug deleted from, or not added to, the list of
contract drugs to request inclusion on that list.
Existing law specifies conditions under which certain drugs for
use in the treatment of acquired immune deficiency syndrome (AIDS) or
an AIDS-related condition or cancer are deemed approved for addition
to the Medi-Cal list of contract drugs or considered a Medi-Cal
benefit.
This bill would require, commencing July 1, 2002, all
pharmaceutical manufacturers to provide to the State Department of
Health Services a state rebate in addition to rebates pursuant to
other provisions of state or federal laws for any drug products that
have been added to the Medi-Cal list of contract drugs pursuant to
the above described provisions related to drugs used to treat AIDS
and cancer. This provision would become inoperative on July 1, 2005,
and would be repealed on January 1, 2006.
Existing law requires the State Department of Health Services to
establish a list of Maximum Allowable Ingredient Costs (MAIC) for
drugs based on reference to certain drug brands.
This bill would revise the basis for establishing the list of MAIC
for drugs. The bill would require the department to update MAICs at
least every 2 months and to establish the estimated acquisition
cost, as defined, of legend and nonlegend drugs, as defined. The
bill would also require the department to establish a list of medical
supplies, including utilization controls applied to each medical
supply product, and a list of Maximum Allowable Product Costs (MAPC)
for medical supplies. The bill would require the department to
repeal certain regulations related to medical supplies.
This bill would authorize the State Department of Health Services
to enter into contracts with manufacturers of enteral formulae that
can be used as a therapeutic regimen to prevent serious disability or
death in patients with medically diagnosed conditions that preclude
the full use of regular food. The bill would require the department
to maintain a list of those products for which contracts have been
executed.
Existing law provides for the establishment of provider
reimbursement rates for incontinence medical supplies covered by the
Medi-Cal program.
This bill would revise the method for determining the
reimbursement rate.
Under the Medi-Cal program, specified medical benefits are
provided to public assistance recipients and certain other low-income
persons.
This bill would include the purchase of prescribed enteral
formulae and diabetic testing supplies as a covered benefit subject
to utilization controls. It would also revise the covered benefits
related to dental care.
Existing law requires the State Department of Health Services to
develop a federal waiver program to test the efficacy of providing an
assisted living benefit to beneficiaries under the Medi-Cal program.
Existing law prohibits the department from implementing the waiver
program developed under this provision if the program will result in
additional costs to the state.
This bill, instead, would prohibit the department from
implementing the waiver program if the benefits provided pursuant to
the program will result in additional costs to the Medi-Cal program.
Under existing law, certain telemedicine services are reimbursable
under the Medi-Cal program.
This bill would require the State Department of Health Services to
allow psychiatrists to receive fee-for-service Medi-Cal
reimbursement for services provided through telemedicine until June
30, 2004, or until a method for reimbursement is developed, as
provided.
Existing law specifies procedures under which personal care
services meeting certain conditions, when provided to a categorically
needy person, as defined, are a covered Medi-Cal benefit to the
extent federal financial participation is available. Under existing
law, these provisions become inoperative on July 1, 2002, and as of
January 1, 2003, are repealed.
This bill would delete the inoperative and repeal dates, thereby
extending these Medi-Cal benefit coverage provisions indefinitely.
Existing law specifies procedures for the monthly advancement of
state funds to counties for costs of administration of the Medi-Cal
program.
This bill would require, within 60 calendar days of the date that
the annual Budget Act is chaptered, the State Department of Health
Services to notify the chairpersons of the fiscal committees of each
house of the Legislature, the Chairperson and the Vice Chairperson of
the Joint Legislative Budget Committee, and appropriate county
representatives if the department plans to withhold and not allocate
any of the baseline allocation for county Medi-Cal eligibility
activities that are appropriated for Medi-Cal administration.
Under existing law, the Medi-Cal program provides for a special
methodology of reimbursement of disproportionate share hospitals for
the provision of inpatient hospital services. Existing law
establishes the Medi-Cal Inpatient Payment Adjustment Fund in the
State Treasury, as a continuously appropriated fund, to be used as
the source for the nonfederal share of payments to disproportionate
share hospitals. Existing law transfers $29,757,690 from the fund to
the Health Care Deposit Fund for the 2000-01 fiscal year and each
fiscal year thereafter.
This bill would transfer $85,000,000 to the Health Care Deposit
Fund for the 2002-03 fiscal year and each fiscal year thereafter.
Because the Health Care Deposit Fund is continuously appropriated,
this bill would make an appropriation.
Existing law requires the State Department of Health Services to
establish a pilot program to provide continuous skilled nursing care
as a benefit of the Medi-Cal program when those services are provided
in accordance with an approved federal waiver meeting certain
requirements. Existing law repeals this provision as of January 1,
2003.
This bill would extend the repeal date of the provision from
January 1, 2003, to January 1, 2006.
Existing law authorizes the board of supervisors of a county that
contracted with the State Department of Health Services pursuant to a
specified provision of law during the 1990-91 fiscal year and any
county with a population under 300,000, as determined in accordance
with the 1990 decennial census, to elect to participate in the County
Medical Services Program (CMSP) for the state administration of
health care services to eligible persons in the county. Existing law
specifies a formula under which counties and the state share the
risk for cost increases of the CMSP not funded through other sources.
This bill would revise this formula.
Existing law authorizes, until January 1, 2003, a county to
establish a County Medical Services Program Governing Board, with a
specified membership, to administer the CMSP.
This bill would extend the operation of these provisions until
January 1, 2008.
Existing law requires that the contract between the State
Department of Health Services and the County Medical Services Program
Governing Board require that the state provide a designated minimum
level of administrative support to the CMSP.
This bill would require, instead, that the County Medical Services
Program Governing Board reimburse up to $3,500,000 for the state
costs of providing administrative support to the CMSP.
Existing law establishes the County Medical Services Program
Account in the County Health Services Fund, which is continuously
appropriated, and specifies the purposes for which moneys in the
account may be used.
This bill would provide that moneys in the account also may be
used to reimburse the State Department of Health Services for state
costs of providing administrative support to the CMSP, thereby making
an appropriation.
Existing law requires the State Department of Health Services, in
conjunction with the State Department of Social Services, to
implement a simplified eligibility process as part of the Food Stamp
program to expedite Medi-Cal program and Healthy Families Program
enrollment.
This bill, instead, would provide that these provisions shall be
implemented on and after July 1, 2003, but only if and to the extent
that federal financial participation is available.
This bill would authorize the State Department of Health Services
to adopt emergency regulations to implement the applicable provisions
of this bill in accordance with the rulemaking provisions of the
Administrative Procedure Act.
The bill would prohibit the State Department of Health Services
from recouping any overpayment made to a provider before October 1,
2002, under a specified provision of the Medi-Cal Act for ambulance
transport services, if the overpayment is not due to the fault of the
provider. It would also add to the requirements of the State
Department of Health Services with regard to completing the design
and implementation of the Children's Medical Services Network (CMS
Net).
The bill would require the California Health and Human Services
Agency to develop a comprehensive plan that responds to the decision
of the United States Supreme Court in Olmstead v. L.C. and that
describes the actions that California may take to improve its
long-term care system so that its residents have available an array
of community care options that allow them to avoid unnecessary
institutionalization.
This bill would specify requirements of the State Department of
Developmental Services related to the use of funds appropriated in
Item 4300-101-0001 of the Budget Act of 2002 pertaining to regional
centers.
The bill would provide that of the amounts appropriated in Item
4260-111-0001 of the Budget Act of 2002 from the Hospital Services
Account, the Physician Services Account, and the Unallocated Account
in the Cigarette and Tobacco Products Surtax Fund, $24,803,000 shall
be administered and allocated for the 2002-03 fiscal year, as
provided in the bill, for distribution through the California
Healthcare for Indigents Program and the rural health services
program.
The bill would provide that the unencumbered balances of the
amounts appropriated in Item 4260-001-0589 of Chapter 50 of the
Statutes of 1999, Item 4260-001-0589 of Chapter 52 of the Statutes of
2000, and Item 4260-001-0589 of Chapter 106 of the Statutes of 2001
are reappropriated and shall be available for encumbrance and
expenditure until July 30, 2005, thereby making an appropriation.
This bill, in order to implement changes in the level of funding
for Medi-Cal services in the Budget Act of 2002, would require the
Director of Health Services to eliminate, with specified exceptions,
all provider rate increases that were provided, effective August 1,
2000, for services rendered in the Medi-Cal program. The bill would
define "provider" for purposes of this requirement.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement, including the creation of a State Mandates Claims Fund
to pay the costs of mandates that do not exceed $1,000,000 statewide
and other procedures for claims whose statewide costs exceed
$1,000,000.
This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
This bill would declare that it is to take effect immediately as an
urgency statute.
Appropriation: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 4426 of the Business and Professions Code is
amended to read:
4426. The State Department of Health Services shall conduct a
study of the adequacy of Medi-Cal pharmacy reimbursement rates
including the cost of providing prescription drugs and services.
SEC. 2. Section 4427 of the Business and Professions Code is
repealed.
SEC. 3. Section 49557.2 of the Education Code is amended to read:
49557.2. (a) (1) Effective July 1, 2003, at the option of the
school district or county superintendent, and to the extent necessary
to implement Section 14005.41 of the Welfare and Institutions Code,
the following information may be incorporated into the School Lunch
Program application packet or notification of eligibility for the
School Lunch Program using simple and culturally appropriate
language:
(A) A notification that if a child qualifies for free school
lunches, then the child may qualify for free or reduced-cost health
coverage.
(B) A request for the applicant's consent for the child to
participate in the Medi-Cal program, if eligible for free school
lunches, and to have the information on the school lunch application
shared with the entity designated by the State Department of Health
Services to make an accelerated determination and the local agency
that determines eligibility under the Medi-Cal program.
(C) A notification that the school district will not forward the
school lunch application to the entity designated by the State
Department of Health Services to make an accelerated determination
and the local agency that determines eligibility under the Medi-Cal
program, without the consent of the child's parent or guardian.
(D) A notification that the school lunch application is
confidential and, with the exception of forwarding the information
for use in health program enrollment upon the consent of the child's
parent or guardian, the school district will not share the
information with any other governmental agency, including the federal
Immigration and Naturalization Service and the Social Security
Administration.
(E) A notification that the school lunch application information
will only be used by the entity designated by the State Department of
Health Services to make an accelerated determination and the state
and local agencies that administer the Medi-Cal program for purposes
directly related to the administration of the program and will not be
shared with other government agencies, including the Immigration and
Naturalization Service and the Social Security Administration for
any purpose other than the administration of the Medi-Cal program.
(F) Information regarding the Medi-Cal program, including
available services, program requirements, rights and
responsibilities, and privacy and confidentiality requirements.
(2) The State Department of Education, in consultation with school
districts, county superintendents of schools, consumer advocates,
counties, the State Department of Health Services, and other
stakeholders, shall make recommendations regarding the School Lunch
Program application, on or before February 1, 2003. The
recommendations shall include specific changes to the School Lunch
Program application materials as necessary to implement Section
14005.41 of the Welfare and Institutions Code, information for staff
as to how to implement the changes, and a description of the process
by which information on the School Lunch Program application will be
shared with the county, as the local agency that determines
eligibility under the Medi-Cal program.
(b) (1) Effective July 1, 2003, school districts and county
superintendents of schools may implement a process to share
information provided on the entity designated by the State Department
of Health Services to make an accelerated determination and the
School Lunch Program application with the entity designated by the
State Department of Health Services to make an accelerated
determination and the local agency that determines eligibility under
the Medi-Cal program, and shall share this information with those
entities, if the applicant consents to that sharing of information.
This information may be shared electronically, physically, or through
whatever method is determined appropriate.
(2) Each school district or county superintendent that chooses to
share information pursuant to this subdivision shall enter into a
memorandum of understanding with the local agency that determines
eligibility under the Medi-Cal program, that sets forth the roles and
responsibilities of each agency and the process to be used in
sharing the information.
(3) The local agency that determines eligibility under the
Medi-Cal program shall only use information provided by applicants on
the school lunch application for purposes directly related to the
administration of the Medi-Cal program.
(4) After school districts share information regarding the school
lunch application with the entity designated by the State Department
of Health Services to make an accelerated determination and the local
agency that determines eligibility under the Medi-Cal program, for
the purpose of determining Medi-Cal program eligibility, the local
agency and the school district shall not share information about
school lunch participation or the Medi-Cal program eligibility
information with each other unless specifically authorized under
other provisions of law.
SEC. 4. Section 1356 of the Health and Safety Code is amended to
read:
1356. (a) Each plan applying for licensure under this chapter
shall reimburse the director for the actual cost of processing the
application, including overhead, up to an amount not to exceed
twenty-five thousand dollars ($25,000). The cost shall be billed not
more frequently than monthly and shall be remitted by the applicant
to the director within 30 days of the date of billing. The director
shall not issue a license to any applicant prior to receiving payment
in full for all amounts charged pursuant to this subdivision.
(b) In addition to other fees and reimbursements required to be
paid under this chapter, each licensed plan shall pay to the director
an amount as estimated by the director for the ensuing fiscal year,
as a reimbursement of its share of all costs and expenses, including,
but not limited to, costs and expenses associated with routine
financial examinations, grievances and complaints including
maintaining a toll-free number for consumer grievances and
complaints, investigation and enforcement, medical surveys and
reports, and overhead, reasonably incurred in the administration of
this chapter and not otherwise recovered by the director under this
chapter or from the Managed Care Fund. The amount may be paid in two
equal installments. The first installment shall be paid on or
before August 1 of each year, and the second installment shall be
paid on or before December 15 of each year. The amount paid by each
plan, except a plan offering only specialized health care service
plan contracts, shall be twelve thousand five hundred dollars
($12,500), plus an amount up to, but not exceeding, an amount
computed in accordance with the following schedule:
Plan Enrollment Amount of Assessment
0 to 25,000 $0 + 65 cents for each enrollee
25,001 to 75,000 $16,250 + 53 cents for each
enrollee in excess of 25,000
75,001 to 150,000 $42,750 + 50 cents for each
enrollee in excess of 75,000
150,001 to 300,000 $80,250 + 47 cents for each
enrollee in excess of 150,000
over 300,000 $150,750 + 45 cents for each
enrollee in excess of 300,000
Plans offering only specialized health care service plan contracts
shall pay seven thousand five hundred dollars ($7,500), plus an
amount up to, but not exceeding, an amount computed in accordance
with the following schedule:
Plan Enrollment Amount of Assessment
0 to 25,000 $0 + 48 cents for each enrollee
25,001 to 75,000 $12,000 + 36 cents for each
enrollee in excess of 25,000
75,001 to 150,000 $30,000 + 30 cents for each
enrollee in excess of 75,000
150,001 to 300,000 $52,500 + 26 cents for each
enrollee in excess of 150,000
over 300,000 $91,500 + 24 cents for each
enrollee in excess of 300,000
The amount paid by each plan shall be for each enrollee enrolled
in its plan in this state as of the preceding March 31, and shall be
fixed by the director by notice to all licensed plans on or before
June 15 of each year. A plan that is unable to report the number of
enrollees enrolled in the plan because it does not collect that data,
shall provide the director with an estimate of the number of
enrollees enrolled in the plan and the method used for determining
the estimate. The director may, upon giving written notice to the
plan, revise the estimate if the commissioner determines that the
method used for determining the estimate was not reasonable.
In determining the amount assessed, the director shall consider
all appropriations from the Managed Care Fund for the support of this
chapter and all reimbursements provided for in this chapter.
(c) Each licensed plan shall also pay two thousand dollars
($2,000), plus an amount up to, but not exceeding, forty-eight
hundredths of one cent ($0.0048) for each enrollee for the purpose of
reimbursing its share of all costs and expenses, including overhead,
reasonably anticipated to be incurred by the department in
administering Sections 1394.7 and 1394.8 during the current fiscal
year. The amount charged shall be remitted within 30 days of the
date of billing.
(d) In no case shall the reimbursement, payment, or other fee
authorized by this section exceed the cost, including overhead,
reasonably incurred in the administration of this chapter.
(e) The director by notice to all licensed plans on or before
September 15 of each year, may require health care service plans to
pay an additional assessment to provide the department with
sufficient revenues to support costs and expenses as set forth in
this section and subdivision (b) of Section 1341.4 for the 2000-01,
2001-02, and 2002-03 fiscal years. Any plan that did not pay its
assessment as required under this subdivision for the 2001-02 fiscal
year shall be assessed the amount due for the 2001-02 fiscal year in
the 2002-03 fiscal year, in addition to the amount due in the 2002-03
fiscal year. The assessment pursuant to this subdivision is
separate and independent of the assessment in subdivision (b), and
may not be aggregated for the purposes of limitation or otherwise
with the assessment in subdivision (b). The assessment pursuant to
this subdivision is not subject to the limitations imposed on
assessments pursuant to Section 1356.1. In imposing an assessment
pursuant to this subdivision the director shall levy on each plan an
amount determined by the director using the categories of plans in
the schedules set forth in subdivision (b). The assessment shall be
paid in full or in two equal installments, as determined by the
department. On July 1, 2003, and thereafter, the director may raise
the assessment limit pursuant to subdivision (b) to incorporate
annual expenditure levels set forth in this subdivision.
(f) For the purpose of calculating the assessment under this
section, an enrollee who is enrolled in one plan and who receives
health care services under arrangements made by another plan or
plans, whether pursuant to a contract, agreement, or otherwise, shall
be considered to be enrolled in each of the plans.
SEC. 5. Section 1797.199 of the Health and Safety Code is amended
to read:
1797.199. (a) There is hereby created in the State Treasury, the
Trauma Care Fund, which, notwithstanding Section 13340 of the
Government Code, is hereby continuously appropriated without regard
to fiscal years to the authority for the purposes specified in
subdivision (c).
(b) The fund shall contain any moneys deposited in the fund
pursuant to appropriation by the Legislature or from any other
source, as well as, notwithstanding Section 16305.7 of the Government
Code, any interest and dividends earned on moneys in the fund.
(c) Moneys in the fund shall be expended by the authority to
provide for allocations to local EMS agencies, for distribution to
local EMS agency-designated trauma centers provided for by this
chapter.
(d) Within 30 days of the effective date of the enactment of an
appropriation for purposes of implementing this chapter, the
authority shall request all local EMS agencies with an approved
trauma plan, that includes at least one designated trauma center, to
submit within 45 days of the request the total number of trauma
patients and the number of trauma patients at each facility that were
reported to the local trauma registry for the most recent fiscal
year for which data are available, pursuant to Section 100257 of
Title 22 of the California Code of Regulations. However, the local
EMS agency's report shall not include any registry entry that is in
reference to a patient who is discharged from the trauma center's
emergency department without being admitted to the hospital unless
the nonadmission is due to the patient's death or transfer to another
facility. Any local EMS agency that fails to provide these data
shall not receive funding pursuant to this section.
(e) Except as provided in subdivisions (j) and (o), the authority
shall distribute all funds to local EMS agencies with an approved
trauma plan that includes at least one designated trauma center in
the local EMS agency's jurisdiction as of July 1 of the fiscal year
in which funds are to be distributed.
(1) The amount provided to each local EMS agency shall be in the
same proportion as the total number of trauma patients reported to
the local trauma registry for each local EMS agency's area of
jurisdiction compared to the total number of all trauma patients
statewide as reported under subdivision (d).
(2) The authority shall send a contract to each local EMS agency
that is to receive funds within 30 days of receiving the required
data and shall distribute the funds to a local EMS agency within 30
days of receiving a signed contract and invoice from the agency.
(f) Local EMS agencies that receive funding under this chapter
shall distribute all those funds to eligible trauma centers, except
that an agency may expend 1 percent for administration. It is the
intent of the Legislature that the funds distributed to eligible
trauma centers be spent on trauma services. The local EMS agency may
utilize a grant-based system, a reimbursement-based system, or other
appropriate methodology to comply with this section. Local EMS
agencies shall take the following factors into consideration when
determining the distribution amounts for each trauma center:
(1) The volume of uninsured trauma patients treated at the trauma
center.
(2) The existence of a high percentage of uninsured trauma
patients relative to the total number of trauma patients treated at
the trauma center.
(3) The acuity mix of uninsured trauma patients treated at the
trauma center.
(g) A trauma center shall be eligible for funding under this
section if it is designated as a trauma center by a local EMS agency
pursuant to Section 1798.165 and complies with the requirements of
this section. Both public and private hospitals designated as trauma
centers shall be eligible for funding.
(h) A trauma center that receives funding under this section shall
agree to remain a trauma center through June 30 of the fiscal year
in which it receives funding. If the trauma center ceases
functioning as a trauma center, it shall pay back to the local EMS
agency a pro rata portion of the funding that has been received. If
there are one or more trauma centers remaining in the local EMS
agency's service area, the local EMS agency shall distribute the
funds among the other trauma centers. If there is no other trauma
center within the local EMS agency's service area, the local EMS
agency shall return the moneys to the authority. The authority shall
deposit any such funds into the reserve described in subdivision
(j). In the case of a local EMS agency that distributes funds using
a reimbursement or fee-for-service system, a trauma center that
ceases functioning as a trauma center shall only be required to pay
back a pro rata portion of the minimum distributed as described in
subdivision (i).
(i) Notwithstanding subdivision (f), the local EMS agency shall
provide from the funds that the local EMS agency receives from the
authority a minimum amount of one hundred fifty thousand dollars
($150,000) to each Level I or Level II trauma center to assist those
centers in ensuring trauma center viability. The local EMS agency
shall provide a Level III trauma center a minimum amount of fifty
thousand dollars ($50,000) for this purpose. If a local EMS agency's
distribution pursuant to subdivision (e) is less than the amount
necessary for each trauma center within the local EMS agency's
jurisdiction to receive the minimum amount provided by this
subdivision, the authority shall include in its distribution to the
agency an additional amount of funds necessary to make up the minimum
amount pursuant to paragraph (1) of subdivision (j) plus 1 percent
of the added amount for local EMS agency administrative costs. Based
upon qualifying patient volume figures and the distribution factors
established in subdivision (f), a trauma center designated as a Level
IV may receive funding as determined appropriate by the local EMS
agency.
(j) Notwithstanding subdivision (e), the authority shall reserve 6
percent of any funds appropriated to the Trauma Care Fund for
distribution during the same fiscal year. The authority may spend
these funds for the purposes specified in paragraphs (1) to (3),
inclusive.
(1) To provide to a local EMS agency, the amount that the agency
needs to make up the full minimum amount specified in subdivision
(i).
(2) To provide a minimum amount to a trauma center that was not
designated on July 1 of the fiscal year as specified in subdivision
(e) but which becomes designated by January 1 of any fiscal year in
which funds are being distributed pursuant to this section. In the
case of such a newly designated center, the minimum distribution
shall equal one-half of the minimum distribution described in
subdivision (i), provided the local EMS agency makes an application
to the authority for this purpose by February 1 of the same fiscal
year.
(3) To the extent that there are funds in the reserve after the
distributions provided by paragraphs (1) and (2) of this subdivision,
to provide additional amounts to a local EMS agency where the
distribution under subdivision (f) does not provide an accurate
reflection of its total trauma volume. Any local EMS agency that
believes the distribution under subdivision (f) does not provide an
accurate accounting of its total trauma patient volume may make
application to the authority for an adjustment.
(A) The application shall state the reason for the request and
shall include supporting data.
(B) The authority shall consider all applications submitted
pursuant to this paragraph and received by February 1 of the fiscal
year.
(C) Based on the application and its supporting information, the
authority shall determine the amount, if any, that the local agency
should receive in addition to the amounts specified in subdivision
(e) and shall allocate an appropriate amount of the reserve in
accordance with its determination.
(k) In order to receive funds pursuant to this section, an
eligible trauma center shall submit, pursuant to a contract between
the trauma center and the local EMS agency, relevant and pertinent
data requested by the local EMS agency. A trauma center shall
demonstrate that it is appropriately submitting data to the local EMS
agency's trauma registry and a local EMS agency shall audit the data
annually within two years of a distribution from the local EMS
agency to a trauma center. Any trauma center receiving funding
pursuant to this section shall report to the local EMS agency how the
funds were used to support trauma services.
(l) It is the intent of the Legislature that all moneys
appropriated to the fund be distributed to local EMS agencies during
the same year the moneys are appropriated. To the extent that any
moneys are not distributed by the authority during the fiscal year in
which the moneys are appropriated, the moneys shall remain in the
fund and be eligible for distribution pursuant to this section during
subsequent fiscal years, except that the minimum distribution
specified in subdivision (i) shall be provided to the extent that
moneys are available in the fund.
(m) By October 31, 2002, the authority shall develop criteria for
the standardized reporting of trauma patients to local trauma
registries. The authority shall seek input from local EMS agencies
to develop the criteria. All local EMS agencies shall utilize the
trauma patient criteria for reporting trauma patients to local trauma
registries by July 1, 2003.
(n) By December 31 of the fiscal year following any fiscal year in
which funds are distributed pursuant to this section, a local EMS
agency that has received funds from the authority pursuant to this
chapter shall provide a report to the authority that details the
amount of funds distributed to each trauma center, the amount of any
balance remaining, and the amount of any claims pending, if any, and
describes how the respective centers used the funds to support trauma
services. The report shall also describe the local EMS agency's
mechanism for distributing the funds to trauma centers, a description
of their audit process and criteria, and a summary of the most
recent audit results.
(o) The authority may retain from any appropriation to the fund an
amount sufficient to implement this section, up to two hundred
eighty thousand dollars ($280,000). This amount may be adjusted to
reflect any increases provided for wages or operating expenses as
part of the authority's budget process.
SEC. 5.5. Section 26157 is added to the Health and Safety Code, to
read:
26157. (a) The department may receive voluntary contributions to
support the department's activities in providing guidance, developing
standards and guidelines and permissible exposure limits, and
adopting regulations relating to indoor mold hazards, including, but
not limited to, duties included under this chapter.
(b) The contributions shall be deposited in the Public Health
Protection from Indoor Mold Hazards Fund, which is hereby created in
the State Treasury. Notwithstanding Section 13340 of the Government
Code, moneys in the fund shall be continuously appropriated to the
department without regard to fiscal years and shall be used to
support the department's activities in providing guidance, developing
standards and guidelines and permissible exposure limits, and
adopting regulations relating to indoor mold hazards, including, but
not limited to, duties included under this chapter to the extent that
funding is available.
SEC. 6. Section 53300 of the Health and Safety Code is amended to
read:
53300. (a) No more than 10 percent of the amount appropriated in
a fiscal year for the purposes of this chapter may be used for state
administration of this chapter, including evaluation and technical
assistance. Technical assistance shall include, but is not limited
to, assisting with collaborations, providing information, and
convening training workshops. The Legislature shall be notified of
the administrative costs of this program pursuant to Section 28 of
the Budget Act.
(b) Notwithstanding the allocation of funds in the Budget Act of
2000 for the supportive housing initiative to the local assistance
Item 4440-101-0001, up to 10 percent of the funds may be spent for
administrative costs, as defined in subdivision (a).
(c) Notwithstanding any other provision of law, the lead agency
shall make all grant awards from funds allocated in the Budget Act of
2001 for the supportive housing initiative no later than June 30,
2002, and shall expend the funds allocated for those grants no later
than June 30, 2005, except for grants awarded for housing costs, as
specified in paragraph (1) of subdivision (b) of Section 53275.
SEC. 7. Section 100171 of the Health and Safety Code is amended to
read:
100171. Notwithstanding any other provision of law, whenever the
department is authorized or required by statute, regulation, due
process (14th amendment, United States Constitution; subdivision (a)
of Section 7 of Article I, California Constitution), or a contract,
to conduct an adjudicative hearing leading to a final decision of the
director or the department, the following shall apply:
(a) The proceeding shall be conducted pursuant to the
administrative adjudication provisions of Chapter 4.5 (commencing
with Section 11400) and Chapter 5 (commencing with Section 11500) of
Part 1 of Division 3 of Title 2 of the Government Code, except as
specified in this section.
(b) Notwithstanding Section 11502 of the Government Code, whenever
the department conducts a hearing under Chapter 4.5 (commencing with
Section 11400) or Chapter 5 (commencing with Section 11500) of Part
1 of Division 3 of Title 2 of the Government Code, the hearing shall
be conducted before an administrative law judge selected by the
department and assigned to a hearing office that complies with the
procedural requirements of Chapter 4.5 (commencing with Section
11400) of Part 1 of Division 3 of Title 2 of the Government Code.
(c) (1) Notwithstanding Section 11508 of the Government Code,
whenever the department conducts a hearing under Chapter 4.5
(commencing with Section 11400) or Chapter 5 (commencing with Section
11500) of Part 1 of Division 3 of Title 2 of the Government Code,
the time and place of the hearing shall be determined by the staff
assigned to the hearing office of the department, except as provided
in paragraph (2) or unless the department by regulation specifies
otherwise.
(2) Formal hearings requested by institutional Medi-Cal providers
and health facilities shall be held in Sacramento.
(d) (1) Unless otherwise specified in this section, the following
sections of the Government Code shall apply to any adjudicative
hearing conducted by the
department only if the department has not, by regulation, specified
an alternative procedure for the particular type of hearing at issue:
Section 11503 (relating to accusations), Section 11504 (relating to
statements of issues), Section 11505 (relating to the contents of
the statement to respondent), Section 11506 (relating to the notice
of defense), Section 11507.6 (relating to discovery rights and
procedures), Section 11508 (relating to the time and place of
hearings), and Section 11516 (relating to amendment of accusations).
(2) Any alternative procedure specified by the department in
accordance with this subdivision shall conform to the purpose of the
Government Code provision it replaces insofar as it is possible to do
so consistent with the specific procedural requirements applicable
to the type of hearing at issue.
(3) Any alternative procedures adopted by the department under
this subdivision shall not diminish the amount of notice given of the
issues to be heard by the department or deprive appellants of the
right to discovery suitable to the particular proceedings. Except as
specified in paragraph (2) of subdivision (c), modifications of
timeframes or of the place of hearing made by regulation may not
lengthen timeframes within which the department is required to act
nor require hearings to be held at a greater distance from the
appellant's place of residence or business than is the case under the
otherwise applicable Government Code provision.
(e) The specific timelines specified in Section 11517 of the
Government Code shall not apply to any adjudicative hearing conducted
by the department to the extent that the department has, by
regulation, specified different timelines for the particular type of
hearing at issue.
(f) In the case of any adjudicative hearing conducted by the
department, "transcript," as used in subdivision (c) of Section 11517
of the Government Code, shall be deemed to include any alternative
form of recordation of the oral proceedings, including, but not
limited to, an audiotape.
(g) Pursuant to Section 11415.50 of the Government Code, the
department may, by regulation, provide for any appropriate informal
procedure to be used for an informal level of review that does not
itself lead to a final decision of the department or the director.
The procedures specified in Article 10 (commencing with Section
11445.10) of Chapter 4.5 of Part 1 of Division 3 of Title 2 of the
Government Code shall not apply to any such an informal level of
review. Informal conferences concerning appeals by institutional
Medi-Cal providers and health facilities may be held in Sacramento or
Los Angeles.
(h) Notwithstanding any other provision of law, any adjudicative
hearing conducted by the department that is conducted pursuant to a
federal statutory or regulatory requirement that contains specific
procedures may be conducted pursuant to those procedures to the
extent they are inconsistent with the procedures specified in this
section.
(i) Nothing in this section shall apply to a fair hearing
involving a Medi-Cal beneficiary insofar as the hearing is, by
agreement or otherwise, heard before an administrative law judge
employed by the State Department of Social Services, or insofar as
the hearing is being held pursuant to Division 4.5 (commencing with
Section 4500) of the Welfare and Institutions Code in connection with
services provided by the State Department of Developmental Services
under applicable federal medicaid waivers. Nothing in this
subdivision shall be interpreted as abrogating the authority of the
State Department of Health Services as the single state agency under
the state medicaid plan.
(j) Nothing in this provision shall supersede express provisions
of law that apply to any hearing that is not adjudicative in nature
or that does not involve due process rights specific to an individual
or specific individuals, as opposed to the general public or a
segment of the general public.
SEC. 8. Article 6 (commencing with Section 101315) is added to
Chapter 3 of Part 3 of Division 101 of the Health and Safety Code, to
read:
Article 6. Federal Funding for Bioterrorism Preparedness and
other Public Health Threats
101315. (a) Federal funding received by the State Department of
Health Services for bioterrorism preparedness and emergency response
is subject to appropriation in the annual Budget Act.
(b) This article shall govern the purposes for which federal
funding may be allocated and expended by local health jurisdictions
for the prevention of, and response to, bioterrorist attacks and
other public health emergencies pursuant to the federally approved
collaborative state-local plan.
(c) A local health jurisdiction shall be ineligible to receive
funding from appropriations made for purposes of this article when
that local health jurisdiction receives directly or through another
local jurisdiction federal funding for the same purposes. Moneys
appropriated in the annual Budget Act for purposes of this article
that would have been allocated to a local health jurisdiction that is
ineligible, pursuant to this subdivision, to receive funding shall
be allocated, as provided in Section 101317, among the remaining
local health jurisdictions that are eligible.
(d) Funds appropriated for the purposes of this article shall not
be used to supplant funding for existing levels of service and shall
only be used for purposes specified in Section 101317.
101317. (a) For purposes of this article, allocations shall be
made to the administrative bodies of qualifying local health
jurisdictions described as public health administrative organizations
in Section 101185, and pursuant to Section 101315, in the following
manner:
(1) (A) For the 2003-04 fiscal year and subsequent fiscal years,
to the administrative bodies of each local health jurisdiction, a
basic allotment of one hundred thousand dollars ($100,000), subject
to the availability of funds appropriated in the annual Budget Act or
some other act.
(B) For the 2002-03 fiscal year, the basic allotment of one
hundred thousand dollars ($100,000) shall be reduced by the amount of
federal funding allocated as part of a basic allotment for the
purposes of this article to local health jurisdictions in the 2001-02
fiscal year.
(2) (A) Except as provided in subdivision (c), after determining
the amount allowed for the basic allotment as provided in paragraph
(1), the balance of the annual Budget Act appropriation for purposes
of this article, if any, shall be allotted on a per capita basis to
the administrative bodies of each local health jurisdiction in the
proportion that the population of that local health jurisdiction
bears to the population of all eligible local health jurisdictions of
the state.
(B) The population estimates used for the calculation of the per
capita allotment pursuant to subparagraph (A) shall be based on the
Department of Finance's E-1 Report, "City/County Populations
Estimates with Annual Percentage Changes" as of January 1 of the
previous year. However, if within a local health jurisdiction there
are one or more city health jurisdictions, the local health
jurisdiction shall subtract the population of the city or cites from
the local health jurisdiction total population for purposes of
calculating the per capita total.
(b) If the amounts appropriated in the annual Budget Act are
insufficient to fully fund the allocations specified in subdivision
(a), the department shall prorate and adjust each local health
jurisdiction's allocation so that the total amount allocated equals
the amount appropriated.
(c) For the 2002-03 fiscal year and subsequent fiscal years, where
the federally approved collaborative state-local plan identifies an
allocation method, other than the basic allotment and per capita
method described in subdivision (a), for specific funding to a local
public health jurisdiction, including, but not limited to, funding
laboratory training, chemical and nuclear terrorism preparedness, and
information technology approaches, that funding shall be paid to the
administrative bodies of those local health jurisdictions in
accordance with the federally approved collaborative state-local plan
for bioterrorism preparedness and other public health threats in the
state.
(d) Funds appropriated pursuant to the annual Budget Act for
allocation to local health jurisdictions pursuant to this article
shall be disbursed quarterly to local health jurisdictions beginning
July 1, 2002, using the following process:
(1) Each fiscal year, upon the submission of an application for
funding by the administrative body of a local health jurisdiction,
the department shall make the first quarterly payment to each
eligible local health jurisdiction. That application shall include a
plan and budget for the local program that is in accordance with the
department's plans and priorities for bioterrorism preparedness and
response, and other public health threats and emergencies, and a
certification by the chairperson of the board of supervisors or the
mayor of a city with a local health department that the funds
received pursuant to this article will not be used to supplant other
funding sources in violation of subdivision (d) of Section 101315.
(2) The department shall establish procedures and a format for the
submission of the local health jurisdiction's plan and budget. The
local health jurisdiction's plan shall be consistent with the
department's plans and priorities for bioterrorism preparedness and
response, and other public health threats and emergencies, in
accordance with requirements specified in the department's federal
grant award. Payments to local health jurisdictions beyond the first
quarter shall be contingent upon the approval of the department of
the local health jurisdiction's plan and the local health
jurisdiction's progress in implementing the provisions of the local
health jurisdiction's plan, as determined by the department.
(3) If a local health jurisdiction does not apply or submits a
noncompliant application for its allocation, those funds provided
under this article may be redistributed according to subdivision (a)
to the remaining local health jurisdictions.
(e) Funds shall be used for activities to improve and enhance
local health jurisdictions' preparedness for and response to
bioterrorism and other public health threats and emergencies,
including laboratory training and information technology, and for any
other purposes, as determined by the department, that are consistent
with the purposes for which the funds were appropriated.
(f) Any local health jurisdiction that receives funds pursuant to
this article shall deposit them in a special Local Public Health
Preparedness Trust Fund established solely for this purpose before
transferring or expending the funds for any of the uses allowed
pursuant to this article. The interest earned on moneys in the fund
shall accrue to the benefit of the fund and shall be expended for the
same purposes as other moneys in the fund.
(g) (1) A local health jurisdiction that receives funding pursuant
to this article shall submit reports that display cost data and the
activities funded by moneys deposited in its Local Public Health
Preparedness Trust Fund to the department on a regular basis in a
form and according to procedures prescribed by the department.
(2) The department, in consultation with local health
jurisdictions, shall develop required content for the reports
required under paragraph (1), which shall include, but shall not be
limited to, data and information needed to implement this article and
to satisfy federal reporting requirements. The chairperson of the
board of supervisors or the mayor of a city with a local health
department shall certify the accuracy of the reports and that the
moneys appropriated for the purposes of this article have not been
used to supplant other funding sources.
(h) The administrative body of a local health jurisdiction may
enter into a contract with the department and the department may
enter into a contract with that local health jurisdiction for the
department to administer all or a portion of the moneys allocated to
the local health jurisdiction pursuant to this article.
(i) The department may recoup from a local health jurisdiction any
moneys allocated pursuant to this article that are unspent or that
are not expended for purposes specified in subdivision (d). The
department may also recoup funds expended by a local health
jurisdiction in violation of subdivision (d) of Section 101315. The
department may withhold quarterly payments of moneys to a local
health jurisdiction if the local health jurisdiction is not in
compliance with this article or the terms of that local health
jurisdiction's plan as approved by the department. Before any funds
are recouped or withheld from a local health jurisdiction, the
department shall meet with local health officials to discuss the
status of the unspent moneys or the disputed use of the funds or
both.
(j) Moneys made available for bioterrorism preparedness pursuant
to this article in the 2001-02 fiscal year shall be available for
expenditure and encumbrance until June 30, 2003. Moneys made
available for bioterrorism preparedness pursuant to this article from
July 1, 2002, to August 30, 2003, inclusive, shall be available for
expenditure and encumbrance until August 30, 2004, subject to
extension of the federal grant authority.
101319. Due to the need to rapidly implement, and to provide
local health jurisdictions with timely funding for the purposes of,
this article, funds appropriated in the annual Budget Act for
purposes of this article for the 2002-03 fiscal year and subsequent
fiscal years shall be allocated through the use of agreements, which
shall not be subject to Part 2 (commencing with Section 10100) of the
Public Contract Code.
SEC. 9. Section 104188 is added to the Health and Safety Code, to
read:
104188. The maximum indirect cost rate that may be charged on any
cancer research program grant awarded to any institution under this
article shall not be more than 25 percent of the institution's direct
costs.
SEC. 10. Section 120955 of the Health and Safety Code is amended
to read:
120955. (a) To the extent that state and federal funds are
appropriated in the annual Budget Act for these purposes, the
director shall establish and may administer a program to provide drug
treatments to persons infected with human immunodeficiency virus
(HIV), the etiologic agent of acquired immune deficiency syndrome
(AIDS). The director shall develop, maintain, and update as
necessary a list of drugs to be provided under this program. Drugs
on the list shall include, but not be limited to, the drugs
zidovudine (AZT) and aerosolized pentamidine.
(b) The director may grant funds to a county public health
department through standard agreements to administer this program in
that county. To maximize the recipients' access to drugs covered by
this program, the director shall urge the county health department in
counties granted these funds to decentralize distribution of the
drugs to the recipients.
(c) The director shall establish a rate structure for
reimbursement for the cost of each drug included in the program.
Rates shall not be less than the actual cost of the drug. However,
the director may purchase a listed drug directly from the
manufacturer and negotiate the most favorable bulk price for that
drug.
(d) Manufacturers of the drugs on the list shall pay the
department a rebate equal to the rebate that would be applicable to
the drug under Section 1927(c) of the federal Social Security Act (42
U.S.C. Sec. 1396r-8(c)) plus an additional rebate to be negotiated
by each manufacturer with the department, except that no rebates
shall be paid to the department under this section on drugs for which
the department has received a rebate under Section 1927(c) of the
federal Social Security Act (42 U.S.C. Sec. 1396r-8(c)) or that have
been purchased on behalf of county health departments or other
eligible entities at discount prices made available under Section
256b of Title 42 of the United States Code.
(e) The department shall submit an invoice, not less than two
times per year, to each manufacturer for the amount of the rebate
required by subdivision (d).
(f) Drugs may be removed from the list for failure to pay the
rebate required by subdivision (d), unless the department determines
that removal of the drug from the list would cause substantial
medical hardship to beneficiaries.
(g) The department may adopt emergency regulations to implement
amendments to this chapter made during the 1997-98 Regular Session,
in accordance with the Administrative Procedure Act, Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code. The initial adoption of emergency regulations
shall be deemed to be an emergency and considered by the Office of
Administrative Law as necessary for the immediate preservation of the
public peace, health and safety, or general welfare. Emergency
regulations adopted pursuant to this section shall remain in effect
for no more than 180 days.
(h) Reimbursement under this chapter shall not be made for any
drugs that are available to the recipient under any other private,
state, or federal programs, or under any other contractual or legal
entitlements, except that the director may authorize an exemption
from this subdivision where exemption would represent a cost savings
to the state.
SEC. 11. Section 124030 of the Health and Safety Code is amended
to read:
124030. As used in this article and Section 120475:
(a) "State board" means the State Maternal, Child, and Adolescent
Health Board.
(b) "Department" means the department.
(c) "Director" means the director.
(d) "Governing body" means the county board of supervisors or
boards of supervisors in the case of counties acting jointly.
(e) "Local board" means local maternal, child, and adolescent
health board.
(f) "Local health jurisdiction" means county health department or
combined health department in the case of counties acting jointly or
city health department within the meaning of Section 101185.
(g) "Child Health and Disability Prevention provider" or "CHDP
provider" means any of the following, if approved for participation
in the Child Health and Disability Prevention program by the
community Child Health and Disability program director in accordance
with program standards and as certified by the department:
(1) A physician licensed to practice medicine in California.
(2) A family nurse practitioner certified pursuant to Sections
2834 and 2836 of the Business and Professions Code.
(3) A pediatric nurse practitioner certified pursuant to Sections
2834 and 2836 of the Business and Professions Code.
(4) A primary care center, clinic, or other public or private
agency or organization that provides outpatient health care services.
(5) A physicians' group.
(6) A licensed clinical laboratory.
SEC. 12. Section 124033 is added to the Health and Safety Code, to
read:
124033. (a) Commencing July 1, 2003, all applications for
services under the Child Health and Disability Prevention program
shall be filed electronically in accordance with subdivision (b) of
Section 14011.7 of the Welfare and Institutions Code.
(b) To implement the program described in subdivisions (b) to (e),
inclusive, of Section 14011.7 of the Welfare and Institutions Code
for the use of an electronic application for the Child Health and
Disability Prevention program and for preenrollment into the Medi-Cal
program or the Healthy Families Program, the following shall apply:
(1) The department may contract with public or private entities,
or utilize existing health care service provider enrollment and
payment mechanisms, including the Medi-Cal program's fiscal
intermediary, only if services provided under the program are
specifically identified and reimbursed in a manner that appropriately
claims federal financial reimbursement.
(2) Contracts, including the Medi-Cal program fiscal intermediary
contract for the Child Health and Disability Prevention Program,
including any contract amendment, any system change pursuant to a
change order, and any project or systems development notice shall be
exempt from Part 2 (commencing with Section 10100) of Division 2 of
the Public Contract Code, Chapter 7 (commencing with Section 11700)
of Part 1 of Division 3 of Title 2 of the Government Code, Section
19130 of the Government Code, and any policies, procedures, or
regulations authorized by these laws.
SEC. 13. Section 124040 of the Health and Safety Code is amended
to read:
124040. (a) The governing body of each county or counties shall
establish a community child health and disability prevention program
for the purpose of providing early and periodic assessments of the
health status of children in the county or counties by July 1, 1974.
However, this shall be the responsibility of the department for all
counties that contract with the state for health services. Contract
counties, at the option of the board of supervisors, may provide
services pursuant to this article in the same manner as other county
programs, provided the option is exercised prior to the beginning of
each fiscal year. Each plan shall include, but is not limited to,
the following requirements:
(1) Outreach and educational services.
(2) Agreements with public and private facilities and
practitioners to carry out the programs.
(3) Health screening and evaluation services for all children
including a physical examination, immunizations appropriate for the
child's age and health history, and laboratory procedures appropriate
for the child's age and population group performed by, or under the
supervision or responsibility of, a physician licensed to practice
medicine in California or by a certified family nurse practitioner or
a certified pediatric nurse practitioner.
(4) Referral for diagnosis or treatment when needed, including,
for all children eligible for Medi-Cal, referral for treatment by a
provider participating in the Medi-Cal program of the conditions
detected, and methods for assuring referral is carried out.
(5) Recordkeeping and program evaluations.
(6) The health screening and evaluation part of each community
child health and disability prevention program plan shall include,
but is not limited to, the following for each child:
(A) A health and development history.
(B) An assessment of physical growth.
(C) An examination for obvious physical defects.
(D) Ear, nose, mouth, and throat inspection, including inspection
of teeth and gums, and for all children three years of age and older
who are eligible for Medi-Cal, referral to a dentist participating in
the Medi-Cal program.
(E) Screening tests for vision, hearing, anemia, tuberculosis,
diabetes, and urinary tract conditions.
(7) An assessment of nutritional status.
(8) An assessment of immunization status.
(9) Where appropriate, testing for sickle-cell trait, lead
poisoning, and other tests that may be necessary to the
identification of children with potential disabilities requiring
diagnosis and possibly treatment.
(10) For all children eligible for Medi-Cal, necessary assistance
with scheduling appointments for services and with transportation.
(b) Dentists receiving referrals of children eligible for Medi-Cal
under this section shall employ procedures to advise the child's
parent or parents of the need for and scheduling of annual
appointments.
(c) Standards for procedures to carry out health screening and
evaluation services and to establish the age at which particular
tests should be carried out shall be established by the director. At
the discretion of the department, these health screening and
evaluation services may be provided at the frequency provided under
the Healthy Families Program and permitted in managed care plans
providing services under the Medi-Cal program, and shall be
contingent upon appropriation in the annual Budget Act.
Immunizations may be provided at the frequency recommended by the
Committee on Infectious Disease of the American Academy of Pediatrics
and the Advisory Committee on Immunization Practices of the Centers
for Disease Control and Prevention.
(d) Each community child health and disability prevention program
shall, pursuant to standards set by the director, establish a record
system that contains a health case history for each child so that
costly and unnecessary repetition of screening, immunization and
referral will not occur and appropriate health treatment will be
facilitated as specified in Section 124085.
SEC. 14. Section 124120 of the Health and Safety Code is amended
to read:
124120. The department may conduct a community outreach and
awareness campaign to inform medical providers, pregnant women, and
the families of newborns and infants on the availability of the
newborn hearing screening program and the value of early hearing
testing. The outreach and awareness campaign shall be conducted by
an independent contractor.
SEC. 15. Section 124250 of the Health and Safety Code is amended
to read:
124250. (a) The following definitions shall apply for purposes of
this section:
(1) "Domestic violence" means the infliction or threat of physical
harm against past or present adult or adolescent female intimate
partners, and shall include physical, sexual, and psychological abuse
against the woman, and is a part of a pattern of assaultive,
coercive, and controlling behaviors directed at achieving compliance
from or control over, that woman.
(2) "Shelter-based" means an established system of services where
battered women and their children may be provided safe or
confidential emergency housing on a 24-hour basis, including, but not
limited to, hotel or motel arrangements, haven, and safe houses.
(3) "Emergency shelter" means a confidential or safe location that
provides emergency housing on a 24-hour basis for battered women and
their children.
(b) The Maternal and Child Health Branch of the State Department
of Health Services shall administer a comprehensive shelter-based
services grant program to battered women's shelters pursuant to this
section.
(c) The Maternal and Child Health Branch shall administer grants,
awarded as the result of a request for application process, to
battered women's shelters that propose to maintain shelters or
services previously granted funding pursuant
to this section, to expand existing services or
create new services, and to establish new battered women's shelters
to provide services, in any of the following four areas:
(1) Emergency shelter to women and their children escaping violent
family situations.
(2) Transitional housing programs to help women and their children
find housing and jobs so that they are not forced to choose between
returning to a violent relationship or becoming homeless. The
programs may offer up to 18 months of housing, case management, job
training and placement, counseling, support groups, and classes in
parenting and family budgeting.
(3) Legal and other types of advocacy and representation to help
women and their children pursue the appropriate legal options.
(4) Other support services for battered women and their children.
(d) (1) The Maternal and Child Health Branch of the State
Department of Health Services shall conduct a minimum of one site
visit per grant term to each agency funded to provide shelter-based
services to battered women and their children. The purpose of the
site visit shall be a performance assessment of, and technical
assistance for, each agency visited. The performance assessment
shall include, but need not be limited to, a review of all of the
following:
(A) Progress in meeting program goals and objectives.
(B) Agency organization and facilities.
(C) Personnel policies, files, and training.
(D) Recordkeeping, budgeting, and expenditures.
(E) Documentation, data collection, and client confidentiality.
(2) Subsequent to each site visit conducted under paragraph (1),
the Maternal and Child Health Branch shall provide a written report
to the agency summarizing the agency's performance, any deficiencies
noted, and any corrective action needed.
(3) Where an agency receives funding from both the Maternal and
Child Health Branch of the State Department of Health Services and
the Domestic Violence Branch of the Office of Criminal Justice
Planning during any grant cycle, the Maternal and Child Health Branch
and the Domestic Violence Branch shall, to the extent feasible,
coordinate agency site visits and share performance assessment data
with the goal of improving efficiency, eliminating duplication, and
reducing administrative costs.
(e) In implementing the grant program pursuant to this section,
the State Department of Health Services shall consult with an
advisory council that shall remain in existence until January 1,
2006. The council shall be composed of not to exceed 13 voting
members and two nonvoting members appointed as follows:
(1) Seven members appointed by the Governor.
(2) Three members appointed by the Speaker of the Assembly.
(3) Three members appointed by the Senate Committee on Rules.
(4) Two nonvoting ex officio members who shall be Members of the
Legislature, one appointed by the Speaker of the Assembly and one
appointed by the Senate Committee on Rules. Any Member of the
Legislature appointed to the council shall meet with, and participate
in the activities of, the council to the extent that participation
is not incompatible with his or her position as a Member of the
Legislature.
The membership of the council shall consist of domestic violence
advocates, battered women service providers, and representatives of
women's organizations, law enforcement, and other groups involved
with domestic violence. At least one-half of the council membership
shall consist of domestic violence advocates or battered women
service providers from organizations such as the California Alliance
Against Domestic Violence.
It is the intent of the Legislature that the council membership
reflect the ethnic, racial, cultural, and geographic diversity of the
state.
(f) The department shall collaborate closely with the council in
the development of funding priorities, the framing of the Request for
Proposals, and the solicitation of proposals.
(g) (1) The Maternal and Child Health Branch of the State
Department of Health Services shall administer grants, awarded as the
result of a request for application process, to agencies to conduct
demonstration projects to serve battered women, including, but not
limited to, creative and innovative service approaches, such as
community response teams and pilot projects to develop new
interventions emphasizing prevention and education, and other support
projects identified by the advisory council.
(2) For purposes of this subdivision, "agency" means a state
agency, a local government, a community-based organization, or a
nonprofit organization.
(h) It is the intent of the Legislature that services funded by
this program include services in underserved and ethnic and racial
communities. Therefore, the Maternal and Child Health Branch of the
State Department of Health Services shall do all of the following:
(1) Fund shelters pursuant to this section that reflect the
ethnic, racial, economic, cultural, and geographic diversity of the
state.
(2) Target geographic areas and ethnic and racial communities of
the state whereby, based on a needs assessment, it is determined that
no shelter-based services exist or that additional resources are
necessary.
(i) The director may award additional grants to shelter-based
agencies when it is determined that there exists a critical need for
shelter or shelter-based services.
(j) As a condition of receiving funding pursuant to this section,
battered women's shelters shall do all of the following:
(1) Provide matching funds or in-kind contributions equivalent to
not less than 20 percent of the grant they would receive. The
matching funds or in-kind contributions may come from other
governmental or private sources.
(2) Ensure that appropriate staff and volunteers having client
contact meet the definition of "domestic violence counselor" as
specified in subdivision (a) of Section 1037.1 of the Evidence Code.
The minimum training specified in paragraph (2) of subdivision (a)
of Section 1037.1 of the Evidence Code shall be provided to those
staff and volunteers who do not meet the requirements of paragraph
(1) of subdivision (a) of Section 1037.1 of the Evidence Code.
SEC. 15.5. Section 124977 of the Health and Safety Code is amended
to read:
124977. (a) It is the intent of the Legislature that, unless
otherwise specified, the program carried out pursuant to this chapter
be fully supported from fees collected for services provided by the
program.
(b) (1) The department shall charge a fee to all payers for any
tests or activities performed pursuant to this chapter. The amount
of the fee shall be established by regulation and periodically
adjusted by the director in order to meet the costs of this chapter.
Notwithstanding any other provision of law, any fees charged for
screening and followup services provided to Medi-Cal eligible
persons, health care service plan enrollees, or persons covered by
disability insurance policies, shall be paid in full directly to the
Genetic Disease Testing Fund, subject to all terms and conditions of
each enrollee's or insured's health care service plan or insurance
coverage, whichever is applicable, including, but not limited to,
copayments and deductibles applicable to these services, and only if
these copayments, deductions, or limitations are disclosed to the
subscriber or enrollee pursuant to the disclosure provisions of
Section 1363.
(2) The department shall expeditiously undertake all steps
necessary to implement the fee collection process, including
personnel, contracts, and data processing, so as to initiate the fee
collection process at the earliest opportunity. In no event shall a
hospital be charged a fee for any test performed pursuant to this
chapter on or after July 1, 2001.
(3) Paragraphs (1) and (2) shall be inoperative for services
provided after June 30, 2002.
(4) Effective for services provided on and after July 1, 2002, the
department shall charge a fee to the hospital of birth, or, for
births not occurring in a hospital, to families of the newborn, for
newborn screening and followup services. The hospital of birth and
families of newborns born outside the hospital shall make payment in
full to the Genetic Disease Testing Fund. The amount of the fee
shall be established by regulation and periodically adjusted by the
director in order to meet the costs of providing services under this
chapter. The department shall not charge or bill Medi-Cal
beneficiaries for services provided under this chapter.
(c) (1) The Legislature finds that timely implementation of
changes in genetic screening programs and continuous maintenance of
quality statewide services requires expeditious regulatory and
administrative procedures, including policies and procedures
developed pursuant to Sections 12101 and 12102 of the Public Contract
Code or Division 25.2 (commencing with Section 38070) of the Health
and Safety Code, to obtain the most cost-effective electronic data
processing, hardware, software services, testing equipment, testing
services, and followup contracts.
(2) The expenditure of funds from the Genetic Disease Testing Fund
for these purposes shall not be subject to Section 12113.5 of, and
Chapter 2 (commencing with Section 10290) of Part 2 of Division 2 of,
the Public Contract Code. The department shall provide the
Department of Finance with documentation that equipment and services
have been obtained at the lowest cost consistent with technical
requirements for a comprehensive high-quality program.
(d) Nothing in this section shall be construed to impose a new
mandated benefit on health care service plans and health insurers.
SEC. 16. Section 125190 is added to the Health and Safety Code, to
read:
125190. Notwithstanding any other provision of law, the
department is considered to be the purchaser, but not the dispenser
or distributor, of blood factor products under the Genetically
Handicapped Person's Program. The department may receive
manufacturers' discounts, rebates, or refunds based on the quantities
purchased under the Genetically Handicapped Person's Program. The
discounts, rebates, or refunds received pursuant to this section
shall be separate from any agreements for discounts, rebates, or
refunds negotiated pursuant to Section 14105.3 of the Welfare and
Institutions Code or any other program.
SEC. 17. Section 127280.1 is added to the Health and Safety Code,
to read:
127280.1. Notwithstanding any other provision of law, up to two
hundred thousand dollars ($200,000) of the moneys collected pursuant
to Section 127280 may be used in the 2002-03 fiscal year by the State
Department of Health Services for data collection on, analysis of,
and reporting on, maternal and perinatal outcomes, if funds are
appropriated in the Budget Act.
SEC. 18. Section 12693.17 of the Insurance Code is amended to
read:
12693.17. "Family contribution sponsor" means a person or entity
that pays the family contribution on behalf of an applicant for any
period of 12 consecutive months and, notwithstanding Section
12693.70, if the sponsor is paying for the initial 12 months of
eligibility, the payment for 12 months is made with the application.
SEC. 19. Section 12693.41 of the Insurance Code is amended to
read:
12693.41. (a) Upon the effective date of coverage of a child
eligible for the program, the board shall arrange for payment of
providers who participate in the Child Health and Disability
Prevention Program pursuant to Article 6 (commencing with Section
124025) of Chapter 3 of Part 2 of Division 106 of the Health and
Safety Code, for well-child health assessments, immunizations, and
initial treatment provided up to 90 days prior to the effective date
of coverage.
(b) The board shall pay only for those services that are eligible
for federal financial participation under Section 2105 of Title XXI
of the Social Security Act and that are approved in the required
state plan under that title, except as specified in Section 12693.76.
(c) (1) Child Health and Disability Prevention Program providers
shall submit charges for the services under subdivision (a) on the
form or in the format specified by the department for the Child
Health and Disability Prevention Program. Those providers shall be
reimbursed at the rates established for these services by the Child
Health and Disability Prevention Program once coverage under the
program is established.
(2) Those providers shall submit charges for services reimbursable
under Medi-Cal on the form or in the format specified by the
department for Medi-Cal. Those providers shall be reimbursed at the
rates established for these services by Medi-Cal once coverage under
Medi-Cal is established.
(d) (1) The board may use the state fiscal intermediary for
medicaid to process the payments authorized in subdivision (a).
(2) The board shall be exempt from the requirements of Chapter 7
(commencing with Section 11700) of Division 3 of Title 2 of the
Government Code and Chapter 3 (commencing with Section 12100) of Part
2 of Division 2 of the Public Contract Code as those requirements
apply to the use of contractual claims processing services by the
state fiscal intermediary.
(e) This section shall become inoperative on April 1, 2003, and,
as of January 1, 2004, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2004, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 20. Section 12693.41 is added to the Insurance Code, to read:
12693.41. (a) The board shall consult and coordinate with the
State Department of Health Services in implementing a preenrollment
program into the Healthy Families Program or the Medi-Cal program
pursuant to subdivision (b) of Section 14011.7 of the Welfare and
Institutions Code. The board shall accept the followup application
provided for in Section 14011.7 of the Welfare and Institutions Code
as an application for the Healthy Families Program. Preenrollment
shall be administered by the State Department of Health Services to
provide full-scope benefits pursuant to Medi-Cal program
requirements, at no cost to the applicant.
(b) The board may use the state fiscal intermediary for medicaid
to process the eligibility determinations and payments required
pursuant to Section 14011.7 of the Welfare and Institutions Code.
(c) The board shall be exempt from the requirements of Chapter 7
(commencing with Section 11700) of Division 3 of Title 2 of the
Government Code and Chapter 3 (commencing with Section 12100) of Part
2 of Division 2 of the Public Contract Code as those requirements
apply to the use of processing services by the state fiscal
intermediary.
(d) The board may adopt emergency regulations to implement
preenrollment into the Healthy Families Program or the Medi-Cal
program pursuant to Section 14011.7 of the Welfare and Institutions
Code. The emergency regulations shall include, but not be limited
to, regulations that implement any changes in rules relating to
eligibility, enrollment, and disenrollment in the programs pursuant
to Sections 12693.45 and 12693.70. The initial adoption of emergency
regulations and one readoption of the initial regulations shall be
deemed to be an emergency and necessary for the immediate
preservation of the public peace, health and safety, and general
welfare. Initial emergency regulations and the first readoption of
those regulations shall be exempt from review by the Office of
Administrative Law. The initial emergency regulations and one
readoption of those regulations authorized by this section shall be
submitted to the Office of Administrative Law for filing with the
Secretary of State and publication in the California Code of
Regulations and each shall remain in effect for no more than 180
days.
(e) This section shall become operative on April 1, 2003.
SEC. 21. Section 12693.43 of the Insurance Code is amended to
read:
12693.43. (a) Applicants applying to the purchasing pool shall
agree to pay family contributions, unless the applicant has a family
contribution sponsor. Family contribution amounts consist of the
following two components:
(1) The flat fees described in subdivision (b) or (d).
(2) Any amounts that are charged to the program by participating
health, dental, and vision plans selected by the applicant that
exceed the cost to the program of the highest cost Family Value
Package in a given geographic area.
(b) In each geographic area, the board shall designate one or more
Family Value Packages for which the required total family
contribution is:
(1) Seven dollars ($7) per child with a maximum required
contribution of fourteen dollars ($14) per month per family for
applicants with annual household incomes up to and including 150
percent of the federal poverty level.
(2) Nine dollars ($9) per child with a maximum required
contribution of twenty-seven dollars ($27) per month per family for
applicants with annual household incomes greater than 150 percent and
up to and including 200 percent of the federal poverty level.
(c) Combinations of health, dental, and vision plans that are more
expensive to the program than the highest cost Family Value Package
may be offered to and selected by applicants. However, the cost to
the program of those combinations that exceeds the price to the
program of the highest cost Family Value Package shall be paid by the
applicant as part of the family contribution.
(d) The board shall provide a family contribution discount to
those applicants who select the health plan in a geographic area that
has been designated as the Community Provider Plan. The discount
shall reduce the portion of the family contribution described in
subdivision (b) to the following:
(1) A family contribution of four dollars ($4) per child with a
maximum required contribution of eight dollars ($8) per month per
family for applicants with annual household incomes up to and
including 150 percent of the federal poverty level.
(2) Six dollars ($6) per child with a maximum required
contribution of eighteen dollars ($18) per month per family for
applicants with annual household incomes greater than 150 percent and
up to and including 200 percent of the federal poverty level.
(e) Applicants, but not family contribution sponsors, who pay
three months of required family contributions in advance shall
receive the fourth consecutive month of coverage with no family
contribution required.
(f) Applicants, but not family contribution sponsors, who pay the
required family contributions by an approved means of electronic fund
transfer shall receive a 25-percent discount from the required
family contributions.
(g) It is the intent of the Legislature that the family
contribution amounts described in this section comply with the
premium cost sharing limits contained in Section 2103 of Title XXI of
the Social Security Act. If the amounts described in subdivision
(a) are not approved by the federal government, the board may adjust
these amounts to the extent required to achieve approval of the state
plan.
SEC. 22. Section 12693.45 of the Insurance Code is amended to
read:
12693.45. (a) After two consecutive months of nonpayment of
family contributions by an applicant, and a reasonable written notice
period of no less than 30 days is provided to the applicant,
subscribers or purchasing credit members may be disenrolled for an
applicant's failure to pay family contributions. The board may
impose or contract for collection actions to collect unpaid family
contributions.
(b) Subject to any additional requirements of federal law,
disenrollments shall be effective at the end of the second
consecutive month of nonpayment.
SEC. 23. Section 12693.70 of the Insurance Code is amended to
read:
12693.70. To be eligible to participate in the program, an
applicant shall meet all of the following requirements:
(a) Be an applicant applying on behalf of an eligible child, which
means a child who is all of the following:
(1) Less than 19 years of age. An application may be made on
behalf of a child not yet born up to three months prior to the
expected date of delivery. Coverage shall begin as soon as
administratively feasible, as determined by the board, after the
board receives notification of the birth. However, no child less
than 12 months of age shall be eligible for coverage until 90 days
after the enactment of the Budget Act of 1999.
(2) Not eligible for no-cost full-scope Medi-Cal or Medicare
coverage at the time of application.
(3) In compliance with Sections 12693.71 and 12693.72.
(4) A child who meets citizenship and immigration status
requirements that are applicable to persons participating in the
program established by Title XXI of the Social Security Act, except
as specified in Section 12693.76.
(5) A resident of the State of California pursuant to Section 244
of the Government Code; or, if not a resident pursuant to Section 244
of the Government Code, is physically present in California and
entered the state with a job commitment or to seek employment,
whether or not employed at the time of application to or after
acceptance in, the program.
(6) (A) In a family with an annual or monthly household income
equal to or less than 200 percent of the federal poverty level.
(B) All income over 200 percent of the federal poverty level but
less than or equal to 250 percent of the federal poverty level shall
be disregarded in calculating annual or monthly household income.
(C) In a family with an annual or monthly household income greater
than 250 percent of the federal poverty level, any income deduction
that is applicable to a child under Medi-Cal shall be applied in
determining the annual or monthly household income. If the income
deductions reduce the annual or monthly household income to 250
percent or less of the federal poverty level, subparagraph (B) shall
be applied.
(b) If the applicant is applying for the purchasing pool, and does
not have a family contribution sponsor the applicant shall pay the
first month's family contribution and agree to remain in the program
for six months, unless other coverage is obtained and proof of the
coverage is provided to the program.
(c) An applicant shall enroll all of the applicant's eligible
children in the program.
(d) In filing documentation to meet program eligibility
requirements, if the applicant's income documentation cannot be
provided, as defined in regulations promulgated by the board, the
applicant's signed statement as to the value or amount of income
shall be deemed to constitute verification.
(e) An applicant shall pay in full any family contributions owed
in arrears for any health, dental, or vision coverage provided by the
program within the prior 12 months.
SEC. 24. Section 12693.981 of the Insurance Code is amended to
read:
12693.981. (a) (1) The Healthy Families-to-Medi-Cal Bridge
Benefits Program is hereby established to provide any person enrolled
for coverage under this part who meets the criteria set forth in
subdivision (b) with a two calendar-month period of health care
benefits in order to provide the person with an opportunity to apply
for Medi-Cal.
(2) The Healthy Families-to-Medi-Cal Bridge Benefits Program shall
be administered by the board.
(b) (1) Any person who meets all of the following requirements
shall be eligible for two additional calendar months of Healthy
Families benefits:
(A) He or she has been receiving, but is no longer eligible for,
benefits under the program.
(B) He or she appears to be income eligible for full-scope
Medi-Cal benefits without a share of cost.
(2) The two additional calendar months of benefits under this
chapter shall begin on the first day of the month following the last
day of the person's eligibility for benefits under the program.
(c) The two-calendar-month period of Healthy Families benefits
provided under this chapter shall be identical to the scope of
benefits that the person was receiving under the program.
(d) Nothing in this section shall be construed to provide Healthy
Families benefits for more than a two calendar-month period under any
circumstances, including the failure to apply for benefits under the
Medi-Cal program or the failure to be made aware of the availability
of the Medi-Cal program unless the circumstances described in
subdivision (b) reoccur.
(e) This section shall become inoperative if an unappealable court
decision or judgment determines that any of the following apply:
(1) The provisions of this section are unconstitutional under the
United States Constitution or the California Constitution.
(2) The provisions of this section do not comply with the State
Children's Health Insurance Program, as set forth in Title XXI of the
federal Social Security Act.
(3) The provisions of this section require that the health care
benefits provided pursuant to this section are required to be
furnished for more than two calendar months.
SEC. 25. Section 4094.2 of the Welfare and Institutions Code is
amended to read:
4094.2. (a) For the purpose of establishing payment rates for
community treatment facility programs, the private nonprofit agencies
selected to operate these programs shall prepare a budget that
covers the total costs of providing residential care and supervision
and mental health services for their proposed programs. These costs
shall include categories that are allowable under California's Foster
Care program and existing programs for mental health services. They
shall not include educational, nonmental health medical, and dental
costs.
(b) Each agency operating a community treatment facility program
shall negotiate a final budget with the local mental health
department in the county in which its facility is located (the host
county) and other local agencies as appropriate. This budget
agreement shall specify the types and level of care and services to
be provided by the community treatment facility program and a payment
rate that fully covers the costs included in the negotiated budget.
All counties that place children in a community treatment facility
program shall make payments using the budget agreement negotiated by
the community treatment facility provider and the host county.
(c) A foster care rate shall be established for each community
treatment facility program by the State Department of Social
Services. These rates shall be established using the existing foster
care ratesetting system for group homes, with modifications designed
as necessary. It is
anticipated that all community treatment facility programs will offer
the level of care and services required to receive the highest
foster care rate provided for under the current group home
ratesetting system.
(d) For the 2001-02 fiscal year and the 2002-03 fiscal year,
community treatment facility programs shall also be paid a community
treatment facility supplemental rate of up to two thousand five
hundred dollars ($2,500) per child per month on behalf of children
eligible under the foster care program and children placed out of
home pursuant to an individualized education program developed under
Section 7572.5 of the Government Code. Subject to the availability
of funds, the supplemental rate shall be shared by the state and the
counties. Counties shall be responsible for paying a county share of
cost equal to 60 percent of the community treatment rate for
children placed by counties in community treatment facilities and the
state shall be responsible for 40 percent of the community treatment
facility supplemental rate. The community treatment facility
supplemental rate is intended to supplement, and not to supplant, the
payments for which children placed in community treatment facilities
are eligible to receive under the foster care program and the
existing programs for mental health services.
(e) For initial ratesetting purposes for community treatment
facility funding, the cost of mental health services shall be
determined by deducting the foster care rate and the community
treatment facility supplemental rate from the total allowable cost of
the community treatment facility program. Payments to certified
providers for mental health services shall be based on eligible
services provided to children who are Medi-Cal beneficiaries, up to
the statewide maximum allowances for these services.
(f) Although there is statutory authorization for up to 400
community treatment facility beds statewide, it is anticipated that
there will be a phased-in implementation of community treatment
facilities, and that the average monthly community treatment facility
caseload during the 2001-02 fiscal year will be approximately 100
and during the 2002-03 fiscal year will be approximately 140.
(g) The department shall provide the community treatment facility
supplemental rates to the counties for advanced payment to the
community treatment facility providers in the same manner as the
regular foster care payment and within the same required payment time
limits.
(h) In order to facilitate a study of the costs of community
treatment facilities, licensed community treatment facilities shall
provide all documents regarding facility operations, treatment, and
placements requested by the department.
(i) It is the intent of the Legislature that the department and
the State Department of Social Services work to maximize federal
financial participation in funding for children placed in community
treatment facilities through funds available pursuant to Titles IV-E
and XIX of the federal Social Security Act (Title 42 U.S.C. Sec. 670
and following and Sec. 1396 and following) and other appropriate
federal programs.
(j) The department and the State Department of Social Services may
adopt emergency regulations necessary to implement joint protocols
for the oversight of community treatment facilities, to modify
existing licensing regulations governing reporting requirements and
other procedural and administrative mandates to take into account the
seriousness and frequency of behaviors that are likely to be
exhibited by the seriously emotionally disturbed children placed in
community treatment facility programs, to modify the existing foster
care ratesetting regulations, and to pay the community treatment
facility supplemental rate. The adoption of these regulations shall
be deemed to be an emergency and necessary for the immediate
preservation of the public peace, health and safety, and general
welfare. The regulations shall become effective immediately upon
filing with the Secretary of State. The regulations shall not remain
in effect more than 180 days unless the adopting agency complies
with all the provisions of Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code, as
required by subdivision (e) of Section 11346.1 of the Government
Code.
SEC. 26. Section 4380 of the Welfare and Institutions Code is
amended to read:
4380. The Legislature authorizes the director, in consultation
with the Secretary of Child Development and Education and the
Superintendent of Public Instruction, to award matching grants to
local educational agencies to pay the state share of the costs of
providing programs that provide school-based early mental health
intervention and prevention services to eligible pupils at
schoolsites of eligible pupils, as follows:
(a) The director shall award matching grants pursuant to this
chapter to local educational agencies throughout the state.
(b) Matching grants awarded under this part shall be awarded for a
period of not more than three years and no single schoolsite shall
be awarded more than one grant, except for a schoolsite that received
a grant prior to July 1, 1992.
(c) The director shall pay to each local educational agency having
an application approved pursuant to requirements in this part the
state share of the cost of the activities described in the
application.
(d) Commencing July 1, 1993, the state share of matching grants
shall be a maximum of 50 percent in each of the three years.
(e) Commencing July 1, 1993, the local share of matching grants
shall be at least 50 percent, from a combination of school district
and cooperating entity funds.
(f) The local share of the matching grant may be in cash or
payment in-kind.
(g) Priority shall be given to those applicants that demonstrate
the following:
(1) The local educational agency will serve the greatest number of
eligible pupils from low-income families.
(2) The local educational agency will provide a strong parental
involvement component.
(3) The local educational agency will provide supportive services
with one or more cooperating entities.
(4) The local educational agency will provide services at a low
cost per child served in the project.
(5) The local educational agency will provide programs and
services that are based on adoption or modification, or both, of
existing programs that have been shown to be effective. No more than
20 percent of the grants awarded by the director may be utilized for
new models.
(6) The local educational agency will provide services to children
who are in out-of-home placement or who are at risk of being in
out-of-home placement.
(h) Eligible supportive services may include the following:
(1) Individual and group intervention and prevention services.
(2) Parent involvement through conferences or training, or both.
(3) Teacher and staff conferences and training related to meeting
project goals.
(4) Referral to outside resources when eligible pupils require
additional services.
(5) Use of paraprofessional staff, who are trained and supervised
by credentialed school psychologists, school counselors, or school
social workers, to meet with pupils on a short-term weekly basis, in
a one-on-one setting as in the Primary Intervention Program
established pursuant to Chapter 4 (commencing with Section 4343) of
Part 3. A minimum of 80 percent of the grants awarded by the
director shall include the basic components of the Primary
Intervention Program.
(6) Any other service or activity that will improve the mental
health of eligible pupils.
Prior to participation by an eligible pupil in either individual
or group services, consent of a parent or guardian shall be obtained.
(i) Each local educational agency seeking a grant under this
chapter shall submit an application to the director at the time, in a
manner, and accompanied by any information the director may
reasonably require.
(j) Each matching grant application submitted shall include all of
the following:
(1) Documentation of need for the school-based early mental health
intervention and prevention services.
(2) A description of the school-based early mental health
intervention and prevention services expected to be provided at the
schoolsite.
(3) A statement of program goals.
(4) A list of cooperating entities that will participate in the
provision of services. A letter from each cooperating entity
confirming its participation in the provision of services shall be
included with the list. At least one letter shall be from a
cooperating entity confirming that it will agree to screen referrals
of low-income children the program has determined may be in need of
mental health treatment services and that, if the cooperating entity
determines that the child is in need of those services and if the
cooperating entity determines that according to its priority process
the child is eligible to be served by it, the cooperating entity will
agree to provide those mental health treatment services.
(5) A detailed budget and budget narrative.
(6) A description of the proposed plan for parent involvement in
the program.
(7) A description of the population anticipated to be served,
including number of pupils to be served and socioeconomic indicators
of sites to receive funds.
(8) A description of the matching funds from a combination of
local education agencies and cooperating entities.
(9) A plan describing how the proposed school-based early mental
health intervention and prevention services program will be continued
after the matching grant has expired.
(10) Assurance that grants would supplement and not supplant
existing local resources provided for early mental health
intervention and prevention services.
(11) A description of an evaluation plan that includes
quantitative and qualitative measures of school and pupil
characteristics, and a comparison of children's adjustment to school.
(k) Matching grants awarded pursuant to this article may be used
for salaries of staff responsible for implementing the school-based
early mental health intervention and prevention services program,
equipment and supplies, training, and insurance.
(l) Salaries of administrative staff and other administrative
costs associated with providing services shall be limited to 5
percent of the state share of assistance provided under this section.
(m) No more than 10 percent of each matching grant awarded
pursuant to this article may be used for matching grant evaluation.
(n) No more than 10 percent of the moneys allocated to the
director pursuant to this chapter may be utilized for program
administration and evaluation.
Program administration shall include both state staff and field
staff who are familiar with and have successfully implemented
school-based early mental health intervention and prevention
services. Field staff may be contracted with by local school
districts or community mental health programs. Field staff shall
provide support in the timely and effective implementation of
school-based early mental health intervention and prevention
services. Reviews of each project shall be conducted at least once
during the first year of funding.
(o) Subject to the approval of the director, at the end of the
fiscal year, a school district may apply unexpended funds to the
budget for the subsequent funding year.
(p) Contracts for the program and administration, or ancillary
services in support of the program, shall be exempt from the
requirements of the Public Contract Code and the State Administrative
Manual, and from approval by the Department of General Services.
SEC. 27. Section 4418.2 is added to the Welfare and Institutions
Code, to read:
4418.2. The department shall support, utilizing regional resource
development projects, the activities specified in Sections 4418.25,
4418.3, and 4418.7.
SEC. 28. Section 4418.25 is added to the Welfare and Institutions
Code, to read:
4418.25. (a) The department shall establish policies and
procedures for the development of an annual community placement plan
by regional centers. The community placement plan shall be based
upon an individual program plan process as referred to in subdivision
(a) of Section 4418.3 and shall be linked to the development of the
annual state budget. The department's policies shall address
statewide priorities, plan requirements, and the statutory roles of
regional centers, developmental centers, and regional resource
development projects in the process of assessing consumers for
community living and in the development of community resources.
(b) The community placement plan shall provide for dedicated
funding for comprehensive assessments of selected developmental
center residents, for identified costs of moving selected individuals
from developmental centers to the community, and for deflection of
selected individuals from developmental center admission. The plans
shall, where appropriate, include budget requests for regional center
operations, assessments, resource development, and ongoing placement
costs. These budget requests are intended to provide supplemental
funding to regional centers. The plan is not intended to limit the
department's or regional centers' responsibility to otherwise conduct
assessments and individualized program planning, and to provide
needed services and supports in the least restrictive, most
integrated setting in accord with the Lanterman Developmental
Disabilities Services Act (Division 4.5 (commencing with Section
4500)).
(c) The department shall review, negotiate, and approve regional
center community placement plans for feasibility and reasonableness,
including recognition of each regional centers' current developmental
center population and their corresponding placement level, as well
as each regional centers' need to develop new and innovative service
models. The department shall hold regional centers accountable for
the development and implementation of their approved plans. The
regional centers shall report, as required by the department, on the
outcomes of their plans. The department shall make aggregate
performance data for each regional center available, upon request, as
well as data on admissions to, and placements from, each
developmental center.
(d) Funds allocated by the department to a regional center for a
community placement plan developed under this section shall be
controlled through the regional center contract to ensure that the
funds are expended for the purposes allocated. Funds allocated for
community placement plans that are not used for that purpose may be
transferred to Item 4300-003-0001 for expenditure in the state
developmental centers if their population exceeds the budgeted level.
Any unspent funds shall revert to the General Fund.
SEC. 29. Section 4418.3 of the Welfare and Institutions Code is
amended to read:
4418.3. (a) It is the intent of the Legislature to ensure that
the transition process from a developmental center to a community
living arrangement is based upon the individual's needs, developed
through the individual program plan process, and ensures that needed
services and supports will be in place at the time the individual
moves. It is further the intent of the Legislature that regional
centers, developmental centers, and regional resource development
projects coordinate with each other for the benefit of their
activities in assessment, in the development of individual program
plans, and in planning, transition, and deflection, and for the
benefit of consumers.
(b) As individuals are identified for possible movement to the
community, an individual planning meeting shall be initiated by the
developmental center, which shall notify the planning team, pursuant
to subdivision (j) of Section 4512, and the regional resource
development project of the meeting. The regional resource
development project shall make services available to the
developmental center and the regional center, including, but not
limited to, consultations with the planning teams and the
identification of services and supports necessary for the consumer to
succeed in community living.
(c) The development of the individual program plan shall be
consistent with Sections 4646 and 4646.5. For the purpose of this
section, the planning team shall include developmental center staff
knowledgeable about the service and support needs of the consumer.
(d) Regional resource development project services may include
providing information in an understandable form to consumers and,
where appropriate, their families, conservators, legal guardians, or
authorized representatives, that will assist them in making decisions
about community living and services and supports. This information
may include affording the consumer the opportunity to visit a variety
of community living arrangements that could meet his or her needs.
If the visits are not feasible, as determined by the planning team, a
family member or other representative of the consumer may conduct
the visits. Regional resource development projects may be requested
to facilitate these visits. The availability of this service shall
be made known by the planning team to consumers and, where
appropriate, their families, conservators, legal guardians, or
authorized representative.
(e) Once the individual program plan is completed and providers of
services and supports are identified and agreed to, pursuant to
subdivision (b) of Section 4646.5, and no less than 15 days prior to
the move, unless otherwise ordered by a court, a transition
conference, which may be facilitated by a regional resource
development project, shall be held. Participants in the transition
conference shall include, but not be limited to, the consumer, where
appropriate the consumer's parents, legal guardian, conservator, or
authorized representative, a regional center representative, a
developmental center representative, and a representative of each
provider of primary services and supports identified in the
individual program plan. This meeting may take place in the
catchment area to which the consumer is moving. If necessary,
conferees may participate by telephone or video conference. The
purpose of this conference shall be to ensure a smooth transition
from the developmental center to the community.
(f) The department, through the appropriate regional resource
development project, shall provide, in cooperation with regional
centers and developmental centers, followup services to help ensure a
smooth transition to the community. Followup services shall
include, but shall not limited to, all of the following:
(1) Regularly scheduled as well as on an as-needed basis, contacts
and visits with consumers and service providers during the 12 months
following the consumers movement date.
(2) Participation in the development of an individual program plan
in accordance with Sections 4646 and 4646.5.
(3) Identification of issues that need resolution.
(4) Arrangement for the provision of developmental center
services, including, but not limited to, medication review, crisis
services, and behavioral consultation.
(g) To ascertain that the individual program plan is being
implemented, that planned services are being provided, and that the
consumer and, where appropriate the consumer's parents, legal
guardian, or conservator, are satisfied with the community living
arrangement, the regional center shall schedule face-to-face reviews
no less than once every 30 days for the first 90 days. Following the
first 90 days, and following notification to the department, the
regional center may conduct these reviews less often as specified in
the individual program plan.
(h) The regional center and the regional resource development
project shall coordinate their followup reviews required pursuant to
subdivisions (f) and (g) and shall share with each other information
obtained during the course of the followup visits.
SEC. 30. Section 4418.7 of the Welfare and Institutions Code is
amended to read:
4418.7. (a) If the regional center determines, or is informed by
the consumer's parents, legal guardian, conservator, or authorized
representative that the community placement of a consumer is at risk
of failing, and that admittance to a state developmental center is a
likelihood, the regional center shall immediately notify the
appropriate regional resource development project, the consumer, and
the consumer's parents, legal guardian, or conservator.
(b) In these cases, the regional resource development project
shall immediately arrange for an assessment of the situation,
including, visiting the consumer, if appropriate, determining
barriers to successful integration, and recommending the most
appropriate means necessary to assist the consumer to remain in the
community. If, based on the assessment, the regional resource
development project determines that additional or different services
and supports are necessary, the department shall ensure that the
regional center provides those services and supports on an emergency
basis. An individual program plan meeting, including the regional
resource development project's representative, shall be convened as
soon as possible to review the emergency services and supports and
determine the consumer's ongoing needs for services and supports.
The regional resource development project shall follow up with the
regional center as to the success of the recommended interventions
until the consumer's living arrangement is stable.
(c) If the regional resource development project, in consultation
with the regional center, the consumer, and the consumer's parents,
legal guardian, or conservator, when appropriate, determines that
admittance to a state developmental center is necessary to prevent a
substantial risk to the individual's health and safety, the regional
resource development project shall immediately facilitate that
admission.
(d) The department shall collect data on the outcomes of efforts
to assist at-risk consumers to remain in the community. The
department shall make aggregate data on the implementation of the
requirements of this section available, upon request.
SEC. 30.5. Section 4631.5 is added to the Welfare and Institutions
Code, to read:
4631.5. (a) The Legislature finds and declares both of the
following:
(1) The state is facing an unprecedented fiscal crisis that will
require an unallocated reduction in the 2002-03 fiscal year for
regional centers' purchase of service budgets of fifty-two million
dollars ($52,000,000).
(2) Even when the state faces an unprecedented fiscal crisis, the
services and supports set forth in the Lanterman Developmental
Disabilities Services Act (Division 4.5 (commencing with Section
4500)) shall continue to be provided to individuals with
developmental disabilities in accordance with state and federal
statutes, regulations, and case law, including Association for
Retarded Citizens v. Department of Developmental Services (1985) 38
Cal.3d 384.
(b) It is the intent of the Legislature that actions taken
pursuant to this section shall not eliminate an individual's
eligibility, adversely affect an individual's health and safety, or
interfere with an individual's rights as described in Section 4502.
(c) In order to ensure that services to eligible consumers are
available throughout the fiscal year, regional centers shall
administer their contracts within the level of funding appropriated
by the annual Budget Act.
(d) Within 30 days of the enactment of the annual Budget Act, and
after consultation with stakeholder organizations, the department
shall determine the amount of unallocated reduction that each
regional center shall make in its purchase-of-service budget and
shall provide each regional center with guidelines, technical
assistance, and a variety of options for reducing operations and
purchase of service costs.
(e) Within 60 days of the enactment of the annual Budget Act, each
regional center shall develop and submit a plan to the department
describing in detail how it intends to absorb the unallocated
reduction and achieve savings necessary to provide services to
eligible consumers throughout the fiscal year within the limitations
of the funds allocated. Prior to adopting the plan, each regional
center shall hold a public hearing in order to receive comment on the
plan. The regional center shall provide notice to the community at
least 10 days in advance of the public hearing. The regional center
shall summarize and respond to the public testimony in its plan.
(f) A regional center shall implement components of its plans upon
approval of the department. Within 30 days of receipt of the plan,
the department shall review and approve, or require modification of,
portions of the regional center's plan.
(g) This section shall become inoperative on July, 1, 2004, and,
as of January 1, 2005, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2005, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 31. Section 4640.6 of the Welfare and Institutions Code is
amended to read:
4640.6. (a) In approving regional center contracts, the
department shall ensure that regional center staffing patterns
demonstrate that direct service coordination are the highest
priority.
(b) Contracts between the department and regional centers shall
require that regional centers implement an emergency response system
that ensures that a regional center staff person will respond to a
consumer, or individual acting on behalf of a consumer, within two
hours of the time an emergency call is placed. This emergency
response system shall be operational 24 hours per day, 365 days per
year.
(c) Contracts between the department and regional centers shall
require regional centers to have service coordinator-to-consumer
ratios, as follows:
(1) An average service coordinator-to-consumer ratio of 1 to 62
for all consumers who have not moved from the developmental centers
to the community since April 14, 1993. In no case shall a service
coordinator for these consumers have an assigned caseload in excess
of 79 consumers for more than 60 days.
(2) An average service coordinator-to-consumer ratio of 1 to 45
for all consumers who have moved from a developmental center to the
community since April 14, 1993. In no case shall a service
coordinator for these consumers have an assigned caseload in excess
of 59 consumers for more than 60 days.
(d) For
purposes of this section, "service coordinator" means a regional
center employee whose primary responsibility includes preparing,
implementing, and monitoring consumers' individual program plans,
securing and coordinating consumer services and supports, and
providing placement and monitoring activities.
(e) In order to ensure that caseload ratios are maintained
pursuant to this section, each regional center shall provide service
coordinator caseload data to the department in September and March of
each fiscal year, commencing in the 1999-2000 fiscal year. The data
shall be submitted in a format prescribed by the department. Within
30 days of receipt of data submitted pursuant to this subdivision,
the department shall make a summary of the data available to the
public upon request. The department shall verify the accuracy of the
data when conducting regional center fiscal audits. Data submitted
by regional centers pursuant to this subdivision shall:
(1) Only include data on service coordinator positions as defined
in subdivision (d). Regional centers shall identify the number of
positions that perform service coordinator duties on less than a
full-time basis. Staffing ratios reported pursuant to this
subdivision shall reflect the appropriate proportionality of these
staff to consumers served.
(2) Be reported separately for service coordinators whose caseload
primarily includes any of the following:
(A) Consumers who are three years of age and older and who have
not moved from the developmental center to the community since April
14, 1993.
(B) Consumers who have moved from a developmental center to the
community since April 14, 1993.
(C) Consumers who are younger than three years of age.
(3) Not include positions that are vacant for more than 60 days.
(f) The department shall provide technical assistance and require
a plan of correction for any regional center that, for two
consecutive reporting periods, fails to maintain service coordinator
caseload ratios required by this section or otherwise demonstrates an
inability to maintain appropriate staffing patterns pursuant to this
section. Plans of correction shall be developed following input
from the local area board, local organizations representing
consumers, family members, regional center employees, including
recognized labor organizations, and service providers, and other
interested parties.
(g) Contracts between the department and regional center shall
require the regional center to have, or contract for, all of the
following areas:
(1) Criminal justice expertise to assist the regional center in
providing services and support to consumers involved in the criminal
justice system as a victim, defendant, inmate, or parolee.
(2) Special education expertise to assist the regional center in
providing advocacy and support to families seeking appropriate
educational services from a school district.
(3) Family support expertise to assist the regional center in
maximizing the effectiveness of support and services provided to
families.
(4) Housing expertise to assist the regional center in accessing
affordable housing for consumers in independent or supportive living
arrangements.
(5) Community integration expertise to assist consumers and
families in accessing integrated services and supports and improved
opportunities to participate in community life.
(6) Quality assurance expertise, to assist the regional center to
provide the necessary coordination and cooperation with the area
board in conducting quality-of-life assessments and coordinating the
regional center quality assurance efforts.
(7) Each regional center shall employ at least one consumer
advocate who is a person with developmental disabilities.
(8) Other staffing arrangements related to the delivery of
services that the department determines are necessary to ensure
maximum cost-effectiveness and to ensure that the service needs of
consumers and families are met.
(h) Any regional center proposing a staffing arrangement that
substantially deviates from the requirements of this section shall
request a waiver from the department. Prior to granting a waiver,
the department shall require a detailed staffing proposal, including,
but not limited to, how the proposed staffing arrangement will
benefit consumers and families served, and shall demonstrate clear
and convincing support for the proposed staffing arrangement from
constituencies served and impacted, that include, but are not limited
to, consumers, families, providers, advocates, and recognized labor
organizations. In addition, the regional center shall submit to the
department any written opposition to the proposal from organizations
or individuals, including, but not limited to, consumers, families,
providers, and advocates, including recognized labor organizations.
The department may grant waivers to regional centers that
sufficiently demonstrate that the proposed staffing arrangement is in
the best interest of consumers and families served, complies with
the requirements of this chapter, and does not violate any
contractual requirements. A waiver shall be approved by the
department for up to 12 months, at which time a regional center may
submit a new request pursuant to this subdivision.
(i) The requirements of subdivisions (c), (f), and (h) shall not
apply when a regional center is required to develop an expenditure
plan pursuant to Section 4791, and when the expenditure plan
addresses the specific impact of the budget reduction on staffing
requirements and the expenditure plan is approved by the department.
(j) (1) Any contract between the department and a regional center
entered into on and after January 1, 2003, shall require that all
employment contracts entered into with regional center staff or
contractors be available to the public for review, upon request. For
purposes of this subdivision, an employment contract or portion
thereof may not be deemed confidential nor unavailable for public
review.
(2) Notwithstanding paragraph (1), the social security number of
the contracting party may not be disclosed.
(3) The term of the employment contract between the regional
center and an employee or contractor shall not exceed the term of the
state's contract with the regional center.
SEC. 32. Section 4643 of the Welfare and Institutions Code is
amended to read:
4643. (a) If assessment is needed, prior to July 1, 2003, the
assessment shall be performed within 120 days following initial
intake. Assessment shall be performed as soon as possible and in no
event more than 60 days following initial intake where any delay
would expose the client to unnecessary risk to his or her health and
safety or to significant further delay in mental or physical
development, or the client would be at imminent risk of placement in
a more restrictive environment. Assessment may include collection
and review of available historical diagnostic data, provision or
procurement of necessary tests and evaluations, and summarization of
developmental levels and service needs and is conditional upon
receipt of the release of information specified in subdivision (b).
On and after July 1, 2003, the assessment shall be performed within
60 days following intake and if unusual circumstances prevent the
completion of assessment within 60 days following intake, this
assessment period may be extended by one 30-day period with the
advance written approval of the department.
(b) In determining if an individual meets the definition of
developmental disability contained in subdivision (a) of Section
4512, the regional center may consider evaluations and tests,
including, but not limited to, intelligence tests, adaptive
functioning tests, neurological and neuropsychological tests,
diagnostic tests performed by a physician, psychiatric tests, and
other tests or evaluations that have been performed by, and are
available from, other sources.
SEC. 33. Section 4646.5 of the Welfare and Institutions Code is
amended to read:
4646.5. (a) The planning process for the individual program plan
described in Section 4646 shall include all of the following:
(1) Gathering information and conducting assessments to determine
the life goals, capabilities and strengths, preferences, barriers,
and concerns or problems of the person with developmental
disabilities. For children with developmental disabilities, this
process should include a review of the strengths, preferences, and
needs of the child and the family unit as a whole. Assessments shall
be conducted by qualified individuals and performed in natural
environments whenever possible. Information shall be taken from the
consumer, his or her parents and other family members, his or her
friends, advocates, providers of services and supports, and other
agencies. The assessment process shall reflect awareness of, and
sensitivity to, the lifestyle and cultural background of the consumer
and the family.
(2) A statement of goals, based on the needs, preferences, and
life choices of the individual with developmental disabilities, and a
statement of specific, time-limited objectives for implementing the
person's goals and addressing his or her needs. These objectives
shall be stated in terms that allow measurement of progress or
monitoring of service delivery. These goals and objectives should
maximize opportunities for the consumer to develop relationships, be
part of community life in the areas of community participation,
housing, work, school, and leisure, increase control over his or her
life, acquire increasingly positive roles in community life, and
develop competencies to help accomplish these goals.
(3) When developing individual program plans for children,
regional centers shall be guided by the principles, process, and
services and support parameters set forth in Section 4685.
(4) A schedule of the type and amount of services and supports to
be purchased by the regional center or obtained from generic agencies
or other resources in order to achieve the individual program plan
goals and objectives, and identification of the provider or providers
of service responsible for attaining each objective, including, but
not limited to, vendors, contracted providers, generic service
agencies, and natural supports. The plan shall specify the
approximate scheduled start date for services and supports and shall
contain timelines for actions necessary to begin services and
supports, including generic services.
(5) When agreed to by the consumer, the parents or legally
appointed guardian of a minor consumer, or the legally appointed
conservator of an adult consumer or the authorized representative,
including those appointed pursuant to Section 4590 and subdivision
(e) of Section 4705, a review of the general health status of the
adult or child including a medical, dental, and mental health needs
shall be conducted. This review shall include a discussion of
current medications, any observed side effects, and the date of last
review of the medication. Service providers shall cooperate with the
planning team to provide any information necessary to complete the
health status review. If any concerns are noted during the review,
referrals shall be made to regional center clinicians or to the
consumer's physician, as appropriate. Documentation of health status
and referrals shall be made in the consumer's record by the service
coordinator.
(6) A schedule of regular periodic review and reevaluation to
ascertain that planned services have been provided, that objectives
have been fulfilled within the times specified, and that consumers
and families are satisfied with the individual program plan and its
implementation.
(b) For all active cases, individual program plans shall be
reviewed and modified by the planning team, through the process
described in Section 4646, as necessary, in response to the person's
achievement or changing needs, and no less often than once every
three years. If the consumer or, where appropriate, the consumer's
parents, legal guardian, or conservator requests an individual
program plan review, the individual program shall be reviewed within
30 days after the request is submitted.
(c) (1) The department, with the participation of representatives
of a statewide consumer organization, the Association of Regional
Center Agencies, an organized labor organization representing service
coordination staff, and the Organization of Area Boards shall
prepare training material and a standard format and instructions for
the preparation of individual program plans, which embodies an
approach centered on the person and family.
(2) Each regional center shall use the training materials and
format prepared by the department pursuant to paragraph (1).
(3) The department shall biennially review a random sample of
individual program plans at each regional center to assure that these
plans are being developed and modified in compliance with Section
4646 and this section.
SEC. 34. Section 4781.5 is added to the Welfare and Institutions
Code, to read:
4781.5. For the 2002-03 fiscal year only, a regional center may
not expend any purchase of service funds for the startup of any new
program unless the expenditure is necessary to protect the consumer's
health or safety or because of other extraordinary circumstances,
and the department has granted prior written authorization for the
expenditure. This provision shall not apply to any of the following:
(a) The purchase of services funds allocated as part of the
department's community placement plan process.
(b) Expenditures for the startup of new programs made pursuant to
a contract entered into before July 1, 2002.
SEC. 34.5. Section 4847 of the Welfare and Institutions Code is
repealed.
SEC. 35. Section 5600.8 of the Welfare and Institutions Code is
amended to read:
5600.8. (a) The department may allocate the funds appropriated in
Schedule (2) of Item 4440-101-0001 of the annual Budget Act, to
county mental health programs that meet programmatic goals and model
adult system of care programs to the satisfaction of the department.
The department shall audit and monitor the use of these funds to
ensure they are used solely in support of Adult System of Care
programming. If county programs receiving adult system of care
funding do not comply with program and audit requirements determined
by the department, funding shall be redistributed to other counties
to implement, expand, or model adult systems of care.
(b) The department may allocate the funds appropriated in Schedule
(3) of Item 4440-101-0001 of the annual Budget Act, to county mental
health programs for Children's System of Care programming. These
funds shall be utilized by counties only in support of a mental
health system serving seriously emotionally disturbed children, in
accordance with the principles and program requirements associated
with the system of care model, as set forth in Part 4 (commencing
with Section 5850). The department shall audit and monitor the use
of these funds to ensure they are used solely in support of the
Children's System of Care program. If county programs receiving
children's system of care funding do not comply with program and
audit requirements determined by the department, funds shall be
redistributed to other counties to implement, expand, or model
children's system of care programming.
SEC. 36. Section 5767 is added to the Welfare and Institutions
Code, to read:
5767. The department, in consultation with a statewide
organization representing county mental health services, shall
strengthen and ensure statewide application of managed care
principles, building on existing county systems, to manage the Early
Periodic Screening Diagnosis and Treatment Program benefit while
ensuring access to eligible Medi-Cal recipients.
SEC. 37. Section 5869 of the Welfare and Institutions Code is
amended to read:
5869. The department shall provide participating counties with
all of the following:
(a) Applications for funding guidelines and format, and
coordination and oversight of the selection process as described in
Article 4 (commencing with Section 5857).
(b) Contracts with each state funded county specifying the
approved budget, performance outcomes, and a scope of work plan for
each year of participation in the children's system of care program.
(c) Technical assistance related to system evaluation.
SEC. 38. Section 5881 of the Welfare and Institutions Code is
amended to read:
5881. (a) Evaluation shall be conducted by both participating
county evaluation staff and, subject to the availability of funds, by
the department.
(b) Evaluation at both levels shall do all of the following:
(1) Ensure that county level systems of care are serving the
targeted population.
(2) Ensure that the timely performance data related to client
outcome and cost avoidance is collected, analyzed, and reported.
(3) Ensure that system of care components are implemented as
intended.
(4) Provide information documenting needs for future planning.
SEC. 39. Section 5882 of the Welfare and Institutions Code is
amended to read:
5882. (a) Participating counties shall assign sufficient
resources to performance evaluation to enable the county to fulfill
all evaluation responsibilities specified in the contract with the
department.
(b) Counties shall cooperate with the department regarding the
development of uniform measures of performance.
SEC. 40. Section 5883 of the Welfare and Institutions Code is
amended to read:
5883. (a) The department shall facilitate improved access to
relevant client and financial data from all state agencies,
including, but not limited to, the State Department of Social
Services, the State Department of Education, the State Department of
Health Services, the State Department of Mental Health, the
Department of the Youth Authority, and the Department of Finance.
(b) The State Department of Mental Health shall expand the funding
allocated to the contract for independent evaluation, as necessary
to accommodate the increase in workload created by the addition of
new sites.
(c) Subject to the availability of funds, the department shall do
all of the following:
(1) Develop uniform data collection and reporting measures
applicable to all participating counties.
(2) Collect, analyze, and report performance outcome data for
participating counties as a group in comparison to state averages.
(3) Offer technical assistance to participating counties related
to data collection, analysis, and reporting.
SEC. 41. Section 14000.03 is added to the Welfare and Institutions
Code, to read:
14000.03. (a) The Legislature finds and declares that Section
1396a(a)(11)(A) of Title 42 of the United States Code provides that
California's state plan for medical assistance under the Medicaid
program must "provide for entering into cooperative arrangements with
the State agencies responsible for administering or supervising the
administration of health services and vocational rehabilitation
services in the State looking toward maximum utilization of such
services in the provision of medical assistance under the plan."
(b) In furtherance of Section 1396a(a)(11)(A) of Title 42 of the
United States Code and Section 7560 of the Government Code, it is the
intent of the Legislature to maximize the amount of federal and
state funds continually available under agreements identified in
Section 1396a(a)(11)(A) of Title 42 of the United States Code and
entered into by the State Department of Health Services by making
later-appropriated and budgeted funds immediately encumbered and
available for expenditure under agreements by operation of law.
(c) Notwithstanding any other provision of law, upon additional
funds being appropriated and budgeted for the support of the services
identified within the scope of work of an agreement of the type
identified in Section 1396a (a)(11)(A) of Title 42 of the United
States Code and previously entered into by the State Department of
Health Services, the amount of the encumbrance in such an agreement
shall be amended, by operation of law, to reflect the newly
appropriated and budgeted funds.
(d) Notwithstanding any other provision of law, once an agreement
of the type identified in Section 1396a (a)(11)(A) of Title 42 of the
United States Code is entered into by the State Department of Health
Services, the agreement shall continue in effect indefinitely and
need not be amended unless the State Department of Health Services
changes the scope of work to be provided under the agreement.
SEC. 42. Section 14000.5 is added to the Welfare and Institutions
Code, to read:
14000.5. On a regional pilot project basis, to the extent
authorized by law, the director may enter into contracts with one or
more nonprofit organizations to perform the functions of the
department's Office of the Ombudsman. These activities may include
outreach, community education and training about health care consumer
rights and responsibilities, including the production and
distribution of consumer-oriented material, individual consumer
assistance, including counseling, advice, assistance, education,
advocacy, and referral as appropriate, establishing and operating a
database to analyze the nature of the inquiries and requests for
assistance, and training of department or county staff. These
services may be made available to any person who may be eligible for
or is receiving benefits under this chapter. Funds appropriated in
the annual Budget Act for the support of the Office of the Ombudsman
may be allocated for this purpose.
SEC. 43. Section 14005.41 of the Welfare and Institutions Code is
amended to read:
14005.41. (a) Notwithstanding any other provision of law, the
department shall deem to have met the income documentation
requirements for participation in the Medi-Cal program, without a
share of cost, any child who is less than six years of age and who
has been determined to be eligible for free meals through a federally
funded program using the National School Lunch application provided
for pursuant to Chapter 13 (commencing with Section 1751) of Title
42 of the United States Code.
(b) Notwithstanding any other provision of law, with regard to any
child who is enrolled in and attending public school in the State of
California, the department shall accept documentation of enrollment
for free meals under the National School Lunch Program as sufficient
documentation of California residency for that child for the purposes
of the Medi-Cal program.
(c) (1) (A) Effective July 1, 2003, notwithstanding any other
provision of law, each county shall participate in a statewide pilot
project to determine Medi-Cal program eligibility for any child under
six years of age and currently enrolled in school in the State of
California who is eligible for free meals under the National School
Lunch Program upon receipt of proof of participation in the National
School Lunch Program and a signed Medi-Cal application, which may be
the supplemented application, described in subdivision (i). Counties
shall notify the parent or guardian of the results of the
eligibility determination.
(B) Effective July 1, 2003, notwithstanding any other provision of
law, each county shall participate in a statewide pilot project to
use the procedure described in this subdivision to determine Medi-Cal
eligibility without a share of cost, and, if eligible, shall enroll
in the Medi-Cal program, any child six years of age or older
currently enrolled in school in the State of California who is
eligible for free meals under the National School Lunch Program, upon
receipt of proof of participation in the National School Lunch
Program and a signed Medi-Cal application, which may be the
supplemented application, described in subdivision (i). If the
county determines from the supplemented application described in
subdivision (i) that the child meets the eligibility requirements for
participation in the Medi-Cal program, the county shall notify the
parent or guardian that the child has been found eligible for the
Medi-Cal program. If the county is unable to determine from the
information on the application as described in subdivision (i)
whether the child is eligible, the county shall contact the family to
seek any additional information regarding income, household
composition, or deductions that the department, in consultation with
the county welfare departments, may determine to be necessary to
complete the Medi-Cal application. If the county determines that the
child does not meet the eligibility requirements for participation
in the Medi-Cal program, the county shall notify the parent or
guardian of the determination and shall send the parent or guardian
an application for the Healthy Families Program.
(2) Each county shall ask the parent or guardian of each child
identified in subparagraph (A) of paragraph (1) and the parent or
guardian of each child whom the county determines to meet the income
eligibility requirements for participation in the Medi-Cal program
under subparagraph (B) of paragraph (1) to provide additional
documentation as required by current law necessary for retention of
eligibility in the Medi-Cal program. If a parent or guardian does
not provide the documentation required for retention of full-scope
Medi-Cal program eligibility, the county shall continue the child's
enrollment in the Medi-Cal program, but only for the limited scope of
Medi-Cal program benefits as described in Section 14007.5.
(d) Nothing in this section shall be construed as preventing the
department from verifying eligibility through the Income Eligibility
Verification System match mandated by Section 1137 of the federal
Social Security Act (42 U.S.C. Sec. 1320b-7) or from requesting
additional information or documentation required by federal law.
(e) Each county shall include its cost of implementing this
section in its annual Medi-Cal administrative budget requests
submitted to the department.
(f) For purposes of this section, the Medi-Cal program application
date shall be the date on which the school lunch application
information is received by the local agency determining eligibility
under the Medi-Cal program.
(g) (1) This section shall be implemented on July 1, 2003, only
if, and to the extent that, federal financial participation is
available for the services provided and only for the period of time
the free National School Lunch Program utilizes a gross income
standard at or below 133 percent of the federal poverty
level. This section shall be
implemented in a manner consistent with any federal approval.
(2) Notwithstanding paragraph (1), if the department determines
that one or more state plan amendments are necessary to ensure full
federal financial participation in the provisions of this section,
the department shall prepare and submit requests for the state plan
amendments to the federal government, after which this section shall
not be implemented until the later of the date the department
receives approval of all necessary state plan amendments, or July 1,
2003.
(h) (1) Notwithstanding subdivision (g), not later than March 1,
2003, the department, in consultation with the State Department of
Education and representatives of the school districts, county
superintendents of schools, local agencies that administer the
Medi-Cal program, consumer advocates, and other stakeholders, shall
develop and distribute the policies and procedures, including any
all-county letters, necessary to implement Section 49557.2 of the
Education Code and this section.
(2) The policies and procedures required to be developed and
distributed pursuant to subdivision (a) shall include, at a minimum,
both of the following:
(A) Processes for the school districts, county superintendents of
schools, and local agencies that administer the Medi-Cal program to
use in forwarding and processing free school lunch application
information pursuant to Section 49557.2 of the Education Code, and in
following up with the applicants to obtain any necessary
documentation required by federal law.
(B) Instructions for implementing the eligibility provisions of
this chapter.
(3) The policies and procedures required to be developed pursuant
to subdivision (a) shall specify all of the following:
(A) The information on the school lunch application may be used to
initiate a Medi-Cal program application only when the applicant has
provided his or her consent pursuant to Section 49557.2 of the
Education Code.
(B) The date of the Medi-Cal program application shall be the date
on which the school lunch application was received by the local
agency that determines eligibility under the Medi-Cal program.
(C) The county, in determining eligibility for the Medi-Cal
program, shall request additional documentation only as required by
federal law, and shall enroll any child whose parent or guardian does
not provide the necessary documentation for full-scope benefits
under the Medi-Cal program in the Medi-Cal program with limited scope
benefits, as described in Section 14007.5.
(i) To the extent federal financial participation is available,
and to the extent administratively feasible, the department shall
utilize the free National School Lunch Application developed under
Section 49557.2 of the Education Code, if supplemented as needed by
simplified forms and disclosures, including Medi-Cal rights and
responsibility notices and privacy notices, as a Medi-Cal application
for children described in this section.
(j) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall implement this section by means of all-county
letters or similar instructions without taking regulatory action.
Thereafter, the department shall adopt regulations in accordance with
the requirements of Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code.
(k) The department shall review the effectiveness of the statewide
pilot project and make recommendations regarding appropriate ways to
expand the use of the approaches contained in this section.
(l) In order to expedite health coverage for children who have
been determined eligible for free meals under the National School
Lunch Program, the department, at its discretion, may choose to
implement this section in whole or in part by exercising the option
described in Section 1396r-1a of Title 42 of the United States Code
to allow information provided on the National School Lunch Program
application referred to, and supplemented as described, in paragraph
(1) of subdivision (a) of Section 49557.2 of the Education Code to
serve as a basis for a preliminary eligibility determination by a
qualified entity designated by the department.
SEC. 44. Section 14011.6 of the Welfare and Institutions Code is
amended to read:
14011.6. (a) To the extent federal financial participation is
available, the department shall exercise the option provided in
Section 1920a of the federal Social Security Act (42 U.S.C. Sec.
1396r-1a) to implement a program for accelerated enrollment of
children.
(b) The department shall designate the single point of entry, as
defined in subdivision (c), as the qualified entity for determining
eligibility under this section.
(c) For purposes of this section, "single point of entry" means
the centralized processing entity that accepts and screens
applications for benefits under the Medi-Cal Program for the purpose
of forwarding them to the appropriate counties.
(d) The department shall implement this section only if, and to
the extent that, federal financial participation is available.
(e) The department shall seek federal approval of any state plan
amendments necessary to implement this section. When federal
approval of the state plan amendment or amendments is received, the
department shall commence implementation of this section on the first
day of the second month following the month in which federal
approval of the state plan amendment or amendments is received, or on
July 1, 2002, whichever is later.
(f) Notwithstanding any other provision of law, the department
shall implement this section only if, and to the extent that, the
federal State Children's Health Insurance Program waiver described in
Section 12693.755 of the Insurance Code is approved by the federal
government.
(g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any regulatory action, implement
this section by means of all-county letters. Thereafter, the
department shall adopt regulations in accordance with the
requirements of Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code.
(h) Upon the receipt of an application for a child who has
coverage pursuant to the accelerated enrollment program, a county
shall determine whether the child is eligible for Medi-Cal benefits.
If the county determines that the child does not meet the
eligibility requirements for participation in the Medi-Cal program,
the county shall report this finding to the Medical Eligibility Data
System so that accelerated enrollment coverage benefits are
discontinued. The information to be reported shall consist of the
minimum data elements necessary to discontinue that coverage for the
child. This subdivision shall become operative on July 1, 2002, or
the date that the program for accelerated enrollment coverage for
children takes effect, whichever is later.
SEC. 45. Section 14011.7 is added to the Welfare and Institutions
Code, to read:
14011.7. (a) To the extent allowed under federal law and only if
federal financial participation is available, the department shall
exercise the option provided in Section 1396r-1a of Title 42 of the
United States Code and the Managed Risk Medical Insurance Board shall
exercise the option provided in Section 1397gg(e)(1)(D) of Title 42
of the United States Code to implement a program for preenrollment of
children into the Medi-Cal program or the Healthy Families Program.
Upon the exercise of both of the federal options described in this
subdivision, the department shall implement and administer a program
of preenrollment of children into the Medi-Cal program or the Healthy
Families Program.
(b) Before July 1, 2003, the department shall develop an
electronic application to serve as the application for preenrollment
into the Medi-Cal program or the Healthy Families Program and to also
serve as an application for the Child Health and Disability
Prevention (CHDP) program, to the extent allowed under federal law.
(c) (1) The department may designate, as necessary, those CHDP
program providers described in paragraphs (1) to (5), inclusive, of
subdivision (g) of Section 124030 of the Health and Safety Code as
qualified entities who are authorized to determine eligibility for
the CHDP program and for preenrollment into either the Medi-Cal
program or the Healthy Families Program as authorized under this
section.
(2) The CHDP provider shall assist the parent or guardian of the
child seeking eligibility for the CHDP program and for preenrollment
into the Medi-Cal program or the Healthy Families Program in
completing the electronic application.
(d) The electronic application developed pursuant to subdivision
(b) may only be filed through the CHDP program when the child is in
need of CHDP program services in accordance with the periodicity
schedule used by the CHDP program.
(e) (1) The electronic application developed pursuant to
subdivision (b) shall request all information necessary for a CHDP
provider to make an immediate determination as to whether a child
meets the eligibility requirements for CHDP and for preenrollment
into either the Medi-Cal program or the Healthy Families Program
pursuant to the federal options described in Section 1396r-1a or
1397gg(e)(1)(D) of Title 42 of the United States Code.
(2) (A) If the electronic application indicates that the child is
seeking eligibility for either no cost full-scope Medi-Cal benefits
or enrollment in the Healthy Families Program, the department shall
mail to the child's parent or guardian a followup application for
Medi-Cal program eligibility or enrollment in the Healthy Families
Program. The parent or guardian of the child shall be advised to
complete and submit to the appropriate entity the followup
application.
(B) The followup application, at a minimum, shall include all
notices and forms necessary for both a Medi-Cal program and a Healthy
Families Program eligibility determination under state and federal
law, including, but not limited to, any information and documentation
that is required for the joint application package described in
Section 14011.1.
(C) The date of application for the Medi-Cal program or the
Healthy Families Program is the date the completed followup
application is submitted with the appropriate entity by the parent or
guardian.
(3) Upon making a determination pursuant to paragraph (1) that a
child is eligible, the CHDP provider shall inform the child's parent
or guardian of both of the following:
(A) That the child has been determined to be eligible for services
under the CHDP program and, if applicable, eligible for
preenrollment into either the Medi-Cal program or the Healthy
Families Program.
(B) That if the child has been determined to be eligible for
preenrollment into either the Medi-Cal program or the Healthy
Families Program, the period of preenrollment eligibility will end on
the last day of the month following the month in which the
determination of preenrollment eligibility is made, unless the parent
or guardian completes and returns to the appropriate entity the
followup application described in paragraph (2) on or before that
date.
(4) If the followup application described in paragraph (2) is
submitted on or before the last day of the month following the month
in which a determination is made that the child is eligible for
preenrollment into either the Medi-Cal program or the Healthy
Families Program, the period of preenrollment eligibility shall
continue until the completion of the determination process for the
applicable program or programs.
(f) The scope and delivery of benefits provided to a child who is
preenrolled for the Healthy Families Program pursuant to this section
shall be identical to the scope and delivery of benefits received by
a child who is preenrolled for the Medi-Cal program pursuant to this
section.
(g) The department and the Managed Risk Medical Insurance Board
shall seek approval of any amendments to the state plan, necessary to
implement this section, for purposes of funding under Title XIX (42
U.S.C. 1396 et seq.) and Title XXI (42 U.S.C. 1397aa et seq.) of the
Social Security Act. Notwithstanding any other provision of law and
only when all necessary federal approvals have been obtained, this
section shall be implemented only to the extent federal financial
participation is available.
(h) Upon the implementation of this section, this section shall
control in the event of a conflict with any provision of Article 6
(commencing with Section 124025) of Chapter 3 of Part 2 of Division
106 of the Health and Safety Code governing the Child Health and
Disability Prevention program.
(i) To implement this section, the department may contract with
public or private entities, or utilize existing health care service
provider enrollment and payment mechanisms, including the Medi-Cal
program's fiscal intermediary, only if services provided under the
program are specifically identified and reimbursed in a manner that
appropriately claims federal financial reimbursement. Contracts,
including the Medi-Cal fiscal intermediary contract for the Child
Health and Disability Prevention Program, including any contract
amendment, any system change pursuant to a change order, and any
project or systems development notice shall be exempt from Part 2
(commencing with Section 10100) of Division 2 of the Public Contract
Code, Chapter 7 (commencing with Section 11700) of Part 1 of Division
3 of Title 2 of the Government Code, Section 19130 of the Government
Code, and any policies, procedures, or regulations authorized by
these laws.
(j) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall implement this section by means of all-county
letters or similar instructions, without taking any further
regulatory action. Thereafter, the department shall adopt
regulations, as necessary, to implement this section in accordance
with the requirements of Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code.
(k) Notwithstanding subdivision (g), in no event shall this
section be implemented before April 1, 2003.
SEC. 46. Section 14011.8 is added to the Welfare and Institutions
Code, to read:
14011.8. (a) Benefits provided to an individual pursuant to a
preliminary determination as described in Section 1396r-1, 1396r-1a,
or 1396r-1b of Title 42 of the United States Code shall end, without
the necessity for any further review or determination by the
department, on or before the last day of the month following the
month in which the preliminary determination was made, unless an
application for medical assistance under the state plan is filed on
or before that date.
(b) If an application for medical assistance is filed on or before
the last day of the month following the month in which the
preliminary determination was made, preliminary benefits shall
continue until the regular eligibility determination based on the
application has been completed. The application shall be treated in
all respects as an initial application for benefits and the following
shall apply:
(1) In the case of an applicant who is found eligible for medical
assistance, benefits shall be granted in an amount and under those
conditions, including imposition of a share of cost, as have been
found applicable pursuant to the regular eligibility determination.
(2) In the case of all other applicants, provision of preliminary
benefits shall end on the day that the regular eligibility
determination is made.
(c) Notwithstanding any other provision of law, medical assistance
pursuant to a preliminary determination as described in Section
1396r-1, 1396r-1a, or 1396r-1b of Title 42 of the United States Code
shall be provided only if and to the extent federal financial
participation is available.
SEC. 47. Section 14011.9 is added to the Welfare and Institutions
Code, to read:
14011.9. (a) On or before October 1, 2002, the department shall
issue instructions to counties via an all-county letter or similar
instructions to establish an automated system for tracking the status
of applications received by county welfare departments from the
centralized processing entity that accepts and screens applications
for benefits under the Medi-Cal program for the purpose of forwarding
these applications to the appropriate counties. Except for
reporting denials of applications on behalf of children enrolled in
accelerated Medi-Cal coverage pursuant to subdivision (g) of Section
14011.6, the department shall not institute a process to require
county welfare departments to routinely manually report to the
Medi-Cal Eligibility Data System (MEDS) regarding the status of
applications for Medi-Cal coverage prior to the development of an
interface between that county's automated eligibility determination
system and the MEDS system for the purposes of implementing this
section. It is the intent of the Legislature that the Health Human
Services Data Center and the counties complete the automation changes
necessary to implement the automated tracking system on or before
July 1, 2003.
(b) This section shall be implemented only to the extent that
federal financial participation is not jeopardized.
(c) Nothing in this section shall be construed as prohibiting the
department from requiring a county to report on the status of an
individual application or to manually generate a report on a
statistically valid sampling of applications pursuant to federally
required monitoring activities.
SEC. 47.5. Section 14019.3 of the Welfare and Institutions Code is
amended to read:
14019.3. (a) A beneficiary or any person on behalf of the
beneficiary who has paid for health care services otherwise covered
by the Medi-Cal program received by the beneficiary shall be entitled
to a return from the provider of any part of the payment that meets
all of the following:
(1) Was rendered during any period prior to the receipt of his or
her Medi-Cal card, for which the card authorizes payment under
Section 14018 or 14019.
(2) Was reimbursed to the provider by the Medi-Cal program,
following all audits and appeals to which the provider is entitled.
(3) Is not payable by a third party under contractual or other
legal entitlement.
(4) Was not used to satisfy his or her paid or obligated liability
for health care services or to establish eligibility.
(b) To the extent permitted by federal law, whether or not a
facility actually evicts a beneficiary, a beneficiary who may validly
be evicted pursuant to Section 1439.7 of the Health and Safety Code,
and who has received and paid for health care services otherwise
covered by the Medi-Cal program shall not be entitled to the return
from the provider of any part of the payment for which service was
rendered during any period prior to the date upon which knowledge is
acquired by the licensee of the application of the beneficiary for
Medi-Cal or the date of application for Medi-Cal, whichever is later.
(c) Upon presentation of the Medi-Cal card or other proof of
eligibility, the provider shall submit a Medi-Cal claim for
reimbursement, subject to the rules and regulations of the Medi-Cal
program.
(d) Notwithstanding subdivision (c), payment received from the
state in accordance with Medi-Cal fee structures shall constitute
payment in full, except that a provider, after making a full refund
to the department of any Medi-Cal payments received for services, may
recover all provider fees to the extent that any other contractual
entitlement, including, but not limited to, a private group or
indemnification insurance program, is obligated to pay the charges
for the care provided the beneficiary.
(e) The provider shall return any and all payments made by the
beneficiary, or any person on behalf of the beneficiary, other than a
third party obligated to pay charges by reason of the beneficiary's
other contractual or legal entitlement for Medi-Cal program covered
services upon receipt of Medi-Cal payment.
(f) To the extent permitted by federal law, the department shall
waive overpayments made to a pharmacy provider that would otherwise
be reimbursable to the department for prescription drugs returned to
the pharmacy provider from a nursing facility upon discontinuation of
the drug therapy or death of the beneficiary.
SEC. 48. Section 14051 of the Welfare and Institutions Code is
amended to read:
14051. (a) "Medically needy person" means any of the following:
(1) An aged, blind, or disabled person who meets the definition of
aged, blind, or disabled under the Supplemental Security Income
Program and whose income and resources are insufficient to provide
for the costs of health care or coverage.
(2) A child in foster care for whom public agencies are assuming
financial responsibility, in whole or in part, or a person receiving
aid under Chapter 2.1 (commencing with Section 16115) of Part 4.
(3) A child who is eligible to receive Medi-Cal benefits pursuant
to interstate agreements for adoption assistance and related services
and benefits entered into under Chapter 2.6 (commencing with Section
16170) of Part 4, to the extent federal financial participation is
available.
(b) "Medically needy family person" means a parent or caretaker
relative of a child who meets the deprivation requirements of Aid to
Families with Dependent Children or a child under 21 years of age or
a pregnant woman of any age with a confirmed pregnancy, exclusive of
those persons specified in subdivision (a), whose income and
resources are insufficient to provide for the costs of health care or
coverage.
SEC. 49. Section 14085.7 of the Welfare and Institutions Code is
amended to read:
14085.7. (a) The Medi-Cal Medical Education Supplemental Payment
Fund is hereby created in the State Treasury. Notwithstanding
Section 13340 of the Government Code, the fund shall be continuously
appropriated to, and under the administrative control of, the
department for the purposes specified in this section. Except as
otherwise limited by this section, the fund shall consist of all of
the following:
(1) All public moneys transferred by public agencies to the
department for deposit into the fund, as permitted under Section
433.51 of Title 42 of the Code of Federal Regulations or any other
applicable federal medicaid laws.
(2) All private moneys donated by private individuals or entities
to the department for deposit in the fund as permitted under
applicable federal medicaid laws.
(3) Any amounts appropriated to the fund by the Legislature.
(4) Any interest that accrues on amounts in the fund.
(b) Any public agency transferring moneys to the fund may, for
that purpose, utilize any revenues, grants, or allocations received
from the state for health care programs or purposes, unless otherwise
prohibited by law. A public agency may also utilize its general
funds or any other public moneys or revenues for purposes of
transfers to the fund, unless otherwise prohibited by law.
(c) The department shall have the discretion to accept or not
accept moneys offered to the department for deposit in the fund. If
the department accepts moneys pursuant to this section, the
department shall obtain federal matching funds to the full extent
permitted by law. The department shall accept only those funds that
are certified by the transferring or donating entity as qualifying
for federal financial participation under the terms of the Medicaid
Voluntary Contribution and Provider-Specific Tax Amendments of 1991
(P.L. 102-234) or Section 433.51 of Title 42 of the Code of Federal
Regulations, as applicable, and may return any funds transferred or
donated in error.
(d) Moneys in the fund shall be used as the source for the
nonfederal share of payments to hospitals under this section. Moneys
shall be allocated from the fund by the department and matched by
federal funds in accordance with customary Medi-Cal accounting
procedures for purposes of payments under subdivision (e).
Distributions from the fund shall be supplemental to any other
amounts that hospitals receive under the contracting program.
(e) For purposes of recognizing medical education costs incurred
for services rendered to Medi-Cal beneficiaries, payments from this
fund shall be negotiated between the California Medical Assistance
Commission and hospitals contracting under this article that meet the
definition of university teaching hospitals or major (nonuniversity)
teaching hospitals as set forth on page 51 and as listed on page 57
of the department's report dated May 1991, entitled "Hospital Peer
Grouping." Payments from the fund shall be used solely for the
purposes identified in the contract between the hospital and the
state.
(f) The state shall be held harmless from any federal disallowance
resulting from this section. A hospital receiving supplemental
reimbursement pursuant to this section shall be liable for any
reduced federal financial participation resulting from the
implementation of this section with respect to that hospital. The
state may recoup any federal disallowance from the hospital.
(g) This section shall become inoperative on July 1, 2004, and, as
of January 1, 2005, is repealed, unless a later enacted statute,
that becomes effective on or before January 1, 2005, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 50. Section 14085.8 of the Welfare and Institutions Code is
amended to read:
14085.8. (a) The Large Teaching Emphasis Hospital and Children's
Hospital Medi-Cal Medical Education Supplemental Payment Fund is
hereby created in the State Treasury.
(b) Notwithstanding Section 13340 of the Government Code, the fund
shall be continuously appropriated to, and under the administrative
control of, the department for the purposes specified in this
section.
(c) Except as otherwise limited by this section, the fund shall
consist of all of the following:
(1) All public moneys transferred by public agencies to the
department for deposit into the fund, as permitted under Section
433.51 of Title 42 of the Code of Federal Regulations or any other
applicable federal medicaid laws.
(2) All private moneys donated by private individuals or entities
to the department for deposit in the fund as permitted under
applicable federal medicaid laws.
(3) Any amounts
appropriated to the fund by the Legislature.
(4) Any interest that accrues on amounts in the fund.
(d) Any public agency transferring moneys to the fund may, for
that purpose, utilize any revenues, grants, or allocations received
from the state for health care programs or purposes, unless otherwise
prohibited by law. A public agency may also utilize its general
funds or any other public moneys or revenues for purposes of
transfers to the fund, unless otherwise prohibited by law.
(e) The department may accept or not accept moneys offered to the
department for deposit in the fund. If the department accepts moneys
pursuant to this section, the department shall obtain federal
matching funds to the full extent permitted by law. The department
shall accept only those funds that are certified by the transferring
or donating entity as qualifying for federal financial participation
under the terms of the Medicaid Voluntary Contribution and
Provider-Specific Tax Amendments of 1991 (P.L. 102-234) or Section
433.51 of Title 42 of the Code of Federal Regulations, as applicable,
and may return any funds transferred or donated in error.
(f) Moneys in the fund shall be used as the source for the
nonfederal share of payments to hospitals under this section. Moneys
shall be allocated from the fund by the department and matched by
federal funds in accordance with customary Medi-Cal accounting
procedures for purposes of payments under subdivision (g).
Distributions from the fund shall be supplemental to any other
amounts that hospitals receive under the contracting program.
(g) (1) For purposes of recognizing medical education costs
incurred for services rendered to Medi-Cal beneficiaries, contracts
for payments from the fund may, at the discretion of the California
Medical Assistance Commission, be negotiated between the commission
and hospitals contracting under this article that are defined as
either of the following:
(A) A large teaching emphasis hospital, as set forth on page 51
and listed on page 57 of the department's report dated May 1991,
entitled "Hospital Peer Grouping," and meets the definition of
eligible hospital as defined in paragraph (3) of subdivision (a) of
Section 14105.98.
(B) A children's hospital pursuant to Section 10727 and meets the
definition of eligible hospital as defined in paragraph (3) of
subdivision (a) of Section 14105.98.
(2) Payments from the fund shall be used solely for the purposes
identified in the contract between the hospital and the state.
(h) The state shall be held harmless from any federal disallowance
resulting from this section. A hospital receiving supplemental
reimbursement pursuant to this section shall be liable for any
reduced federal financial participation resulting from the
implementation of this section with respect to that hospital. The
state may recoup any federal disallowance from the hospital.
(i) This section shall become inoperative on July 1, 2004, and, as
of January 1, 2005, is repealed, unless a later enacted statute,
that becomes effective on or before January 1, 2005, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 51. Section 14103.6 of the Welfare and Institutions Code, as
amended by Section 1 of Chapter 1005 of the Statutes of 1975, is
amended to read:
14103.6. The director, or a carrier acting under regulations
adopted by the director, may require that any individual provider
shall receive prior authorization before providing services when the
director or carrier determines that the provider has been rendering
unnecessary services.
At any time the director determines that it is necessary to
postpone elective services pursuant to Section 14120, he or she shall
require prior authorization for those services determined to be
generally elective under the provisions of Section 14103.4, except a
service which costs less than one hundred dollars ($100) or a lower
amount determined by the director. This lower amount may be applied
generally or for specific services. The director may terminate the
requirement for prior authorization when he or she determines that it
is no longer necessary to postpone elective services.
Prior authorization for services provided by persons licensed
under the provisions of Chapter 4 (commencing with Section 1600) and
Chapter 7 (commencing with Section 3000) of Division 2 of the
Business and Professions Code shall be determined by consultants
licensed under Chapter 4 or Chapter 7 respectively. Prior
authorization for all other elective services shall be determined by
consultants licensed under the provisions of Chapter 5 (commencing
with Section 2000) of Division 2 of the Business and Professions
Code, provided, however, that prior authorization for pharmaceutical
services may be determined by persons licensed under the provisions
of Chapter 9 (commencing with Section 4000) of Division 2 of the
Business and Professions Code, and prior authorization for services
provided in an inpatient setting may be reviewed and approved, but
not denied, by a person licensed under the provisions of Chapter 6
(commencing with Section 2700) of Division 2 of the Business and
Professions Code, working under the supervision of a consultant
licensed under the provisions of Chapter 5 (commencing with Section
2000) of Division 2 of the Business and Professions Code.
In no event shall prior authorization be required when there is a
bona fide emergency requiring immediate treatment.
In carrying out this section, notwithstanding Section 19130 of the
Government Code, the department may contract, either directly or
through the fiscal intermediary, for staff to accomplish the
treatment authorization request reviews and medical case management,
including appeals. The fiscal intermediary contract, including any
contract amendment, system change pursuant to a change order, and
project or systems development notice shall be exempt from Part 2
(commencing with Section 10100) of Division 2 of the Public Contract
Code, Chapter 7 (commencing with Section 11700) of Part 1 of Division
3 of Title 2 of the Government Code, and any policies, procedures,
or regulations authorized by those laws.
SEC. 52. Section 14103.6 of the Welfare and Institutions Code, as
amended by Section 1 of Chapter 682 of the Statutes of 1985, is
amended to read:
14103.6. The director, or a carrier acting under regulations
adopted by the director, may require that any individual provider
shall receive prior authorization before providing services when the
director or carrier determines that the provider has been rendering
unnecessary services.
At any time the director determines that it is necessary to
postpone elective services pursuant to Section 14120, he or she shall
require prior authorization for those services determined to be
generally elective under the provisions of Section 14103.4, except a
service which costs less than one hundred dollars ($100) or a lower
amount determined by the director. This lower amount may be applied
generally or for specific services. The director may terminate the
requirement for prior authorization when he or she determines that it
is no longer necessary to postpone elective services.
Prior authorization for services provided by persons licensed
under the provisions of Chapter 4 (commencing with Section 1600) and
Chapter 7 (commencing with Section 3000) of Division 2 of the
Business and Professions Code shall be determined by consultants
licensed under Chapter 4 or Chapter 7 respectively. Prior
authorization for all other elective services shall be determined by
consultants licensed under the provisions of Chapter 5 (commencing
with Section 2000) of Division 2 of the Business and Professions
Code, provided, however, that prior authorization for pharmaceutical
services may be determined by persons licensed under the provisions
of Chapter 9 (commencing with Section 4000) of Division 2 of the
Business and Professions Code, and prior authorization for services
provided in an inpatient setting may be reviewed and approved, but
not denied, by a person licensed under the provisions of Chapter 6
(commencing with Section 2700) of Division 2 of the Business and
Professions Code, working under the supervision of a consultant
licensed under the provisions of Chapter 5 (commencing with Section
2000) of Division 2 of the Business and Professions Code.
The consultants shall render decisions on prior authorization
requests in a timely manner. A timely manner shall be deemed to be
an average of five working days after the prior authorization request
is received by the department. A decision shall be an approval,
denial, modification, or request for additional information. A
supplemental authorization request submitted with additional
information requested by a consultant shall be processed in a timely
manner as if it were an original authorization request. If no
decision on a prior authorization request is rendered by the
consultant within 30 days of receipt by the department, the request
shall be deemed to be approved. Final decisions of the department on
all requests for prior authorization shall be reviewable under the
department's provider appeal and fair hearing procedures. If the
request is denied, the department shall send notice to the provider
and beneficiary of the right to appeal the decision.
In no event shall prior authorization be required when there is a
bona fide emergency requiring immediate treatment.
In carrying out this section, notwithstanding Section 19130 of the
Government Code, the department may contract, either directly or
through the fiscal intermediary, for staff to accomplish the
treatment authorization request reviews and medical case management,
including appeals. The fiscal intermediary contract, including any
contract amendment, system change pursuant to a change order, and
project or systems development notice shall be exempt from Part 2
(commencing with Section 10100) of Division 2 of the Public Contract
Code, Chapter 7 (commencing with Section 11700) of Part 1 of Division
3 of Title 2 of the Government Code, and any policies, procedures,
or regulations authorized by those laws.
SEC. 53. Section 14105.18 is added to the Welfare and Institutions
Code, to read:
14105.18. (a) Notwithstanding any other provision of law,
provider rates of payment for services rendered in all of the
following programs shall be identical to the rates of payment for the
same service performed by the same provider type pursuant to the
Medi-Cal program.
(1) The California Children's Services Program established
pursuant to Article 5 (commencing with Section 123800) of Chapter 3
of Part 2 of Division 106 of the Health and Safety Code.
(2) The Genetically Handicapped Person's Program established
pursuant to Article 1 (commencing with Section 125125) of Chapter 2
of Part 5 of Division 106 of the Health and Safety Code.
(3) The Breast and Cervical Cancer Early Detection Program
established pursuant to Article 1.5 (commencing with Section 104150)
of Chapter 2 of Part 1 of Division 103 of the Health and Safety Code
and the breast cancer programs specified in Section 30461.6 of the
Revenue and Taxation Code.
(4) The State-Only Family Planning Program established pursuant to
Division 24 (commencing with Section 24000).
(5) The Family Planning, Access, Care, and Treatment (Family PACT)
Waiver Program established pursuant to subdivision (aa) of Section
14132.
(b) The director may identify in regulations other programs not
listed in subdivision (a) in which providers shall be paid rates of
payment that are identical to the rates of payments in the Medi-Cal
program pursuant to subdivision (a).
(c) Notwithstanding subdivision (a), services provided under any
of the programs described in subdivisions (a) and (b) may be
reimbursed at rates greater than the Medi-Cal rate that would
otherwise be applicable if those rates are adopted by the director in
regulations.
SEC. 53.5. Section 14105.2 of the Welfare and Institutions Code is
amended to read:
14105.2. (a) The allowable markup payable for the dispensing of
medical supplies by assistive device and sickroom supply dealers and
pharmacies shall not exceed 23 percent of the cost of the item
dispensed, as defined by the department.
(b) Payment for diabetic testing supplies shall not exceed the
cost of the item dispensed, as defined by the department, plus a fee
equal to the maximum professional fee component used in the payment
for legend generic drug types.
SEC. 54. Section 14105.3 of the Welfare and Institutions Code is
amended to read:
14105.3. (a) The department is considered to be the purchaser,
but not the dispenser or distributor, of prescribed drugs under the
Medi-Cal program for the purpose of enabling the department to obtain
from manufacturers of prescribed drugs the most favorable price for
those drugs furnished by one or more manufacturers, based upon the
large quantity of the drugs purchased under the Medi-Cal program, and
to enable the department, notwithstanding any other provision of
state law, to obtain from the manufacturers discounts, rebates, or
refunds based on the quantities purchased under the program, insofar
as may be permissible under federal law. Nothing in this section
shall interfere with usual and customary distribution practices in
the drug industry.
(b) The department may enter into exclusive or nonexclusive
contracts on a bid or negotiated basis with manufacturers,
distributors, dispensers, or suppliers of appliances, durable medical
equipment, medical supplies, and other product-type health care
services and with laboratories for clinical laboratory services for
the purpose of obtaining the most favorable prices to the state and
to assure adequate quality of the product or service. This
subdivision shall not apply to pharmacies licensed pursuant to
Section 4080 of the Business and Professions Code.
(c) Notwithstanding subdivision (b), the department may not enter
into a contract with a clinical laboratory unless the clinical
laboratory operates in conformity with Chapter 3 (commencing with
Section 1200) of Division 2 of the Business and Professions Code and
the regulations adopted thereunder, and Section 263a of Title 42 of
the United States Code and the regulations adopted thereunder.
(d) The department shall contract with manufacturers of
single-source drugs on a negotiated basis, and with manufacturers of
multisource drugs on a bid or negotiated basis.
(e) In carrying out contracting activity for this or any section
associated with the Medi-Cal list of contract drugs, notwithstanding
Section 19130 of the Government Code, the department may contract,
either directly or through the fiscal intermediary, for pharmacy
consultant staff necessary to accomplish the contracting process or
treatment authorization request reviews. The fiscal intermediary
contract, including any contract amendment, system change pursuant to
a change order, and project or systems development notice shall be
exempt from Part 2 (commencing with Section 10100) of Division 2 of
the Public Contract Code, Chapter 7 (commencing with Section 11700)
of Part 1 of Division 3 of Title 2 of the Government Code, and any
policies, procedures, or regulations authorized by these provisions.
(f) In order to achieve maximum cost savings the Legislature
hereby determines that an expedited contract process for contracts
under this section is necessary. Therefore contracts under this
section shall be exempt from Chapter 2 (commencing with Section
10290) of Part 2 of Division 2 of the Public Contract Code.
(g) For purposes of implementing the contracting provisions
specified in this section, the department shall do all of the
following:
(1) Ensure adequate access for Medi-Cal patients to quality
laboratory testing services in the geographic regions of the state
where contracting occurs.
(2) Consult with the statewide association of clinical
laboratories and other appropriate stakeholders on the implementation
of the contracting provisions specified in this section to ensure
maximum access for Medi-Cal patients consistent with the savings
targets projected by the 2002-03 Budget Conference Committee for
clinical laboratory services provided under the Medi-Cal program.
(3) Consider which types of laboratories are appropriate for
implementing the contracting provisions specified in this section,
including independent laboratories, outreach laboratory programs of
hospital based laboratories, clinic laboratories, physician office
laboratories, and group practice laboratories.
SEC. 55. Section 14105.31 of the Welfare and Institutions Code is
amended to read:
14105.31. For purposes of the Medi-Cal contract drug list, the
following definitions shall apply:
(a) "Single-source drug" means a drug that is produced and
distributed under an original New Drug Application approved by the
federal Food and Drug Administration. This shall include a drug
marketed by the innovator manufacturer and any cross-licensed
producers or distributors operating under the New Drug Application,
and shall also include a biological product, except for vaccines,
marketed by the innovator manufacturer and any cross-licensed
producers or distributors licensed by the federal Food and Drug
Administration pursuant to Section 262 of Title 42 of the United
States Code. A drug ceases to be a single-source drug when the same
drug in the same dosage form and strength manufactured by another
manufacturer is approved by the federal Food and Drug Administration
under the provisions for an Abbreviated New Drug Application.
(b) "Best price" means the negotiated price, or the manufacturer's
lowest price available to any class of trade organization or entity,
including, but not limited to, wholesalers, retailers, hospitals,
repackagers, providers, or governmental entities within the United
States, that contracts with a manufacturer for a specified price for
drugs, inclusive of cash discounts, free goods, volume discounts,
rebates, and on- or off-invoice discounts or credits, shall be based
upon the manufacturer's commonly used retail package sizes for the
drug sold by wholesalers to retail pharmacies.
(c) "Equalization payment amount" means the amount negotiated
between the manufacturer and the department for reimbursement by the
manufacturer, as specified in the contract. The equalization payment
amount shall be based on the difference between the manufacturer's
direct catalog price charged to wholesalers and the manufacturer's
best price, as defined in subdivision (b).
(d) "Manufacturer" means any person, partnership, corporation, or
other institution or entity that is engaged in the production,
preparation, propagation, compounding, conversion, or processing of
drugs, either directly or indirectly by extraction from substances of
natural origin, or independently by means of chemical synthesis, or
by a combination of extraction and chemical synthesis, or in the
packaging, repackaging, labeling, relabeling, and distribution of
drugs.
(e) "Price escalator" means a mutually agreed upon price specified
in the contract, to cover anticipated cost increases over the life
of the contract.
(f) "Medi-Cal pharmacy costs" or "Medi-Cal drug costs" means all
reimbursements to pharmacy providers for services or merchandise,
including single-source or multiple-source prescription drugs,
over-the-counter medications, and medical supplies, or any other
costs billed by pharmacy providers under the Medi-Cal program.
(g) "Medicaid rebate" means the rebate payment made by drug
manufacturers pursuant to Section 1927 of the federal Social Security
Act (42 U.S.C. Sec. 1396r-8).
(h) "State rebate" means any negotiated rebate under the Drug
Discount Program in addition to the medicaid rebate.
(i) "Date of mailing" means the date that is evidenced by the
postmark date by the United States Postal Service or other common
mail carrier on the envelope.
SEC. 56. Section 14105.33 of the Welfare and Institutions Code is
amended to read:
14105.33. (a) The department may enter into contracts with
manufacturers of single-source and multiple-source drugs, on a bid or
nonbid basis, for drugs from each major therapeutic category, and
shall maintain a list of those drugs for which contracts have been
executed.
(b) (1) Contracts executed pursuant to this section shall be for
the manufacturer's best price, as defined in Section 14105.31, which
shall be specified in the contract, and subject to agreed-upon price
escalators, as defined in that section. The contracts shall provide
for an equalization payment amount, as defined in Section 14105.31,
to be remitted to the department quarterly. The department shall
submit an invoice to each manufacturer for the equalization payment
amount, including supporting utilization data from the department's
prescription drug paid claims tapes within 30 days of receipt of the
Centers for Medicare and Medicaid Services' file of manufacturer
rebate information. In lieu of paying the entire invoiced amount, a
manufacturer may contest the invoiced amount pursuant to procedures
established by the federal Centers for Medicare and Medicaid Services'
Medicaid Drug Rebate Program Releases or regulations by mailing a
notice, that shall set forth its grounds for contesting the invoiced
amount, to the department within 38 days of the department's mailing
of the state invoice and supporting utilization data. For purposes
of state accounting practices only, the contested balance shall not
be considered an accounts receivable amount until final resolution of
the dispute pursuant to procedures established by the federal
Centers for Medicare and Medicaid Services' Medicaid Drug Rebate
Program Releases or regulations that results in a finding of an
underpayment by the manufacturer. Manufacturers may request, and the
department shall timely provide, at cost, Medi-Cal provider level
drug utilization data, and other Medi-Cal utilization data necessary
to resolve a contested department-invoiced rebate amount.
(2) The department shall provide for an annual audit of
utilization data used to calculate the equalization amount to verify
the accuracy of that data. The findings of the audit shall be
documented in a written audit report to be made available to
manufacturers within 90 days of receipt of the report from the
auditor. Any manufacturer may receive a copy of the audit report
upon written request. Contracts between the department and
manufacturers shall provide for any equalization payment adjustments
determined necessary pursuant to an audit.
(3) Utilization data used to determine an equalization payment
amount shall exclude data from both of the following:
(A) Health maintenance organizations, as defined in Section 300e
(a) of Title 42 of the United States Code, including those
organizations that contract under Section 1396b(m) of Title 42 of the
United States Code.
(B) Capitated plans that include a prescription drug benefit in
the capitated rate, and that have negotiated contracts for rebates or
discounts with manufacturers.
(c) In order that Medi-Cal beneficiaries may have access to a
comprehensive range of therapeutic agents, the department shall
ensure that there is representation on the list of contract drugs in
all major therapeutic categories. Except as provided in subdivision
(a) of Section 14105.35, the department shall not be required to
contract with all manufacturers who negotiate for a contract in a
particular category. The department shall ensure that there is
sufficient representation of single-source and multiple-source drugs,
as appropriate, in each major therapeutic category.
(d) The department shall select the therapeutic categories to be
included on the list of contract drugs, and the order in which it
seeks contracts for those categories. The department may establish
different contracting schedules for single-source and multiple-source
drugs within a given therapeutic category.
(e) (1) In order to fully implement subdivision (d), the
department shall, to the extent necessary, negotiate or renegotiate
contracts to ensure there are as many single-source drugs within each
therapeutic category or subcategory as the department determines
necessary to meet the health needs of the Medi-Cal population. The
department may determine in selected therapeutic categories or
subcategories that no single-source drugs are necessary because there
are currently sufficient multiple-source drugs in the therapeutic
category or subcategory on the list of contract drugs to meet the
health needs of the Medi-Cal population. However, in no event shall
a beneficiary be denied continued use of a drug which is part of a
prescribed therapy in effect as of September 2, 1992, until the
prescribed therapy is no longer prescribed.
(2) In the development of decisions by the department on the
required number of single-source drugs in a therapeutic category or
subcategory, and the relative therapeutic merits of each drug in a
therapeutic category or subcategory, the department shall consult
with the Medi-Cal Contract Drug Advisory Committee. The committee
members shall communicate their comments and recommendations to the
department within 30 business days of a request for consultation, and
shall disclose any associations with pharmaceutical manufacturers or
any remuneration from pharmaceutical manufacturers.
(f) In order to achieve maximum cost savings, the Legislature
declares that an expedited process for contracts under this section
is necessary. Therefore, contracts entered into on a nonbid basis
shall be exempt from Chapter 2 (commencing with Section 10290) of
Part 2 of Division 2 of the Public Contract Code.
(g) In no event shall a beneficiary be denied continued use of a
drug that is part of a prescribed therapy in effect as of September
2, 1992, until the prescribed therapy is no longer prescribed.
(h) Contracts executed pursuant to this section shall be
confidential and shall be exempt from disclosure under the California
Public Records Act (Chapter 3.5 (commencing with Section 6250) of
Division 7 of Title 1 of the Government Code).
(i) The department shall provide individual notice to Medi-Cal
beneficiaries at least 60 calendar days prior to the effective date
of the deletion or suspension of any drug from the list of contract
drugs. The notice shall include a description of the beneficiary's
right to a fair hearing and shall encourage the beneficiary to
consult a physician to determine if an appropriate substitute
medication is available
from Medi-Cal.
(j) In carrying out the provisions of this section, the department
may contract either directly, or through the fiscal intermediary,
for pharmacy consultant staff necessary to initially accomplish the
treatment authorization request reviews.
(k) (1) Manufacturers shall calculate and pay interest on late or
unpaid rebates. The interest shall not apply to any prior period
adjustments of unit rebate amounts or department utilization
adjustments.
(2) For state rebate payments, manufacturers shall calculate and
pay interest on late or unpaid rebates for quarters that begin on or
after the effective date of the act that added this subdivision.
(3) Following final resolution of any dispute pursuant to
procedures established by the federal Centers for Medicare and
Medicaid Services' Medicaid Drug Rebate Program Releases or
regulations regarding the amount of a rebate, any underpayment by a
manufacturer shall be paid with interest calculated pursuant to
subdivisions (m) and (n), and any overpayment, together with interest
at the rate calculated pursuant to subdivisions (m) and (n), shall
be credited by the department against future rebates due.
(l) Interest pursuant to subdivision (k) shall begin accruing 38
calendar days from the date of mailing of the invoice, including
supporting utilization data sent to the manufacturer. Interest shall
continue to accrue until the date of mailing of the manufacturer's
payment.
(m) Except as specified in subdivision (n), interest rates and
calculations pursuant to subdivision (k) for medicaid rebates and
state rebates shall be identical and shall be determined by the
federal Centers for Medicare and Medicaid Services' Medicaid Drug
Rebate Program Releases or regulations.
(n) If the date of mailing of a state rebate payment is 69 days or
more from the date of mailing of the invoice, including supporting
utilization data sent to the manufacturer, the interest rate and
calculations pursuant to subdivision (k) shall be as specified in
subdivision (m), however the interest rate shall be increased by 10
percentage points. This subdivision shall apply to payments for
amounts invoiced for any quarters that begin on or after the
effective date of the act that added this subdivision.
(o) If the rebate payment is not received, the department shall
send overdue notices to the manufacturer at 38, 68, and 98 days after
the date of mailing of the invoice, and supporting utilization data.
If the department has not received a rebate payment, including
interest, within 180 days of the date of mailing of the invoice,
including supporting utilization data, the manufacturer's contract
with the department shall be deemed to be in default and the contract
may be terminated in accordance with the terms of the contract. For
all other manufacturers, if the department has not received a rebate
payment, including interest, within 180 days of the date of mailing
of the invoice, including supporting utilization data, all of the
drug products of those manufacturers shall be made available only
through prior authorization effective 270 days after the date of
mailing of the invoice, including utilization data sent to
manufacturers.
(p) If the manufacturer provides payment or evidence of payment to
the department at least 40 days prior to the proposed date the drug
is to be made available only through prior authorization pursuant to
subdivision (o), the department shall terminate its actions to place
the manufacturers' drug products on prior authorization.
(q) The department shall direct the state's fiscal intermediary to
remove prior authorization requirements imposed pursuant to
subdivision (o) and notify providers within 60 days after payment by
the manufacturer of the rebate, including interest. If a contract
was in place at the time the manufacturers' drugs were placed on
prior authorization, removal of prior authorization requirements
shall be contingent upon good faith negotiations and a signed
contract with the department.
(r) A beneficiary may obtain drugs placed on prior authorization
pursuant to subdivision (o) if the beneficiary qualifies for
continuing care status. To be eligible for continuing care status, a
beneficiary must be taking the drug when its manufacturer is placed
on prior authorization status. Additionally, the department shall
have received a claim for the drug with a date of service that is
within 100 days prior to the date the manufacturer was placed on
prior authorization.
(s) A beneficiary may remain eligible for continuing care status,
provided that a claim is submitted for the drug in question at least
every 100 days and the date of service of the claim is within 100
days of the date of service of the last claim submitted for the same
drug.
(t) Drugs covered pursuant to Sections 14105.43 and 14133.2 shall
not be subject to prior authorization pursuant to subdivision (o),
and any other drug may be exempted from prior authorization by the
department if the director determines that an essential need exists
for that drug, and there are no other drugs currently available
without prior authorization that meet that need.
(u) It is the intent of the Legislature in enacting subdivisions
(k) to (t), inclusive, that the department and manufacturers shall
cooperate and make every effort to resolve rebate payment disputes
within 90 days of notification by the manufacturer to the department
of a dispute in the calculation of rebate payments.
SEC. 57. Section 14105.332 is added to the Welfare and
Institutions Code, to read:
14105.332. State and federal rebates that are owed to the state
for drugs dispensed to fee-for-service Medi-Cal beneficiaries shall
not be reduced to the state if a manufacturer reports, to the Centers
for Medicare and Medicaid Services or the department, a revised drug
product's average manufacturer price or best price as these terms
are defined pursuant to Section 1927 of the federal Social Security
Act (42 U.S.C. Sec. 1396r-8) for any calendar quarter in which the
rebate was due.
SEC. 58. Section 14105.337 of the Welfare and Institutions Code is
amended to read:
14105.337. (a) Effective January 1, 2000, the department shall
increase reimbursement to pharmacists by twenty-five cents ($0.25)
per prescription for all drug prescription claims reimbursed through
the Medi-Cal program.
(b) Effective July 1, 2002, the department shall increase
reimbursement to pharmacists by an additional fifteen cents ($0.15)
per prescription for all drug prescription claims reimbursed through
the Medi-Cal program.
(c) (1) The department shall reduce reimbursement to pharmacists
in the amount reimbursement was increased pursuant to subdivisions
(a) and (b) with respect to pharmacy services rendered on and after
the date that this subdivision is enacted. Claims submitted by
pharmacists for beneficiaries residing in a nursing facility shall be
exempt from this subdivision.
(2) This subdivision shall become inoperative on July 1, 2004.
SEC. 59. Section 14105.34 of the Welfare and Institutions Code is
amended to read:
14105.34. (a) The department shall provide for an annual written
report of Medi-Cal pharmacy costs or Medi-Cal drug costs, as defined
in subdivision (f) of Section 14105.31.
(b) The annual report shall be consistent with the relevant
sections of the Quarterly Report of Expenditures for the Medi-Cal
Assistance Program, known as the HCFA-64 Report, provided to the
Centers for Medicare and Medicaid Services. The report shall include
the following expenditure and receipt information:
(1) The total annual equalization payment amounts received by the
department pursuant to agreements with the Centers for Medicare and
Medicaid Services of the United States Department of Health and Human
Services.
(2) The total annual equalization payment amounts received
pursuant to state contracts with drug manufacturers.
(3) Total drug cost amounts upon which equalization payments were
made.
SEC. 60. Section 14105.35 of the Welfare and Institutions Code is
amended to read:
14105.35. (a) (1) On and after July 1, 1990, drugs included on
the Medi-Cal drug formulary shall be included on the list of contract
drugs until the department and the manufacturer have concluded
contract negotiations or the department suspends the drug from the
list of contract drugs pursuant to the provisions of this
subdivision.
The department shall, in writing, invite any manufacturer with
single-source drug products on the formulary as of July 1, 1990, to
enter into negotiations relative to the retention of its drug or
drugs. As to the issue of cost, the department shall accept the
manufacturer's best price as sufficient for purposes of entering into
a contract to retain the drug or drugs on the list of contract
drugs.
If the department and a manufacturer enter into a contract for
retention of a drug or drugs on the list of contract drugs, the drug
or drugs shall be retained on the list of contract drugs for the
effective term of the contract.
If a manufacturer refuses to enter into negotiations with the
department pursuant to this subdivision, or if after 30 days of
negotiation, the manufacturer has not agreed to execute a contract
for a drug at the manufacturer's best price, the department may
suspend from the list of contract drugs the manufacturer's
single-source drug in question for a period of at least 180 days.
The department shall lift the suspension upon execution of a contract
for that drug. Consistent with the provisions of this section, the
department shall delete the Medi-Cal drug formulary specified in
paragraphs (b), (c), (d), and (e) of Section 59999 of Title 22 of the
California Code of Regulations.
(2) On and after July 1, 1990, the director may retain a drug on
the Medi-Cal list of contract drugs even if no contract is executed
with a manufacturer, if the director determines that an essential
need exists for that drug, and there are no other drugs currently on
the formulary that meet that need.
(3) The director may delete a drug from the list of contract drugs
if the director determines that the drug presents problems of safety
or misuse. The director's decision as to safety shall be based upon
published medical literature, and the director's decision as to
misuse shall be based on published medical literature and claims data
supplied by the fiscal intermediary.
(b) Any reference to the Medi-Cal drug formulary by statute or
regulation shall be construed as referring to the list of contract
drugs.
(c) (1) Any drug in the process of being added to the formulary by
contract agreement pursuant to Section 14105.3, executed prior to
the effective date of this section, shall be added to the list of
contract drugs.
(2) Contracts pursuant to Section 14105.3 executed prior to
January 1, 1991, shall be considered to be contracts executed
pursuant to Section 14105.33, and the department shall exempt the
drugs included in these contracts from the initial therapeutic
category review in which they would normally be considered.
(3) Nothing in this section shall be construed to require the
department to discontinue negotiations into which it has entered with
any manufacturer as of the effective date of this section.
Contracts entered into as a result of these negotiations shall be
exempt from the initial therapeutic category review in which they
would normally be considered.
SEC. 61. Section 14105.37 of the Welfare and Institutions Code is
amended to read:
14105.37. (a) The department shall notify each manufacturer of
drugs in therapeutic categories selected pursuant to Section 14105.33
of the provisions of Sections 14105.31 to 14105.42, inclusive.
(b) If, within 45 days of notification, a manufacturer does not
enter into negotiations for a contract pursuant to those sections,
the department may suspend or delete from the list of contract drugs,
or refuse to consider for addition, drugs of that manufacturer in
the selected therapeutic categories.
(c) If, after 150 days from the initial notification, a contract
is not executed for a drug currently on the list of contract drugs,
the department may suspend or delete the drug from the list of
contract drugs.
(d) If, within 150 days from the initial notification, a contract
is executed for a drug currently on the list of contract drugs, the
department shall retain the drug on the list of contract drugs.
(e) If, within 150 days from the date of the initial notification,
a contract is executed for a drug not currently on the list of
contract drugs, the department shall add the drug to the list of
contract drugs.
(f) The department shall terminate all negotiations 150 days after
the initial notification.
(g) The department may suspend or delete any drug from the list of
contract drugs at the expiration of the contract term or when the
contract between the department and the manufacturer of that drug is
terminated.
(h) In the absence of a contract, the department may suspend or
delete any drug from the list of contract drugs.
(i) Any drug suspended from the list of contract drugs pursuant to
this section or Section 14105.35 shall be subject to prior
authorization, as if that drug were not on the list of contract
drugs.
(j) Any drug suspended from the list of contract drugs pursuant to
this section or Section 14105.35 may be deleted from the list of
contract drugs in accordance with Section 14105.38.
SEC. 62. Section 14105.38 of the Welfare and Institutions Code is
amended to read:
14105.38. (a) (1) In the event the department determines a drug
should be deleted from the list of contract drugs, the department
shall conduct a public hearing, as provided in this section, to
receive comment on the impact of removing the drug.
(2) (A) The department shall provide written notice 30 days prior
to the hearing.
(B) The department shall send the notice required by this
subdivision to the manufacturer of the drug proposed to be deleted
and to organizations representing Medi-Cal beneficiaries.
(b) (1) The hearing panel shall consist of the Chief, Medi-Cal
Drug Discount Program, who shall serve as chair, and the Medi-Cal
Contract Drug Advisory Committee.
(2) The hearing shall be recorded and transcribed, and the
transcript available for public review.
(3) Subsequent to hearing all public comment, and within 30 days
of the hearing, each panel member shall submit a recommendation
regarding deletion of the drug and the reason for the recommendation
to the director.
(c) The director shall consider public comments provided at the
hearing and the recommendations of each panel member in determining
whether to delete the drug.
SEC. 63. Section 14105.39 of the Welfare and Institutions Code is
amended to read:
14105.39. (a) (1) A manufacturer of a new single-source drug may
request inclusion of its drug on the list of contract drugs pursuant
to Section 14105.33 provided all of the following conditions are met:
(A) The request is made within 12 months of approval for marketing
by the federal Food and Drug Administration.
(B) The manufacturer agrees to negotiate a contract with the
department to provide the drug at the manufacturer's best price.
(C) (i) The manufacturer provides the department with necessary
information, as specified by the department, in the request.
(ii) Notwithstanding clause (i), either of the following may be
submitted by the manufacturer in lieu of the Summary Basis of
Approval prepared by the federal Food and Drug Administration for
that drug:
(I) The federal Food and Drug Administration's approval or
approvable letter for the drug and federal Food and Drug
Administration's approved labeling.
(II) The federal Food and Drug Administration's medical officers'
and pharmacologists' reviews and the federal Food and Drug
Administration's approved labeling.
(D) The department had concluded contracting for the therapeutic
category in which the drug is included prior to approval of the drug
by the federal Food and Drug Administration.
(2) Within 90 days from receipt of the request, the department
shall evaluate the request using the criteria identified in
subdivision (d), and shall submit the drug to the Medi-Cal Contract
Drug Advisory Committee.
(b) Any petition for the addition to or deletion of a drug to the
Medi-Cal drug formulary submitted prior to July 31, 1990, shall be
deemed to be denied. A manufacturer who has submitted a petition
deemed denied may request inclusion of that drug on the list of
contract drugs provided all of the following conditions are met:
(1) The manufacturer agrees to negotiate for a contract with the
department to provide the drug at the manufacturer's best price.
(2) The manufacturer provides the department with necessary
information, as specified by the department, in the request.
(3) The manufacturer submits the request to the department prior
to October 1, 1990.
(c) (1) To ensure that the health needs of Medi-Cal beneficiaries
are met consistent with the intent of this chapter, the department
shall, when evaluating a decision to execute a contract, and when
evaluating drugs for retention on, addition to, or deletion from, the
list of contract drugs, use all of the following criteria:
(A) The safety of the drug.
(B) The effectiveness of the drug.
(C) The essential need for the drug.
(D) The potential for misuse of the drug.
(E) The cost of the drug.
(2) The deficiency of a drug when measured by one of these
criteria may be sufficient to support a decision that the drug should
not be added or retained, or should be deleted from the list.
However, the superiority of a drug under one criterion may be
sufficient to warrant the addition or retention of the drug,
notwithstanding a deficiency in another criterion.
(d) (1) A manufacturer of single-source drugs denied a contract
pursuant to this section or Section 14105.33 or 14105.37, may file an
appeal of that decision with the director within 30 calendar days of
the department's written decision.
(2) Within 30 calendar days of the manufacturer's appeal, the
director shall request a recommendation regarding the appeal from the
Medi-Cal Contract Drug Advisory Committee. The committee shall
provide its recommendation in writing, within 30 calendar days of the
director's request.
(3) The director shall issue a final decision on the appeal within
30 calendar days of the recommendation.
(e) Deletions made to the list of contract drugs, including those
made pursuant to Section 14105.37, shall become effective no sooner
than 30 days after publication of the changes in provider bulletins.
(f) A manufacturer of a drug deleted from, or not added to, the
list of contract drugs may request inclusion of the drug on the list
of preferred prior authorization drugs that is hereby established as
a subset of the list of contract drugs. To ensure that the health
needs of Medi-Cal beneficiaries are met, the department shall
evaluate the request pursuant to subdivision (c). The department
shall give preference for prior authorization drugs based on the
medical need or continuing care of the beneficiary. The department
may contract with manufacturers of drugs on the list of preferred
prior authorization drugs. Contracts executed pursuant to this
subdivision are subject to Section 14105.33.
(g) Changes made to the list of contract drugs under this or any
other section are exempt from the requirements of the Administrative
Procedure Act (Chapter 3.5 (commencing with Section 11340), Chapter 4
(commencing with Section 11370), and Chapter 5 (commencing with
Section 11500) of Part 1 of Division 3 of Title 2 of the Government
Code), and shall not be subject to the review and approval of the
Office of Administrative Law.
SEC. 64. Section 14105.4 of the Welfare and Institutions Code, as
amended by Section 78 of Chapter 93 of the Statutes of 2000, is
repealed.
SEC. 65. Section 14105.4 of the Welfare and Institutions Code, as
amended by Section 77 of Chapter 93 of the Statutes of 2000, is
amended to read:
14105.4. (a) The director shall appoint a Medi-Cal Contract Drug
Advisory Committee for the purpose of providing scientific and
medical analysis on drugs contained on the list of contract drugs.
The duties of the committee shall be as follows:
(1) To review drugs in the Medi-Cal list of contract drugs and
make written recommendations to the director as to the addition of
any drug or the deletion of any drug from the list. These
recommendations shall be in accordance with subdivision (c) of
Section 14105.39.
(2) To review and report in writing to the director as to the
comparative therapeutic effect of drugs in accordance with Section
14053.5.
(3) To prepare a fair, impartial, and independent recommendation
in writing, regarding appeals from manufacturers made pursuant to
subdivision (d) of Section 14105.39.
(b) The committee shall consist of at least one representative
from each of the following groups:
(1) Physicians.
(2) Pharmacists.
(3) Schools of pharmacy or pharmacologists.
(4) Medi-Cal beneficiaries.
(c) Members of the committee shall be reimbursed for necessary
travel and other expenses incurred in the performance of official
committee duties.
(d) In order to provide sufficient scientific information and
analysis in the therapeutic categories under review, the director may
replace a representative if required for specific expertise.
(e) The director shall notify the committee of the decisions made
on the recommendations.
SEC. 66. Section 14105.405 of the Welfare and Institutions Code is
amended to read:
14105.405. (a) A Medi-Cal beneficiary, within 90 days of receipt
of the director's notice to beneficiaries pursuant to subdivision (i)
of Section 14105.33, informing them of the decision to delete or
suspend a drug from the list of contract drugs, may request a fair
hearing pursuant to Chapter 7 (commencing with Section 10950) of Part
2.
(b) Any beneficiary filing a fair hearing request regarding the
deletion or suspension of a drug from the list of contract drugs
shall be granted a treatment authorization request for that drug
until a final decision is adopted by the director. Should the
beneficiary seek judicial review of the director's decision, a
treatment authorization request shall be granted for that drug until
a final decision is issued by the court.
(c) (1) Any Medi-Cal beneficiary, within one year of the director'
s decision pursuant to Section 10959, may file a petition with the
superior court, under the provisions of Section 1094.5 of the Code of
Civil Procedure, praying for a review of both the legal and factual
basis for the director's decision.
(2) The director shall be the sole respondent in these
proceedings.
(d) Any Medi-Cal beneficiary injured as a result of being denied a
drug which is determined to be medically necessary may sue for
injunctive or declaratory relief to review the director's decision to
delete or suspend a drug from the list of contract drugs.
SEC. 67. Section 14105.41 of the Welfare and Institutions Code, as
amended by Section 81 of Chapter 93 of the Statutes of 2000, is
repealed.
SEC. 68. Section 14105.41 of the Welfare and Institutions Code, as
amended by Section 80 of Chapter 93 of the Statutes of 2000, is
amended to read:
14105.41. Moneys accruing to the department from contracts
executed pursuant to Section 14105.33 shall be deposited in the
Health Care Deposit Fund, and shall be subject to appropriation by
the Legislature.
SEC. 69. Section 14105.42 of the Welfare and Institutions Code is
amended to read:
14105.42. (a) The department shall report to the Legislature
after the first three major therapeutic categories have been reviewed
and contracts executed. The report shall include the estimated
savings, number of manufacturers entering negotiations, number of
contracts executed, number of drugs added and deleted, and impact on
Medi-Cal beneficiaries and providers.
(b) The department shall report to the Legislature, through the
annual budget process, on the cost-effectiveness of contracts
executed pursuant to Section 14105.33.
SEC. 70. Section 14105.43 of the Welfare and Institutions Code is
amended to read:
14105.43. (a) (1) Notwithstanding other provisions of this
chapter, any drug which is approved by the federal Food and Drug
Administration for use in the treatment of acquired immune deficiency
syndrome (AIDS) or an AIDS-related condition shall be deemed to be
approved for addition to the Medi-Cal list of contract drugs only for
the purpose of treating AIDS or an AIDS-related condition, for the
period prior to the completion of the procedures established pursuant
to Section 14105.33.
(2) (A) In addition to any drug that is deemed to be approved
pursuant to paragraph (1), any drug that meets any of the following
criteria shall be a Medi-Cal benefit, subject to utilization
controls:
(i) Any vaccine to protect against human immunodeficiency virus
(HIV) infection.
(ii) Any antiviral agent, immune modulator, or other agent to be
administered to persons who have been infected with human
immunodeficiency virus to counteract the effects of that infection.
(iii) Any drug or biologic used to treat opportunistic infections
associated with acquired immune deficiency syndrome, that have been
found to be medically accepted indications and that has either been
approved by the federal Food and Drug Administration or recognized
for that use in one of the following:
(I) The American Medical Association Drug Evaluations.
(II) The United States Pharmacopoeia Dispensing Information.
(III) Two articles from peer reviewed medical journals that
present data supporting the proposed use or uses as generally safe
and effective.
(iv) Any drug or biologic used to treat the chemotherapy-induced
suppression of the human immune system resulting from the treatment
of acquired immune deficiency syndrome.
(3) The department shall add any drug deemed to be approved
pursuant to paragraph (1) to the Medi-Cal list of contract drugs or
allow the provision of the drug as a Medi-Cal benefit, subject to
utilization controls, pursuant to paragraph (2), only if the
manufacturer of the drug has executed a contract with the Centers for
Medicare and Medicaid Services which provides for rebates in
accordance with Section 1396r-8 of Title 42 of the United States
Code.
(b) Any drug deemed to be
approved pursuant to paragraph (1) of subdivision (a) shall be
immediately added to the Medi-Cal list of contract drugs, and shall
be exempt from the contract requirements of Section 14105.33.
(c) If it is determined pursuant to subdivision (c) of Section
14105.39 that a drug to which subdivision (a) applies should not be
placed on the Medi-Cal list of contract drugs, that drug shall no
longer be deemed to be approved for addition to the list of contract
drugs pursuant to subdivision (a).
SEC. 71. Section 14105.436 is added to the Welfare and
Institutions Code, to read:
14105.436. (a) Effective July 1, 2002, all pharmaceutical
manufacturers shall provide to the department a state rebate, in
addition to rebates pursuant to other provisions of state or federal
law, for any drug products that have been added to the Medi-Cal list
of contract drugs pursuant to Section 14105.43 or 14133.2 and
reimbursed through the Medi-Cal outpatient fee-for-service drug
program. The state rebate shall be negotiated as necessary between
the department and the pharmaceutical manufacturer. The negotiations
shall take into account offers such as rebates, discounts, disease
management programs, and other cost savings offerings and shall be
retroactive to July 1, 2002.
(b) The department may use existing administrative mechanisms for
any drug for which the department does not obtain a rebate pursuant
to subdivision (a). The department may only use those mechanisms in
the event that, by February 1, 2003, the manufacturer refuses to
provide the additional rebate.
(c) In no event shall a beneficiary be denied continued use of a
drug that is part of a prescribed therapy and that is the subject of
an administrative mechanism pursuant to subdivision (b) until the
prescribed therapy is no longer prescribed.
(d) This section shall become inoperative on July 1, 2005, and, as
of January 1, 2006, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2006, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 72. Section 14105.45 of the Welfare and Institutions Code is
amended to read:
14105.45. (a) The department shall establish a list of Maximum
Allowable Ingredient Costs (MAIC) for drugs, which shall be published
in provider bulletins. On the effective date of this section, MAICS
listed in Title 22 of the California Code of Regulations shall be
included in the list of MAICS. MAICS shall no longer be listed in
regulations. The department shall repeal Section 51513.3 of Title 22
of the California Code of Regulations.
(b) The department shall update existing MAICS and establish
additional MAICS in accordance with all of the following:
(1) The department shall base an MAIC on the mean of the wholesale
selling prices of drugs generically equivalent to the innovator
brand that are available in California from selected major wholesale
drug distributors. For the purposes of this section, "wholesale
selling price" means the price, including discounts and rebates, paid
by a pharmacy to a wholesale drug distributor for a drug.
(2) The decision regarding therapeutic equivalency shall be based
on the federal Food and Drug Administration determinations. For
antacid drugs, therapeutic equivalency shall be determined by the
department based on review of in vitro scientific data.
(3) The department shall request information from drug
manufacturers regarding the availability of their products throughout
the state to outpatient pharmacies through the usual and customary
distribution channels in sufficient quantities to meet the needs of
the Medi-Cal program.
(4) The department shall update MAICS at least every two months
and notify Medi-Cal providers at least 30 days prior to the effective
date of an MAIC.
(c) Notwithstanding the provisions of Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code, actions under this section shall not be subject to the
Administrative Procedure Act, or to the review and approval of the
Office of Administrative Law.
SEC. 73. Section 14105.46 is added to the Welfare and Institutions
Code, to read:
14105.46. (a) For purposes of this section, the following
definitions apply:
(1) "Estimated acquisition cost" means the department's best
estimate of the price generally and currently paid by providers for a
drug product sold by a particular manufacturer or principal labeler
in a standard package.
(2) "Legend" means any drug whose labeling states "Caution:
Federal law prohibits dispensing without prescription" or words of
similar import.
(3) "Nonlegend" means any drug whose labeling does not contain the
statement referenced in paragraph (2).
(4) "Single-source," "innovator multiple source," and
"noninnovator multiple source" drugs have the same meaning as those
terms are defined in Section 1396r-8(k)(7) of Title 42 of the United
States.
(5) "Average sales price" means the price reported to the
department as required by agreements between the State of California
and the manufacturer.
(6) "Average wholesale price" means the price for a drug product
listed in the department's price reference source.
(7) "Direct price" means the price for a drug product purchased
directly from a drug manufacturer listed in the department's price
reference source.
(b) The department shall establish the estimated acquisition cost
of legend and nonlegend drugs as follows:
(1) For single-source and innovator multiple source drugs, the
estimated acquisition cost shall be equal to the lower of the average
sales price, as reported to the department by a drug manufacturer,
and the average wholesale price minus 10 percent.
(2) For noninnovator multiple source drugs, the estimated
acquisition cost shall be equal to the lower of the average sales
price, as reported to the department by a drug manufacturer, and the
average wholesale price minus 10 percent.
(c) Direct price shall not be used by the department to establish
estimated acquisition cost.
(d) The reimbursement for legend and nonlegend drugs shall consist
of the cost of the drug plus a professional fee for services.
SEC. 74. Section 14105.47 is added to the Welfare and Institutions
Code, to read:
14105.47. (a) (1) The department shall establish a list of
medical supplies. The list shall specify utilization controls to be
applied to each medical supply product.
(2) The utilization controls specified shall include, but not be
limited to, those provided by regulation of the department. The
department shall repeal Section 59998 of Title 22 of the California
Code of Regulations, which establishes requirements for medical
supplies.
(3) The department shall notify providers at least 30 days prior
to the effective date of a change in utilization controls.
(b) (1) The department shall establish a list of maximum allowable
product costs (MAPCS) for medical supplies, which shall be published
in provider bulletins.
(2) The department shall repeal the provisions of Section 51520.1
of Title 22 of the California Code of Regulations.
(3) The department shall update existing MAPCS and establish
additional MAPCS in accordance with all of the following:
(A) In establishing the MAPCS, the director shall assure that
eligible persons shall receive medical supply products that are
available to the public generally, without discrimination or
segregation based purely on economic disability.
(B) All related medical supply products within each particular
medical supply type available for retail distribution shall be
reviewed by the department in consultation with representatives from
the California Association of Medical Product Suppliers and the
California Pharmacists Association.
(C) The department shall base MAPCS on the mean of the wholesale
selling price of related medical supply products that are available
in California. For purposes of this section, "wholesale selling
price" means the price, including discounts and rebates, paid by a
provider to a wholesaler, distributor, or manufacturer for a medical
supply product.
(D) The department shall notify Medi-Cal providers at least 30
days prior to the effective date of MAPCS.
(c) Notwithstanding the provisions of Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of the Government Code,
actions under this section shall not be subject to the Administrative
Procedure Act or to the review and approval of the Office of
Administrative Law.
SEC. 75. Section 14105.65 of the Welfare and Institutions Code is
repealed.
SEC. 76. Section 14105.8 is added to the Welfare and Institutions
Code, to read:
14105.8. (a) The department may enter into contracts with
manufacturers of enteral formulae that can be used as a therapeutic
regimen to prevent serious disability or death in patients with
medically diagnosed conditions that preclude the full use of regular
food, on a bid or nonbid basis. The department shall maintain a list
of those products for which contracts have been executed. Rebates
created by these contracts shall be managed through the department's
drug rebate accounting system.
(b) For the purpose of this benefit, enteral formulae is defined
as those products that have been classified by the Statistical
Analysis Durable Medical Equipment Regional Carrier (SADMERC) into
one of the product classifications used for reimbursement in the
Medicare program. SADMERC classified enteral formulae, Category V:
modular components do not meet the test as a replacement for regular
food pursuant to subdivision (a) and shall not be a benefit of the
Medi-Cal program, except that the Medi-Cal program may deem a SADMERC
Category V classified enteral formulae as a benefit when the
department determines that the use of the product is neither
investigational nor experimental when used as a therapeutic regimen
to prevent serious disability or death in patients with medically
diagnosed conditions. Infant formulas and enteral formulae covered
by the Woman, Infant and Children (WIC) program for individuals
enrolled in WIC shall not be a benefit of the Medi-Cal program.
(c) In order that Medi-Cal beneficiaries may have access to a
comprehensive range of enteral formulae pursuant to subdivision (a),
the department shall ensure that there is representation on the list
of both general use and specialized use enteral formulae. The
Medi-Cal program may deem an enteral formulae not classified by
SADMERC as a benefit if it meets the medical need of patients with
medically diagnosed conditions that preclude the full use of regular
food.
(d) In order to achieve maximum cost savings, the Legislature
declares that an expedited process for contracts under this section
is necessary. Therefore, contracts entered into on a nonbid basis
shall be exempt from Chapter 2 (commencing with Section 10290) of
Part 2 of Division 2 of the Public Contract Code.
(e) (1) A manufacturer of an enteral formulae denied a contract
pursuant to this section may file an appeal of that decision with the
director within 30 calendar days of the department's written
decision.
(2) The director shall issue a final decision on the appeal within
60 calendar days of the postmark date of the appeal.
(f) Deletions made to the list of enteral formulae shall become
effective no sooner than 30 days after publication of the changes in
provider bulletins.
(g) Changes made to the list of enteral formulae under this or any
other section are exempt from the requirements of the Administrative
Procedure Act (Chapter 3.5 (commencing with Section 11340), Chapter
4 (commencing with Section 11370), and Chapter 5 (commencing with
Section 11500) of Part 1 of Division 3 of Title 2 of the Government
Code), and shall not be subject to the review and approval of the
Office of Administrative Law.
(h) In no event shall a beneficiary be denied continued use of an
enteral formulae, pursuant to subdivisions (b) and (j), that has been
deleted from the list of enteral formulae. To be eligible for
continuing care status under this subdivision, a beneficiary must be
taking the enteral formulae product when the product is deleted.
Additionally, the department shall have received a claim for the
enteral formulae product with a date of service that is within 100
days prior to the date the product was deleted. A beneficiary shall
remain eligible for continuing care status provided that a claim is
submitted for the enteral formulae product in question at least every
100 days and the date of service of the claim is within 100 days of
the date of service of the last claim submitted for the same enteral
formulae product.
(i) The department shall provide individual notice to Medi-Cal
beneficiaries at least 60 calendar days prior to the effective date
of the deletion of any enteral formulae from the list of enteral
formulae. The notice shall include a description of the beneficiary'
s right to a fair hearing and shall encourage the beneficiary to
consult a physician to determine if an appropriate substitute enteral
formulae is available from Medi-Cal.
(j) Enteral formulae authorized pursuant to subdivision (a) shall
be available only through prior authorization. The department may
designate those enteral formulae that are without a contract as not
being a benefit of the Medi-Cal program, except in the case of
continuing care as described in subdivision (h) of this section.
(k) Contracts executed pursuant to this section shall be
confidential and shall be exempt from disclosure under the California
Public Records Act (Chapter 3.5 (commencing with Section 6250) of
Division 7 of Title 1 of the Government Code).
(l) (1) Manufacturers shall calculate and pay interest on late or
unpaid rebates.
(2) Interest pursuant to paragraph (1) shall begin accruing 38
calendar days from the date of mailing of the quarterly invoice,
including supporting utilization data sent to the manufacturer.
Interest shall continue to accrue until the date of mailing of the
manufacturer's payment.
(3) Interest rates and calculations pursuant to paragraph (1)
shall be identical and shall be equal to the drug rebate interest
rates as determined by the federal Centers for Medicare and Medicaid
Services' Medicaid Drug Rebate Program Releases or regulations.
(4) If the date of mailing of a state rebate payment is 69 days of
more from the date of mailing of the invoice, including supporting
utilization data sent to the manufacturer, the interest rate shall be
as specified in paragraph (3), however the interest rate shall be
increased by 10 percentage points.
(m) The department may adopt emergency regulations to implement
this section in accordance with the rulemaking provisions of the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code).
SEC. 77. Section 14105.85 is added to the Welfare and Institutions
Code, to read:
14105.85. Effective July 1, 2002, payment for enteral formulae
dispensed by a pharmacy provider shall be based on the estimated
acquisition cost for that product plus a percentage markup to be
determined by the department in consultation with provider
representatives from the California Association of Medical Product
Suppliers and the California Pharmacists Association. The percentage
markup shall consider the costs of handling, storage, delivery, and
billing for those products. Any changes to the percentage markup may
be implemented with 30-day notice to the provider community via a
provider bulletin or other specific notification to providers.
SEC. 78. Section 14105.91 of the Welfare and Institutions Code is
repealed.
SEC. 79. Section 14105.915 of the Welfare and Institutions Code is
repealed.
SEC. 80. Section 14105.916 of the Welfare and Institutions Code is
repealed.
SEC. 81. Section 14125 of the Welfare and Institutions Code is
amended to read:
14125. The purpose of this article is to establish provider
reimbursement rates for incontinence medical supplies covered by the
Medi-Cal program. Reimbursement for incontinence medical supplies
shall consist of the weighted average of the negotiated contract
prices within each product category, plus a markup fee equal to 38
percent of the resulting adjusted contract price.
SEC. 83. Section 14132 of the Welfare and Institutions Code is
amended to read:
14132. The following is the schedule of benefits under this
chapter:
(a) Outpatient services are covered as follows:
Physician, hospital or clinic outpatient, surgical center,
respiratory care, optometric, chiropractic, psychology, podiatric,
occupational therapy, physical therapy, speech therapy, audiology,
acupuncture to the extent federal matching funds are provided for
acupuncture, and services of persons rendering treatment by prayer or
healing by spiritual means in the practice of any church or
religious denomination insofar as these can be encompassed by federal
participation under an approved plan, subject to utilization
controls.
(b) Inpatient hospital services, including, but not limited to,
physician and podiatric services, physical therapy and occupational
therapy, are covered subject to utilization controls.
(c) Nursing facility services, subacute care services, and
services provided by any category of intermediate care facility for
the developmentally disabled, including podiatry, physician, nurse
practitioner services, and prescribed drugs, as described in
subdivision (d), are covered subject to utilization controls.
Respiratory care, physical therapy, occupational therapy, speech
therapy, and audiology services for patients in nursing facilities
and any category of intermediate care facility for the
developmentally disabled are covered subject to utilization controls.
(d) Purchase of prescribed drugs is covered subject to the
Medi-Cal List of Contract Drugs and utilization controls.
(e) Outpatient dialysis services and home hemodialysis services,
including physician services, medical supplies, drugs and equipment
required for dialysis, are covered, subject to utilization controls.
(f) Anesthesiologist services when provided as part of an
outpatient medical procedure, nurse anesthetist services when
rendered in an inpatient or outpatient setting under conditions set
forth by the director, outpatient laboratory services, and X-ray
services are covered, subject to utilization controls. Nothing in
this subdivision shall be construed to require prior authorization
for anesthesiologist services provided as part of an outpatient
medical procedure or for portable X-ray services in a nursing
facility or any category of intermediate care facility for the
developmentally disabled.
(g) Blood and blood derivatives are covered.
(h) (1) Emergency and essential diagnostic and restorative dental
services, except for orthodontic, fixed bridgework, and partial
dentures that are not necessary for balance of a complete artificial
denture, are covered, subject to utilization controls. The
utilization controls shall allow emergency and essential diagnostic
and restorative dental services and prostheses that are necessary to
prevent a significant disability or to replace previously furnished
prostheses which are lost or destroyed due to circumstances beyond
the beneficiary's control. The department's utilization controls
shall not require X-rays as a condition of reimbursement for fillings
for children under 18 years of age. Notwithstanding the foregoing,
the director may by regulation provide for certain fixed artificial
dentures necessary for obtaining employment or for medical conditions
which preclude the use of removable dental prostheses, and for
orthodontic services in cleft palate deformities administered by the
department's California Children Services Program.
(2) For persons 21 years of age or older, the services specified
in paragraph (1) shall be provided subject to the following
conditions:
(A) Periodontal treatment is not a benefit.
(B) Endodontic therapy is not a benefit except for vital
pulpotomy.
(C) Laboratory processed crowns are not a benefit.
(D) Removable prosthetics shall be a benefit only for patients as
a requirement for employment.
(E) The director may, by regulation, provide for the provision of
fixed artificial dentures that are necessary for medical conditions
that preclude the use of removable dental prostheses.
(F) Notwithstanding the conditions specified in subparagraphs (A)
to (E), inclusive, the department may approve services for persons
with special medical disorders subject to utilization review.
(3) Paragraph (2) shall become inoperative July 1, 1995.
(i) Medical transportation is covered, subject to utilization
controls.
(j) Home health care services are covered, subject to utilization
controls.
(k) Prosthetic and orthotic devices and eyeglasses are covered,
subject to utilization controls. Utilization controls shall allow
replacement of prosthetic and orthotic devices and eyeglasses
necessary because of loss or destruction due to circumstances beyond
the beneficiary's control. Frame styles for eyeglasses replaced
pursuant to this subdivision shall not change more than once every
two years, unless the department so directs.
Orthopedic and conventional shoes are covered when provided by a
prosthetic and orthotic supplier on the prescription of a physician
and when at least one of the shoes will be attached to a prosthesis
or brace, subject to utilization controls. Modification of stock
conventional or orthopedic shoes when medically indicated, is covered
subject to utilization controls. When there is a clearly
established medical need that cannot be satisfied by the modification
of stock conventional or orthopedic shoes, custom-made orthopedic
shoes are covered, subject to utilization controls.
(l) Hearing aids are covered, subject to utilization controls.
Utilization controls shall allow replacement of hearing aids
necessary because of loss or destruction due to circumstances beyond
the beneficiary's control.
(m) Durable medical equipment and medical supplies are covered,
subject to utilization controls. The utilization controls shall
allow the replacement of durable medical equipment and medical
supplies when necessary because of loss or destruction due to
circumstances beyond the beneficiary's control. The utilization
controls shall allow authorization of durable medical equipment
needed to assist a disabled beneficiary in caring for a child for
whom the disabled beneficiary is a parent, stepparent, foster parent,
or legal guardian, subject to the availability of federal financial
participation. The department shall adopt emergency regulations to
define and establish criteria for assistive durable medical equipment
in accordance with the rulemaking provisions of the Administrative
Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code).
(n) Family planning services are covered, subject to utilization
controls.
(o) Inpatient intensive rehabilitation hospital services,
including respiratory rehabilitation services, in a general acute
care hospital are covered, subject to utilization controls, when
either of the following criteria are met:
(1) A patient with a permanent disability or severe impairment
requires an inpatient intensive rehabilitation hospital program as
described in Section 14064 to develop function beyond the limited
amount that would occur in the normal course of recovery.
(2) A patient with a chronic or progressive disease requires an
inpatient intensive rehabilitation hospital program as described in
Section 14064 to maintain the patient's present functional level as
long as possible.
(p) Adult day health care is covered in accordance with Chapter
8.7 (commencing with Section 14520).
(q) (1) Application of fluoride, or other appropriate fluoride
treatment as defined by the department, other prophylaxis treatment
for children 17 years of age and under, are covered.
(2) All dental hygiene services provided by a registered dental
hygienist in alternative practice pursuant to Sections 1768 and 1770
of the Business and Professions Code may be covered as long as they
are within the scope of Denti-Cal benefits and they are necessary
services provided by a registered dental hygienist in alternative
practice.
(r) (1) Paramedic services performed by a city, county, or special
district, or pursuant to a contract with a city, county, or special
district, and pursuant to a program established under Article 3
(commencing with Section 1480) of Chapter 2.5 of Division 2 of the
Health and Safety Code by a paramedic certified pursuant to that
article, and consisting of defibrillation and those services
specified in subdivision (3) of Section 1482 of the article.
(2) All providers enrolled under this subdivision shall satisfy
all applicable statutory and regulatory requirements for becoming a
Medi-Cal provider.
(3) This subdivision shall be implemented only to the extent
funding is available under Section 14106.6.
(s) In-home medical care services are covered when medically
appropriate and subject to utilization controls, for beneficiaries
who would otherwise require care for an extended period of time in an
acute care hospital at a cost higher than in-home medical care
services. The director shall have the authority under this section
to contract with organizations qualified to provide in-home medical
care services to those persons. These services may be provided to
patients placed in shared or congregate living arrangements, if a
home setting is not medically appropriate or available to the
beneficiary. As used in this section, "in-home medical care service"
includes utility bills directly attributable to continuous, 24-hour
operation of life-sustaining medical equipment, to the extent that
federal financial participation is available.
As used in this subdivision, in-home medical care services,
include, but are not limited to:
(1) Level of care and cost of care evaluations.
(2) Expenses, directly attributable to home care activities, for
materials.
(3) Physician fees for home visits.
(4) Expenses directly attributable to home care activities for
shelter and modification to shelter.
(5) Expenses directly attributable to additional costs of special
diets, including tube feeding.
(6)
Medically related personal services.
(7) Home nursing education.
(8) Emergency maintenance repair.
(9) Home health agency personnel benefits which permit coverage of
care during periods when regular personnel are on vacation or using
sick leave.
(10) All services needed to maintain antiseptic conditions at
stoma or shunt sites on the body.
(11) Emergency and nonemergency medical transportation.
(12) Medical supplies.
(13) Medical equipment, including, but not limited to, scales,
gurneys, and equipment racks suitable for paralyzed patients.
(14) Utility use directly attributable to the requirements of home
care activities which are in addition to normal utility use.
(15) Special drugs and medications.
(16) Home health agency supervision of visiting staff which is
medically necessary, but not included in the home health agency rate.
(17) Therapy services.
(18) Household appliances and household utensil costs directly
attributable to home care activities.
(19) Modification of medical equipment for home use.
(20) Training and orientation for use of life-support systems,
including, but not limited to, support of respiratory functions.
(21) Respiratory care practitioner services as defined in Sections
3702 and 3703 of the Business and Professions Code, subject to
prescription by a physician and surgeon.
Beneficiaries receiving in-home medical care services are entitled
to the full range of services within the Medi-Cal scope of benefits
as defined by this section, subject to medical necessity and
applicable utilization control. Services provided pursuant to this
subdivision, which are not otherwise included in the Medi-Cal
schedule of benefits, shall be available only to the extent that
federal financial participation for these services is available in
accordance with a home- and community-based services waiver.
(t) Home- and community-based services approved by the United
States Department of Health and Human Services may be covered to the
extent that federal financial participation is available for those
services under waivers granted in accordance with Section 1396n of
Title 42 of the United States Code. The director may seek waivers
for any or all home- and community-based services approvable under
Section 1396n of Title 42 of the United States Code. Coverage for
those services shall be limited by the terms, conditions, and
duration of the federal waivers.
(u) Comprehensive perinatal services, as provided through an
agreement with a health care provider designated in Section 14134.5
and meeting the standards developed by the department pursuant to
Section 14134.5, subject to utilization controls.
The department shall seek any federal waivers necessary to
implement the provisions of this subdivision. The provisions for
which appropriate federal waivers cannot be obtained shall not be
implemented. Provisions for which waivers are obtained or for which
waivers are not required shall be implemented notwithstanding any
inability to obtain federal waivers for the other provisions. No
provision of this subdivision shall be implemented unless matching
funds from Subchapter XIX (commencing with Section 1396) of Chapter 7
of Title 42 of the United States Code are available.
(v) Early and periodic screening, diagnosis, and treatment for any
individual under 21 years of age is covered, consistent with the
requirements of Subchapter XIX (commencing with Section 1396) of
Chapter 7 of Title 42 of the United States Code.
(w) Hospice service which is Medicare-certified hospice service is
covered, subject to utilization controls. Coverage shall be
available only to the extent that no additional net program costs are
incurred.
(x) When a claim for treatment provided to a beneficiary includes
both services which are authorized and reimbursable under this
chapter, and services which are not reimbursable under this chapter,
that portion of the claim for the treatment and services authorized
and reimbursable under this chapter shall be payable.
(y) Home- and community-based services approved by the United
States Department of Health and Human Services for beneficiaries with
a diagnosis of AIDS or ARC, who require intermediate care or a
higher level of care.
Services provided pursuant to a waiver obtained from the Secretary
of the United States Department of Health and Human Services
pursuant to this subdivision, and which are not otherwise included in
the Medi-Cal schedule of benefits, shall be available only to the
extent that federal financial participation for these services is
available in accordance with the waiver, and subject to the terms,
conditions, and duration of the waiver. These services shall be
provided to individual beneficiaries in accordance with the client's
needs as identified in the plan of care, and subject to medical
necessity and applicable utilization control.
The director may under this section contract with organizations
qualified to provide, directly or by subcontract, services provided
for in this subdivision to eligible beneficiaries. Contracts or
agreements entered into pursuant to this division shall not be
subject to the Public Contract Code.
(z) Respiratory care when provided in organized health care
systems as defined in Section 3701 of the Business and Professions
Code, and as an in-home medical service as outlined in subdivision
(s).
(aa) (1) There is hereby established in the department, a program
to provide comprehensive clinical family planning services to any
person who has a family income at or below 200 percent of the federal
poverty level, as revised annually, and who is eligible to receive
these services pursuant to the waiver identified in paragraph (2).
This program shall be known as the Family Planning, Access, Care, and
Treatment (Family PACT) Waiver Program.
(2) The department shall seek a waiver for a program to provide
comprehensive clinical family planning services as described in
paragraph (8). The program shall be operated only in accordance with
the waiver and the statutes and regulations in paragraph (4) and
subject to the terms, conditions, and duration of the waiver. The
services shall be provided under the program only if the waiver is
approved by the federal Centers for Medicare and Medicaid Services in
accordance with Section 1396n of Title 42 of the United States Code
and only to the extent that federal financial participation is
available for the services.
(3) Solely for the purposes of the waiver and notwithstanding any
other provision of law, the collection and use of an individual's
social security number shall be necessary only to the extent required
by federal law.
(4) Sections 14105.3 to 14105.39, inclusive, 14107.11, 24005, and
24013, and any regulations adopted under these statutes shall apply
to the program provided for under this subdivision. No other
provision of law under the Medi-Cal program or the State-Only Family
Planning Program shall apply to the program provided for under this
subdivision.
(5) 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, without taking regulatory action, the
provisions of the waiver after its approval by the federal Health
Care Financing Administration and the provisions of this section by
means of an all-county letter or similar instruction to providers.
Thereafter, the department shall adopt regulations to implement this
section and the approved waiver in accordance with the requirements
of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division
3 of Title 2 of the Government Code. Beginning six months after the
effective date of the act adding this subdivision, the department
shall provide a status report to the Legislature on a semiannual
basis until regulations have been adopted.
(6) In the event that the Department of Finance determines that
the program operated under the authority of the waiver described in
paragraph (2) is no longer cost-effective, this subdivision shall
become inoperative on the first day of the first month following the
issuance of a 30-day notification of that determination in writing by
the Department of Finance to the chairperson in each house that
considers appropriations, the chairpersons of the committees, and the
appropriate subcommittees in each house that considers the State
Budget, and the Chairperson of the Joint Legislative Budget
Committee.
(7) If this subdivision ceases to be operative, all persons who
have received or are eligible to receive comprehensive clinical
family planning services pursuant to the waiver described in
paragraph (2) shall receive family planning services under the
Medi-Cal program pursuant to subdivision (n) if they are otherwise
eligible for Medi-Cal with no share of cost, or shall receive
comprehensive clinical family planning services under the program
established in Division 24 (commencing with Section 24000) either if
they are eligible for Medi-Cal with a share of cost or if they are
otherwise eligible under Section 24003.
(8) For purposes of this subdivision, "comprehensive clinical
family planning services" means the process of establishing
objectives for the number and spacing of children, and selecting the
means by which those objectives may be achieved. These means include
a broad range of acceptable and effective methods and services to
limit or enhance fertility, including contraceptive methods, federal
Food and Drug Administration approved contraceptive drugs, devices,
and supplies, natural family planning, abstinence methods, and basic,
limited fertility management. Comprehensive clinical family
planning services include, but are not limited to, preconception
counseling, maternal and fetal health counseling, general
reproductive health care, including diagnosis and treatment of
infections and conditions, including cancer, that threaten
reproductive capability, medical family planning treatment and
procedures, including supplies and followup, and informational,
counseling, and educational services. Comprehensive clinical family
planning services shall not include abortion, pregnancy testing
solely for the purposes of referral for abortion or services
ancillary to abortions, or pregnancy care that is not incident to the
diagnosis of pregnancy. Comprehensive clinical family planning
services shall be subject to utilization control and include all of
the following:
(A) Family planning related services and male and female
sterilization. Family planning services for men and women shall
include emergency services and services for complications directly
related to the contraceptive method, federal Food and Drug
Administration approved contraceptive drugs, devices, and supplies,
and followup, consultation, and referral services, as indicated,
which may require treatment authorization requests.
(B) All United States Department of Agriculture, federal Food and
Drug Administration approved contraceptive drugs, devices, and
supplies that are in keeping with current standards of practice and
from which the individual may choose.
(C) Culturally and linguistically appropriate health education and
counseling services, including informed consent, that include all of
the following:
(i) Psychosocial and medical aspects of contraception.
(ii) Sexuality.
(iii) Fertility.
(iv) Pregnancy.
(v) Parenthood.
(vi) Infertility.
(vii) Reproductive health care.
(viii) Preconception and nutrition counseling.
(ix) Prevention and treatment of sexually transmitted infection.
(x) Use of contraceptive methods, federal Food and Drug
Administration approved contraceptive drugs, devices, and supplies.
(xi) Possible contraceptive consequences and followup.
(xii) Interpersonal communication and negotiation of relationships
to assist individuals and couples in effective contraceptive method
use and planning families.
(D) A comprehensive health history, updated at next periodic visit
(between 11 and 24 months after initial examination) that includes a
complete obstetrical history, gynecological history, contraceptive
history, personal medical history, health risk factors, and family
health history, including genetic or hereditary conditions.
(E) A complete physical examination on initial and subsequent
periodic visits.
(ab) Purchase of prescribed enteral formulae is covered, subject
to the Medi-Cal list of enteral formulae and utilization controls.
(ac) Diabetic testing supplies are covered when provided by a
pharmacy, subject to utilization controls.
SEC. 84. Section 14132.26 of the Welfare and Institutions Code is
amended to read:
14132.26. (a) The department shall develop a program that
requires a waiver of federal law to test the efficacy of providing an
assisted living benefit to beneficiaries under the Medi-Cal program.
Assisted living benefits shall include, but are not limited to, the
care and supervision activities specified in Section 1569.2 of the
Health and Safety Code and Section 87101 of Title 22 of the
California Code of Regulations, and other health-related services.
The program developed pursuant to this section shall be known as the
waiver program for purposes of this section. The department shall
submit any necessary waiver applications or modifications to the
medicaid state plan to the Health Care Financing Administration to
implement the waiver program, and shall implement the waiver program
only to the extent federal financial participation is available.
(b) The department shall develop the waiver program in conjunction
with other state departments, consumers, consumer advocates, housing
and service providers, and experts in the fields of gerontology,
geriatric health, nursing services, and independent living.
(c) The assisted living benefit shall be designed to provide
eligible individuals with a range of services that enable them to
remain in the least restrictive and most homelike environment while
receiving the medical and personal care necessary to protect their
health and well-being. Benefits provided pursuant to this waiver
program shall include only those not otherwise available under the
state plan, and may include, but are not limited to, medicine
management, coordination with a primary health care provider, and
case management.
(d) (1) Eligible individuals shall be those who are eligible for
the Medi-Cal program and are determined by the department to be
eligible for placement in a nursing facility, as defined under
subdivisions (c) and (d) of Section 1250 of the Health and Safety
Code. Eligibility shall be based on an assessment of an individual's
ability to perform functional and instrumental activities of daily
living, as well as the individual's medical diagnosis and prognosis,
and other criteria, including other Medi-Cal services that the
beneficiary is receiving, as specified in the waiver.
(2) An eligible individual shall participate in the waiver program
only if he or she is fully informed of the program and the nature of
the assisted living benefit and indicates in writing his or her
choice to participate.
(e) (1) The waiver program shall test the effectiveness of
providing a Medi-Cal assisted living benefit through two service
delivery approaches, as specified in paragraphs (2) and (3).
(2) Under the first model, an assisted living benefit shall be
provided to residents of licensed residential care facilities.
Facility participation in the program shall be determined by the
department in conjunction with the State Department of Social
Services and in accordance with the criteria for participation
specified in the waiver. Under this model the facility operator
shall be responsible for the provision of services allowed under the
benefit, either directly or through contracts with other provider
agencies, as permitted and specified in the waiver. During
participation in the waiver program, residential care facilities
shall comply with all terms and conditions of the waiver. The
department and the State Department of Social Services, may, as
determined necessary and appropriate, waive provisions contained in
Division 2 (commencing with Section 1200) of the Health and Safety
Code, subdivision (h) of Section 14132.95, and Title 22 of the
California Code of Regulations for facilities providing services to
waiver program participants.
(3) Under the second model, an assisted living benefit shall be
provided to residents in publicly funded senior and disabled housing
projects. Under this model an independent agency, pursuant to a
contract with the department, shall be responsible for the provision
of case management and other services to eligible individuals, as
specified in the waiver.
(f) The department shall evaluate the effectiveness of the waiver
program.
(1) The evaluation shall include, but not be limited to,
participant satisfaction, health, and safety, the quality of life of
the participant receiving the assisted living benefit, and
demonstration of the cost neutrality of the waiver program as
specified in federal guidelines.
(2) The evaluation shall estimate the projected savings, if any,
in the budgets of state and local governments if the program was
expanded statewide.
(3) The evaluation shall be submitted to the appropriate policy
and fiscal committees of the Legislature on or before January 1,
2003.
(g) The department shall limit the number of participants in the
waiver program during the initial three years of its operation to a
number that will be statistically significant for purposes of the
program evaluation and that meets any requirements of the federal
Health Care Financing Administration, including a request to waive
statewide implementation requirements for the waiver program during
the initial years of evaluation.
(h) In implementing this section, the department may enter into
contracts for the provision of essential administrative and other
services. Contracts entered into under this section may be on a
noncompetitive bid basis, and shall be exempt from the requirements
of Chapter 2 (commencing with Section 10290) of Part 2 of Division 2
of the Public Contract Code.
(i) The department shall not implement the waiver program
specified in subdivision (a) if the benefits provided pursuant to the
waiver program will result in additional costs to the Medi-Cal
program.
(j) The waiver program shall be developed and implemented only to
the extent that funds are appropriated or otherwise available for
that purpose.
SEC. 85. Section 14132.73 is added to the Welfare and Institutions
Code, to read:
14132.73. The State Department of Health Services shall allow
psychiatrists to receive fee-for-service Medi-Cal reimbursement for
services provided through telemedicine until June 30, 2004, or until
the State Department of Mental Health and mental health plans, in
collaboration with stakeholders, develop a method for reimbursing
psychiatric services provided through telemedicine that is
administratively feasible for the mental health plans, primary care
providers, and psychiatrists providing the services, whichever occurs
later.
SEC. 85.5. Section 14132.88 of the Welfare and Institutions Code
is amended to read:
14132.88. (a) Notwithstanding subdivision (h) of Section 14132
and to the extent funds are made available in the annual Budget Act
for this purpose, the following are covered benefits for
beneficiaries 21 years of age or older under this chapter:
(1) One dental prophylaxis cleaning per year.
(2) One initial dental examination by a dentist.
(b) The following are covered benefits for beneficiaries under 21
years of age under this chapter:
(1) Two dental prophylaxis cleanings per year.
(2) Two periodic dental examinations per year.
SEC. 86. Section 14132.95 of the Welfare and Institutions Code is
amended to read:
14132.95. (a) Personal care services, when provided to a
categorically needy person as defined in Section 14050.1 is a covered
benefit to the extent federal financial participation is available
if these services are:
(1) Provided in the beneficiary's home and other locations as may
be authorized by the director subject to federal approval.
(2) Authorized by county social services staff in accordance with
a plan of treatment.
(3) Provided by a qualified person.
(4) Provided to a beneficiary who has a chronic, disabling
condition that causes functional impairment that is expected to last
at least 12 consecutive months or that is expected to result in death
within 12 months and who is unable to remain safely at home without
the services described in this section.
(b) The department shall seek federal approval of a state plan
amendment necessary to include personal care as a medicaid service
pursuant to subdivision (f) of Section 440.170 of Title 42 of the
Code of Federal Regulations. For any persons who meet the criteria
specified in subdivision (a) or (p), but for whom federal financial
participation is not available, eligibility shall be available
pursuant to Article 7 (commencing with Section 12300) of Chapter 3,
if otherwise eligible.
(c) Subdivision (a) shall not be implemented unless the department
has obtained federal approval of the state plan amendment described
in subdivision (b), and the Department of Finance has determined, and
has informed the department in writing, that the implementation of
this section will not result in additional costs to the state
relative to state appropriation for in-home supportive services under
Article 7 (commencing with Section 12300) of Chapter 3, in the
1992-93 fiscal year.
(d) (1) For purposes of this section, personal care services shall
mean all of the following:
(A) Assistance with ambulation.
(B) Bathing, oral hygiene and grooming.
(C) Dressing.
(D) Care and assistance with prosthetic devices.
(E) Bowel, bladder, and menstrual care.
(F) Skin care.
(G) Repositioning, range of motion exercises, and transfers.
(H) Feeding and assurance of adequate fluid intake.
(I) Respiration.
(J) Paramedical services.
(K) Assistance with self-administration of medications.
(2) Ancillary services including meal preparation and cleanup,
routine laundry, shopping for food and other necessities, and
domestic services may also be provided as long as these ancillary
services are subordinate to personal care services. Ancillary
services may not be provided separately from the basic personal care
services.
(e) (1) (A) After consulting with the State Department of Social
Services, the department shall adopt emergency regulations to
establish the amount, scope, and duration of personal care services
available to persons described in subdivision (a) in the fiscal year
whenever the department determines that General Fund expenditures for
personal care services provided under this section and expenditures
of both General Fund moneys and federal funds received under Title XX
of the federal Social Security Act for services pursuant to Article
7 (commencing with Section 12300) of Chapter 3, are expected to
exceed the General Fund appropriation and the federal appropriation
under Title XX of the federal Social Security Act provided for the
1992-93 fiscal year pursuant to Article 7 (commencing with Section
12300) of Chapter 3, as it read on June 30, 1992, as adjusted for
caseload growth or as increased in the Budget Act or appropriated by
statute. At least 30 days prior to filing these regulations with the
Secretary of State, the department shall give notice of the expected
content of these regulations to the fiscal committees of both houses
of the Legislature.
(B) In establishing the amount, scope, and duration of personal
care services, the department shall ensure that General Fund
expenditures for personal care services provided for under this
section and expenditures of both General Fund moneys and federal
funds received under Title XX of the federal Social Security Act for
services pursuant to Article 7 (commencing with Section 12300) of
Chapter 3, do not exceed the General Fund appropriation and the
federal appropriation under Title XX of the federal Social Security
Act provided for the 1992-93 fiscal year pursuant to Article 7
(commencing with Section 12300) of Chapter 3, as it read on June 30,
1992, as adjusted for caseload growth or as increased in the Budget
Act or appropriated by statute.
(C) For purposes of this subdivision, "caseload growth" means an
adjustment factor determined by the department based on (1) growth in
the number of persons eligible for benefits under Chapter 3
(commencing with Section 12000) on the basis of their disability, (2)
the average increase in the number of hours in the program
established pursuant to Article 7 (commencing with Section 12300) of
Chapter 3 in the 1988-89 to 1992-93 fiscal years, inclusive, due to
the level of impairment, and (3) any increase in program costs that
is required by an increase in the mandatory minimum wage.
(2) In establishing the amount, scope, and duration of personal
care services pursuant to this subdivision, the department may define
and take into account, among other things:
(A) The extent to which the particular personal care services are
essential or nonessential.
(B) Standards establishing the medical necessity of the services
to be provided.
(C) Utilization controls.
(D) A minimum number of hours of personal care services that must
first be assessed as needed as a condition of receiving personal care
services pursuant to this section.
The level of personal care services shall be established so as to
avoid, to the extent feasible within budgetary constraints, medical
out-of-home placements.
(3) To the extent that General Fund expenditures for services
provided under this section and expenditures of both General Fund
moneys and federal funds received under Title XX of the federal
Social Security Act for services pursuant to Article 7 (commencing
with Section 12300) of Chapter 3 in the 1992-93 fiscal year, adjusted
for caseload growth, exceed General Fund expenditures for services
provided under this section and expenditures of both General Fund
moneys and federal funds received under Title XX of the federal
Social Security Act for services pursuant to Article 7 (commencing
with Section 12300) of Chapter 3 in any fiscal year, the excess of
these funds shall be expended for any purpose as directed in the
Budget Act or as otherwise statutorily disbursed by the Legislature.
(f) Services pursuant to this section shall be
rendered, under the administrative direction of the State Department
of Social Services, in the manner authorized in Article 7
(commencing with Section 12300) of Chapter 3, for the In-Home
Supportive Services program. A provider of personal care services
shall be qualified to provide the service and shall be a person other
than a member of the family. For purposes of this section, a family
member means a parent of a minor child or a spouse.
(g) A beneficiary who is eligible for assistance under this
section shall receive services that do not exceed 283 hours per month
of personal care services.
(h) Personal care services shall not be provided to residents of
facilities licensed by the department, and shall not be provided to
residents of a community care facility or a residential care facility
for the elderly licensed by the Community Care Licensing Division of
the State Department of Social Services.
(i) Subject to any limitations that may be imposed pursuant to
subdivision (e), determination of need and authorization for services
shall be performed in accordance with Article 7 (commencing with
Section 12300) of Chapter 3.
(j) (1) To the extent permitted by federal law, reimbursement
rates for personal care services shall be equal to the rates in each
county for the same mode of services in the In-Home Supportive
Services program pursuant to Article 7 (commencing with Section
12300) of Chapter 3, plus any increase provided in the annual Budget
Act for personal care services rates or included in a county budget
pursuant to paragraph (2).
(2) (A) The department shall establish a provider reimbursement
rate methodology to determine payment rates for the individual
provider mode of service that does all of the following:
(i) Is consistent with the functions and duties of entities
created pursuant to Section 12301.6.
(ii) Makes any additional expenditure of state general funds
subject to appropriation in the annual Budget Act.
(iii) Permits county-only funds to draw down federal financial
participation consistent with federal law.
(B) This ratesetting method shall be in effect in time for any
rate increases to be included in the annual Budget Act.
(C) The department may, in establishing the ratesetting method
required by subparagraph (A), do both of the following:
(i) Deem the market rate for like work in each county, as
determined by the Employment Development Department, to be the cap
for increases in payment rates for individual practitioner services.
(ii) Provide for consideration of county input concerning the rate
necessary to ensure access to services in that county.
(D) If an increase in individual practitioner rates is included in
the annual Budget Act, the state-county sharing ratio shall be as
established in Section 12306. If the annual Budget Act does not
include an increase in individual practitioner rates, a county may
use county-only funds to meet federal financial participation
requirements consistent with federal law.
(3) (A) By November 1, 1993, the department shall submit a state
plan amendment to the federal Health Care Financing Administration to
implement this subdivision. To the extent that any element or
requirement of this subdivision is not approved, the department shall
submit a request to the federal Health Care Financing Administration
for any waivers as would be necessary to implement this subdivision.
(B) The provider reimbursement ratesetting methodology authorized
by the amendments to this subdivision in the 1993-94 Regular Session
of the Legislature shall not be operative until all necessary federal
approvals have been obtained.
(k) (1) The State Department of Social Services shall, by
September 1, 1993, notify the following persons that they are
eligible to participate in the personal care services program:
(A) Persons eligible for services pursuant to the Pickle
Amendment, as adopted October 28, 1976.
(B) Persons eligible for services pursuant to subsection (c) of
Section 1383c of Title 42 of the United States Code.
(2) The State Department of Social Services shall, by September 1,
1993, notify persons to whom paragraph (1) applies and who receive
advance payment for in-home supportive services that they will
qualify for services under this section without a share of cost if
they elect to accept payment for services on an arrears rather than
an advance payment basis.
(l) An individual who is eligible for services subject to the
maximum amount specified in subdivision (b) of Section 12303.4 shall
be given the option of hiring his or her own provider.
(m) The county welfare department shall inform in writing any
individual who is potentially eligible for services under this
section of his or her right to the services.
(n) It is the intent of the Legislature that this entire section
be an inseparable whole and that no part of it be severable. If any
portion of this section is found to be invalid, as determined by a
final judgment of a court of competent jurisdiction, this section
shall become inoperative.
(o) Paragraphs (2) and (3) of subdivision (a) shall be implemented
so as to conform to federal law authorizing their implementation.
(p) (1) Personal care services shall be provided as a covered
benefit to a medically needy aged, blind, or disabled person, as
defined in subdivision (a) of Section 14051, to the same extent and
under the same requirements as they are provided under subdivision
(a) of this section to a categorically needy, aged, blind, or
disabled person, as defined in subdivision (a) of Section 14050.1,
and to the extent that federal financial participation is available.
(2) The department shall seek federal approval of a state plan
amendment necessary to include personal care services described in
paragraph (1) as a medicaid service pursuant to subdivision (f) of
Section 440.170 of Title 42 of the Code of Federal Regulations.
(3) In the event that the Department of Finance determines that
expenditures of both General Fund moneys for personal care services
provided under this subdivision to medically needy aged, blind, or
disabled persons together with expenditures of both General Fund
moneys and federal funds received under Title XX of the federal
Social Security Act for all aged, blind, and disabled persons
receiving in-home supportive services pursuant to Article 7
(commencing with Section 12300) of Chapter 3, in the 2000-01 fiscal
year or in any subsequent fiscal year, are expected to exceed the
General Fund appropriation and the federal appropriation received
under Title XX of the federal Social Security Act for expenditures
for all aged, blind, and disabled persons receiving in-home
supportive services provided in the 1999-2000 fiscal year pursuant to
Article 7 (commencing with Section 12300) of Chapter 3, as it read
on June 30, 1998, as adjusted for caseload growth or as changed in
the Budget Act or by statute or regulation, then this subdivision
shall cease to be operative on the first day of the month that begins
after the expiration of a period of 30 days subsequent to a
notification in writing by the Director of the Department of Finance
to the chairperson of the committee in each house that considers
appropriations, the chairpersons of the committees and the
appropriate subcommittees in each house that consider the State
Budget, and the Chairperson of the Joint Legislative Budget
Committee.
(4) Solely for purposes of paragraph (3), caseload growth means an
adjustment factor determined by the department based on:
(A) Growth in the number of persons eligible for benefits under
Chapter 3 (commencing with Section 12000) on the basis of their
disability.
(B) The average increase in the number of hours in the program
established pursuant to Article 7 (commencing with Section 12300) of
Chapter 3 in the 1994-95 to 1998-99 fiscal years, inclusive, due to
the level of impairment.
(C) Any increase in program cost that is required by an increase
in hourly costs pursuant to the Budget Act or statute.
(5) In the event of a final judicial determination by any court of
appellate jurisdiction or a final determination by the Administrator
of the federal Centers for Medicare and Medicaid Services that
personal care services must be provided to any medically needy person
who is not aged, blind, or disabled, then this subdivision shall
cease to be operative on the first day of the first month that begins
after the expiration of a period of 30 days subsequent to a
notification in writing by the Director of Finance to the chairperson
of the committee in each house that considers appropriations, the
chairpersons of the committees and the appropriate subcommittees in
each house that consider the State Budget, and the Chairperson of the
Joint Legislative Budget Committee.
(6) If this subdivision ceases to be operative, all aged, blind,
and disabled persons who would have received or been eligible to
receive in-home supportive services pursuant to Article 7 (commencing
with Section 12300) of Chapter 3, but for receiving services under
this subdivision, shall be eligible immediately upon this section
becoming inoperative for services pursuant to Article 7 (commencing
with Section 12300) of Chapter 3.
(7) The department shall implement this subdivision on April 1,
1999, but only if the department has obtained federal approval of the
state plan amendments described in paragraph (2) of this
subdivision.
SEC. 87. Section 14150 is added to the Welfare and Institutions
Code, to read:
14150. Within 60 calendar days of the date that the annual Budget
Act is chaptered, the department shall notify the chairpersons of
the fiscal committees of each house of the Legislature, the
Chairperson and the Vice Chairperson of the Joint Legislative Budget
Committee, and appropriate county representatives if the department
plans to withhold and not allocate any of the baseline allocation for
county Medi-Cal eligibility activities that are appropriated for
Medi-Cal administration.
SEC. 88. Section 14163 of the Welfare and Institutions Code is
amended to read:
14163. (a) For purposes of this section, the following
definitions shall apply:
(1) "Public entity" means a county, a city, a city and county, the
State of California, the University of California, a local health
care district, a local health authority, or any other political
subdivision of the state.
(2) "Hospital" means a health facility that is licensed pursuant
to Chapter 2 (commencing with Section 1250) of Division 2 of the
Health and Safety Code to provide acute inpatient hospital services,
and includes all components of the facility.
(3) "Disproportionate share hospital" means a hospital providing
acute inpatient services to Medi-Cal beneficiaries that meets the
criteria for disproportionate share status relating to acute
inpatient services set forth in Section 14105.98.
(4) "Disproportionate share list" means the annual list of
disproportionate share hospitals for acute inpatient services issued
by the department pursuant to Section 14105.98.
(5) "Fund" means the Medi-Cal Inpatient Payment Adjustment Fund.
(6) "Eligible hospital" means, for a particular state fiscal year,
a hospital on the disproportionate share list that is eligible to
receive payment adjustment amounts under Section 14105.98 with
respect to that state fiscal year.
(7) "Transfer year" means the particular state fiscal year during
which, or with respect to which, public entities are required by this
section to make an intergovernmental transfer of funds to the
Controller.
(8) "Transferor entity" means a public entity that, with respect
to a particular transfer year, is required by this section to make an
intergovernmental transfer of funds to the Controller.
(9) "Transfer amount" means an amount of intergovernmental
transfer of funds that this section requires for a particular
transferor entity with respect to a particular transfer year.
(10) "Intergovernmental transfer" means a transfer of funds from a
public entity to the state, that is local government financial
participation in Medi-Cal pursuant to the terms of this section.
(11) "Licensee" means an entity that has been issued a license to
operate a hospital by the department.
(12) "Annualized Medi-Cal inpatient paid days" means the total
number of Medi-Cal acute inpatient hospital days, regardless of dates
of service, for which payment was made by or on behalf of the
department to a hospital, under present or previous ownership, during
the most recent calendar year ending prior to the beginning of a
particular transfer year, including all Medi-Cal acute inpatient
covered days of care for hospitals that are paid on a different basis
than per diem payments.
(13) "Medi-Cal acute inpatient hospital day" means any acute
inpatient day of service attributable to patients who, for those
days, were eligible for medical assistance under the California state
plan, including any day of service that is reimbursed on a basis
other than per diem payments.
(14) "OBRA 1993 payment limitation" means the hospital-specific
limitation on the total annual amount of payment adjustments to each
eligible hospital under the payment adjustment program that can be
made with federal financial participation under Section 1396r-4(g) of
Title 42 of the United States Code as implemented pursuant to the
Medi-Cal State Plan.
(b) The Medi-Cal Inpatient Payment Adjustment Fund is hereby
created in the State Treasury. Notwithstanding Section 13340 of the
Government Code, the fund shall be continuously appropriated to, and
under the administrative control of, the department for the purposes
specified in subdivision (d). The fund shall consist of the
following:
(1) Transfer amounts collected by the Controller under this
section, whether submitted by transferor entities pursuant to
applicable provisions of this section or obtained by offset pursuant
to subdivision (j).
(2) Any other intergovernmental transfers deposited in the fund,
as permitted by Section 14164.
(3) Any interest that accrues with respect to amounts in the fund.
(c) Moneys in the fund, which shall not consist of any state
general funds, shall be used as the source for the nonfederal share
of payments to hospitals pursuant to Section 14105.98. Moneys shall
be allocated from the fund by the department and matched by federal
funds in accordance with customary Medi-Cal accounting procedures,
and used to make payments pursuant to Section 14105.98.
(d) Except as otherwise provided in Section 14105.98 or in any
provision of law appropriating a specified sum of money to the
department for administering this section and Section 14105.98,
moneys in the fund shall be used only for the following:
(1) Payments to hospitals pursuant to Section 14105.98.
(2) Transfers to the Health Care Deposit Fund as follows:
(A) In the amount of two hundred thirty-nine million seven hundred
fifty-seven thousand six hundred ninety dollars ($239,757,690) for
the 1994-95 and 1995-96 fiscal years.
(B) In the amount of two hundred twenty-nine million seven hundred
fifty-seven thousand six hundred ninety dollars ($229,757,690) for
the 1996-97 fiscal year.
(C) In the amount of one hundred fifty-four million seven hundred
fifty-seven thousand six hundred ninety dollars ($154,757,690) for
the 1997-98 fiscal year.
(D) In the amount of one hundred fourteen million seven hundred
fifty-seven thousand six hundred ninety dollars ($114,757,690) for
the 1998-99 fiscal year.
(E) (i) In the amount of eighty-four million seven hundred
fifty-seven thousand six hundred ninety dollars ($84,757,690) for the
1999-2000 fiscal year.
(ii) It is the intent of the Legislature that the economic benefit
of any reduction in the amount transferred, or to be transferred, to
the Health Care Deposit Fund pursuant to this subdivision for the
1999-2000 fiscal year, as compared to the amount so transferred for
the 1998-99 fiscal year, be allocated equally between public and
nonpublic disproportionate share hospitals. To implement the
reduction in clause (i) the department shall, by June 30, 2000,
adjust the calculations in Section 14105.98 in order to allocate the
funds in accordance with this clause.
(F) In the amount of twenty-nine million seven hundred fifty-seven
thousand six hundred ninety dollars ($29,757,690) for the 2000-01
fiscal year and the 2001-02 fiscal year.
(G) In the amount of eighty-five million dollars ($85,000,000) for
the 2002-03 fiscal year and each fiscal year thereafter.
(H) The transfers from the fund shall be made in six equal monthly
installments to the Medi-Cal local assistance appropriation item
(Item 4260-101-0001 of the annual Budget Act) in support of Medi-Cal
expenditures. The first installment shall accrue in October of each
transfer year, and all other installments shall accrue monthly
thereafter from November through March.
(e) For the 1991-92 state fiscal year, the department shall
determine, no later than 70 days after the enactment of this section,
the transferor entities for the 1991-92 transfer year. To make this
determination, the department shall utilize the disproportionate
share list for the 1991-92 fiscal year issued by the department
pursuant to paragraph (1) of subdivision (f) of Section 14105.98.
The department shall identify each eligible hospital on the list for
which a public entity is the licensee as of July 1, 1991. The public
entity that is the licensee of each identified eligible hospital
shall be a transferor entity for the 1991-92 transfer year.
(f) The department shall determine, no later than 70 days after
the enactment of this section, the transfer amounts for the 1991-92
transfer year.
The transfer amounts shall be determined as follows:
(1) The eligible hospitals for 1991-92 shall be identified. For
each hospital, the applicable total per diem payment adjustment
amount under Section 14105.98 for the 1991-92 transfer year shall be
computed. This amount shall be multiplied by 80 percent of the
eligible hospital's annualized Medi-Cal inpatient paid days as
determined from all Medi-Cal paid claims records available through
April 1, 1991. The products of these calculations for all eligible
hospitals shall be added together to determine an aggregate sum for
the 1991-92 transfer year.
(2) The eligible hospitals for 1991-92 involving transferor
entities as licensees shall be identified. For each hospital, the
applicable total per diem payment adjustment amount under Section
14105.98 for the 1991-92 transfer year shall be computed. This
amount shall be multiplied by 80 percent of the eligible hospital's
annualized Medi-Cal inpatient paid days as determined from all
Medi-Cal paid claims records available through April 1, 1991. The
products of these calculations for all eligible hospitals with
transferor entities as licensees shall be added together to determine
an aggregate sum for the 1991-92 transfer year.
(3) The aggregate sum determined under paragraph (1) shall be
divided by the aggregate sum determined under paragraph (2), yielding
a factor to be utilized in paragraph (4).
(4) The factor determined in paragraph (3) shall be multiplied by
the amount determined for each hospital under paragraph (2). The
product of this calculation for each hospital in paragraph (2) shall
be divided by 1.771, yielding a transfer amount for the particular
transferor entity for the transfer year.
(g) For the 1991-92 transfer year, the department shall notify
each transferor entity in writing of its applicable transfer amount
or amounts.
(h) For the 1992-93 transfer year and subsequent transfer years,
transfer amounts shall be determined in the same procedural manner as
set forth in subdivision (f), except:
(1) The department shall use all of the following:
(A) The disproportionate share list applicable to the particular
transfer year to determine the eligible hospitals.
(B) The payment adjustment amounts calculated under Section
14105.98 for the particular transfer year. These amounts shall take
into account any projected or actual increases or decreases in the
size of the payment adjustment program as are required under Section
14105.98 for the particular year in question, including any decreases
resulting from the application of the OBRA 1993 payment limitation.
The department may issue interim, revised, and supplemental transfer
requests as necessary and appropriate to address changes in payment
adjustment levels that occur under Section 14105.98. All transfer
requests, or adjustments thereto, issued to transferor entities by
the department shall meet the requirements set forth in subdivision
(i).
(C) Data regarding annualized Medi-Cal inpatient paid days for the
most recent calendar year ending prior to the beginning of the
particular transfer year, as determined from all Medi-Cal paid claims
records available through April 1 preceding the particular transfer
year.
(D) The status of public entities as licensees of eligible
hospitals as of July 1 of the particular transfer year.
(E) For the 1993-94 transfer year and subsequent transfer years,
the divisor to be used for purposes of the calculation referred to in
paragraph (4) of subdivision (f) shall be determined by the
department. The divisor shall be calculated to ensure that the
appropriate amount of transfers from transferor entities are received
into the fund to satisfy the requirements of Section 14105.98,
exclusive of the amounts described in paragraph (2) of this
subdivision, and to satisfy the requirements of paragraph (2) of
subdivision (d), for the particular transfer year. For the 1993-94
transfer year, the divisor shall be 1.742.
(F) The following provisions shall apply for certain transfer
amounts relating to nonsupplemental payments under Section 14105.98:
(i) For the 1998-99 transfer year, transfer amounts shall be
determined as though the payment adjustment amounts arising pursuant
to subdivision (ag) of Section 14105.98 were increased by the amounts
paid or payable pursuant to subdivision (af) of Section 14105.98.
(ii) Any transfer amounts paid by a transferor entity pursuant to
subparagraph (C) of paragraph (2) shall serve as credit for the
particular transferor entity against an equal amount of its transfer
obligation for the 1998-99 transfer year.
(iii) For the 1999-2000 transfer year, transfer amounts shall be
determined as though the amount to be transferred to the Health Care
Deposit Fund, as referred to in paragraph (2) of subdivision (d),
were reduced by 28 percent.
(2) (A) Except as provided in subparagraphs (B), (C), and (D), for
the 1993-94 transfer year and subsequent transfer years, transfer
amounts shall be increased for the particular transfer year in the
amounts necessary to fund the nonfederal share of the total
supplemental payment adjustment amounts of all types that arise under
Section 14105.98. These increases shall be paid only by those
transferor entities that are licensees of hospitals that are
projected to receive some or all of the particular supplemental
payments, and the increases shall be paid by the transferor entities
on a pro rata basis in connection with the particular supplemental
payments. For purposes of this paragraph, supplemental payment
adjustment amounts shall be deemed to arise for the particular
transfer year as of the date specified in Section 14105.98. Transfer
amounts to fund the nonfederal share of the payments shall be paid
for the particular transfer year within 20 days after the department
notifies the transferor entity in writing of the additional transfer
amount to be paid.
(B) For the 1995-96 transfer year, the nonfederal share of the
secondary supplemental payment adjustments described in paragraph (9)
of subdivision (y) of Section 14105.96 shall be funded as follows:
(i) Ninety-nine percent of the nonfederal share shall be funded by
a transfer from the University of California.
(ii) One percent of the nonfederal share shall be funded by
transfers from those public entities that are the licensees of the
hospitals included in the "other public hospitals" group referred to
in clauses (ii) and (iii) of subparagraph (B) of paragraph (9) of
subdivision (y) of Section 14105.98. The transfer responsibilities
for this 1 percent shall be allocated to the particular public
entities on a pro rata basis, based on a formula or formulae
customarily used by the department for allocating transfer amounts
under this section. The formula or formulae shall take into account,
through reallocation of transfer amounts as appropriate, the
situation of hospitals whose secondary supplemental payment
adjustments are restricted due to the application of the limitation
set forth in clause (v) of subparagraph (B) of paragraph (9) of
subdivision (y) of Section 14105.98.
(iii) All transfer amounts under this subparagraph shall be paid
by the particular transferor entities within 30 days after the
department notifies the transferor entity in writing of the transfer
amount to be paid.
(C) For the 1997-98 transfer year, transfer amounts to fund the
nonfederal share of the supplemental payment adjustments described in
subdivision (af) of Section 14105.98 shall be funded by a transfer
from the County of Los Angeles.
(D) (i) For the 1998-99 transfer year, transfer amounts to fund
the nonfederal share of the supplemental payment adjustment amounts
arising under subdivision (ah) of Section 14105.98 shall be increased
as set forth in clause (ii).
(ii) The transfer amounts otherwise calculated to fund the
supplemental payment adjustments referred to in clause (i) shall be
increased on a pro rata basis by an amount equal to 28 percent of the
amount to be transferred to the Health Care Deposit Fund for the
1999-2000 fiscal year, as referred to in paragraph (2) of subdivision
(d).
(3) The department shall prepare preliminary analyses and
calculations regarding potential transfer amounts, and potential
transferor entities shall be notified by the department of estimated
transfer amounts as soon as reasonably feasible regarding any
particular transfer year. Written notices of transfer amounts shall
be issued by the department as soon as possible with respect to each
transfer year. All state agencies shall take all necessary steps in
order to supply applicable data to the department to accomplish these
tasks. The Office of Statewide Health Planning and Development
shall provide to the department quarterly access to the edited and
unedited confidential
patient discharge data files for all Medi-Cal eligible patients. The
department shall maintain the confidentiality of that data to the
same extent as is required of the Office of Statewide Health Planning
and Development. In addition, the Office of Statewide Health
Planning and Development shall provide to the department, not later
than March 1 of each year, the data specified by the department, as
the data existed on the statewide database file as of February 1 of
each year, from all of the following:
(A) Hospital annual disclosure reports, filed with the Office of
Statewide Health Planning and Development pursuant to Section 443.31
or 128735 of the Health and Safety Code, for hospital fiscal years
that ended during the calendar year ending 13 months prior to the
applicable February 1.
(B) Annual reports of hospitals, filed with the Office of
Statewide Health Planning and Development pursuant to Section 439.2
or 127285 of the Health and Safety Code, for the calendar year ending
13 months prior to the applicable February 1.
(C) Hospital patient discharge data reports, filed with the Office
of Statewide Health Planning and Development pursuant to subdivision
(g) of Section 443.31 or 128735 of the Health and Safety Code, for
the calendar year ending 13 months prior to the applicable February
1.
(D) Any other materials on file with the Office of Statewide
Health Planning and Development.
(4) Transfer amounts calculated by the department may be increased
or decreased by a percentage amount consistent with the Medi-Cal
state plan.
(5) For the 1993-94 fiscal year, the transfer amount that would
otherwise be required from the University of California shall be
increased by fifteen million dollars ($15,000,000).
(6) Notwithstanding any other provision of law, except for
subparagraph (D) of paragraph (2), the total amount of transfers
required from the transferor entities for any particular transfer
year shall not exceed the sum of the following:
(A) The amount needed to fund the nonfederal share of all payment
adjustment amounts applicable to the particular payment adjustment
year as calculated under Section 14105.98. Included in the
calculations for this purpose shall be any decreases in the program
as a whole, and for individual hospitals, that arise due to the
provisions of Section 1396r-4(f) or (g) of Title 42 of the United
States Code.
(B) The amount needed to fund the transfers to the Health Care
Deposit Fund, as referred to in subdivision (d).
(7) (A) Except as provided in subparagraphs (B) and (C) and in
paragraph (2) of subdivision (j), and except for a prudent reserve
not to exceed two million dollars ($2,000,000) in the Medi-Cal
Inpatient Payment Adjustment Fund, any amounts in the fund, including
interest that accrues with respect to the amounts in the fund, that
are not expended, or estimated to be required for expenditure, under
Section 14105.98 with respect to a particular transfer year shall be
returned on a pro rata basis to the transferor entities for the
particular transfer year within 120 days after the department
determines that the funds are not needed for an expenditure in
connection with the particular transfer year.
(B) The department shall determine the interest amounts that have
accrued in the fund from its inception through June 30, 1995, and, no
later than January 1, 1996, shall distribute these interest amounts
to transferor entities:
(C) With respect to those particular amounts in the fund resulting
solely from the provisions of subparagraph (D) of paragraph (2), the
department shall determine by September 30, 1999, whether these
particular amounts exceed 28 percent of the amount to be transferred
to the Health Care Deposit Fund for the 1999-2000 fiscal year, as
referred to in paragraph (2) of subdivision (d). Any excess amount
so determined shall be returned to the particular transferor entities
on a pro rata basis no later than October 31, 1999.
(D) Regarding any funds returned to a transferor entity under
subparagraph (A) or (C), or interest amounts distributed to a
transferor entity under subparagraph (B), the department shall
provide to the transferor entity a written statement that explains
the basis for the particular return or distribution of funds and
contains the general calculations used by the department in
determining the amount of the particular return or distribution of
funds.
(i) (1) For the 1991-92 transfer year, each transferor entity
shall pay its transfer amount or amounts to the Controller, for
deposit in the fund, in eight equal installments.
(2) (A) Except as provided in subparagraphs (B) and (C), for the
1992-93 transfer year and subsequent transfer years, each transferor
entity shall pay its transfer amount or amounts to the Controller,
for deposit in the fund, in eight equal installments. However, for
the 1997-98 and subsequent transfer years, each transferor entity
shall pay its transfer amount or amounts to the Controller, for
deposit in the fund, in the form of periodic installments according
to a timetable established by the department. The timetable shall be
structured to effectuate, on a reasonable basis, the prompt
distribution of all nonsupplemental payment adjustments under Section
14105.98, and transfers to the Health Care Deposit Fund under
subdivision (d).
(B) For the 1994-95 transfer year, each transferor entity shall
pay its transfer amount or amounts to the Controller, for deposit in
the fund, in five equal installments.
(C) For the 1995-96 transfer year, each transferor entity shall
pay its transfer amount or amounts to the Controller, for deposit in
the fund, in five equal installments.
(D) Except as otherwise specifically provided, subparagraphs (A)
to (C), inclusive, shall not apply to increases in transfer amounts
described in paragraph (2) of subdivision (h) or to additional
transfer amounts described in subdivision (o).
(E) All requests for transfer payments, or adjustments thereto,
issued by the department shall be in writing and shall include (i) an
explanation of the basis for the particular transfer request or
transfer activity, (ii) a summary description of program funding
status for the particular transfer year, and (iii) the general
calculations used by the department in connection with the particular
transfer request or transfer activity.
(3) A transferor entity may use any of the following funds for
purposes of meeting its transfer obligations under this section:
(A) General funds of the transferor entity.
(B) Any other funds permitted by law to be used for these
purposes, except that a transferor entity shall not submit to the
Controller any federal funds unless those federal funds are
authorized by federal law to be used to match other federal funds.
In addition, no private donated funds from any health care provider,
or from any person or organization affiliated with the health care
provider, shall be channeled through a transferor entity or any other
public entity to the fund, unless the donated funds will qualify
under federal rules as a valid component of the nonfederal share of
the Medi-Cal program and will be matched by federal funds. The
transferor entity shall be responsible for determining that funds
transferred meet the requirements of this subparagraph.
(j) (1) If a transferor entity does not submit any transfer amount
within the time period specified in this section, the Controller
shall offset immediately the amount owed against any funds which
otherwise would be payable by the state to the transferor entity.
The Controller, however, shall not impose an offset against any
particular funds payable to the transferor entity where the offset
would violate state or federal law.
(2) Where a withhold or a recoupment occurs pursuant to the
provisions of paragraph (2) of subdivision (r) of Section 14105.98,
the nonfederal portion of the amount in question shall remain in the
fund, or shall be redeposited in the fund by the department, as
applicable. The department shall then proceed as follows:
(A) If the withhold or recoupment was imposed with respect to a
hospital whose licensee was a transferor entity for the particular
state fiscal year to which the withhold or recoupment related, the
nonfederal portion of the amount withheld or recouped shall serve as
a credit for the particular transferor entity against an equal amount
of transfer obligations under this section, to be applied whenever
the transfer obligations next arise. Should no such transfer
obligation arise within 180 days, the department shall return the
funds in question to the particular transferor entity within 30 days
thereafter.
(B) For other situations, the withheld or recouped nonfederal
portion shall be subject to paragraph (7) of subdivision (h).
(k) All transfer amounts received by the Controller or amounts
offset by the Controller shall immediately be deposited in the fund.
(l) For purposes of this section, the disproportionate share list
utilized by the department for a particular transfer year shall be
identical to the disproportionate share list utilized by the
department for the same state fiscal year for purposes of Section
14105.98. Nothing on a disproportionate share list, once issued by
the department, shall be modified for any reason other than
mathematical or typographical errors or omissions on the part of the
department or the Office of Statewide Health Planning and Development
in preparation of the list.
(m) Neither the intergovernmental transfers required by this
section, nor any elective transfer made pursuant to Section 14164,
shall create, lead to, or expand the health care funding or service
obligations for current or future years for any transferor entity,
except as required of the state by this section or as may be required
by federal law, in which case the state shall be held harmless by
the transferor entities on a pro rata basis.
(n) Except as otherwise permitted by state and federal law, no
transfer amount submitted to the Controller under this section, and
no offset by the Controller pursuant to subdivision (j), shall be
claimed or recognized as an allowable element of cost in Medi-Cal
cost reports submitted to the department.
(o) Whenever additional transfer amounts are required to fund the
nonfederal share of payment adjustment amounts under Section 14105.98
that are distributed after the close of the particular payment
adjustment year to which the payment adjustment amounts apply, the
additional transfer amounts shall be paid by the parties who were the
transferor entities for the particular transfer year that was
concurrent with the particular payment adjustment year. The
additional transfer amounts shall be calculated under the formula
that was in effect during the particular transfer year. For transfer
years prior to the 1993-94 transfer year, the percentage of the
additional transfer amounts available for transfer to the Health Care
Deposit Fund under subdivision (d) shall be the percentage that was
in effect during the particular transfer year. These additional
transfer amounts shall be paid by transferor entities within 20 days
after the department notifies the transferor entity in writing of the
additional transfer amount to be paid.
(p) (1) Ten million dollars ($10,000,000) of the amount
transferred from the Medi-Cal Inpatient Payment Adjustment Fund to
the Health Care Deposit Fund due to amounts transferred attributable
to years prior to the 1993-94 fiscal year is hereby appropriated
without regard to fiscal years to the State Department of Health
Services to be used to support the development of managed care
programs under the department's plan to expand Medi-Cal managed care.
(2) These funds shall be used by the department for both of the
following purposes: (A) distributions to counties or other local
entities that contract with the department to receive those funds to
offset a portion of the costs of forming the local initiative entity,
and (B) distributions to local initiative entities that contract
with the department to receive those funds to offset a portion of the
costs of developing the local initiative health delivery system in
accordance with the department's plan to expand Medi-Cal managed
care.
(3) Entities contracting with the department for any portion of
the ten million dollars ($10,000,000) shall meet the objectives of
the department's plan to expand Medi-Cal managed care with regard to
traditional and safety net providers.
(4) Entities contracting with the department for any portion of
the ten million dollars ($10,000,000) may be authorized under those
contracts to utilize their funds to provide for reimbursement of the
costs of local organizations and entities incurred in participating
in the development and operation of a local initiative.
(5) To the full extent permitted by state and federal law, these
funds shall be distributed by the department for expenditure at the
local level in a manner that qualifies for federal financial
participation under the medicaid program.
(q) (1) Any local initiative entity that has performed
unanticipated additional work for the purposes identified in
subparagraph (B) of paragraph (2) of subdivision (p) resulting in
additional costs attributable to the development of its local
initiative health delivery system, may file a claim for reimbursement
with the department for the additional costs incurred due to delays
in start dates through the 1996-97 fiscal year. The claim shall be
filed by the local initiative entity not later than 90 days after the
effective date of the act adding this subdivision, and shall not
seek extra compensation for any sum that is or could have been
asserted pursuant to the contract disputes and appeals resolution
provisions of the local initiative entity's respective two-plan model
contract. All claims for unanticipated additional incurred costs
shall be submitted with adequate supporting documentation including,
but not limited to, all of the following:
(A) Invoices, receipts, job descriptions, payroll records, work
plans, and other materials that identify the unanticipated additional
claimed and incurred costs.
(B) Documents reflecting mitigation of costs.
(C) To the extent lost profits are included in the claim,
documentation identifying those profits and the manner of
calculation.
(D) Documents reflecting the anticipated start date, the actual
start date, and reasons for the delay between the dates, if any.
(2) In determining any amount to be paid, the department shall do
all of the following:
(A) Conduct a fiscal analysis of the local initiative entity's
claimed costs.
(B) Determine the appropriate amount of payment, after taking into
consideration the supporting documentation and the results of any
audit.
(C) Provide funding for any such payment, as approved by the
Department of Finance through the deficiency process.
(D) Complete the determination required in subparagraph (B) within
six months after receipt of a local initiative entity's completed
claim and supporting documentation. Prior to final determination,
there shall be a review and comment period for that local initiative
entity.
(E) Make reasonable efforts to obtain federal financial
participation. In the event federal financial participation is not
allowed for this payment, the state's payment shall be 50 percent of
the total amount determined to be payable.
SEC. 89. Section 14495.10 of the Welfare and Institutions Code is
amended to read:
14495.10. (a) The department shall establish a pilot program to
provide continuous skilled nursing care as a benefit of the Medi-Cal
program, when those services are provided in accordance with an
approved federal waiver meeting the requirements of subdivision (b).
"Continuous skilled nursing care" means medically necessary care
provided by, or under the supervision of, a registered nurse within
his or her scope of practice, seven days a week, 24 hours per day, in
a health facility participating in the pilot program. This care
shall include a minimum of eight hours per day provided by or under
the direct supervision of a registered nurse. Each health facility
providing continuous skilled nursing care in the pilot program shall
have a minimum of one registered nurse or one licensed vocational
nurse awake and in the facility at all times.
(b) The department shall submit to the federal Health Care
Financing Administration, no later than April 1, 2000, a federal
waiver request developed in consultation with the State Department of
Developmental Services and the Association of Regional Center
Agencies, pursuant to Section 1915(b) of the federal Social Security
Act to provide continuous skilled nursing care services under the
pilot program.
(c) (1) The pilot program shall be conducted to explore more
flexible models of health facility licensure to provide continuous
skilled nursing care to developmentally disabled individuals in the
least restrictive health facility setting, and to evaluate the effect
of the pilot program on the health, safety, and quality of life of
individuals, and the cost-effectiveness of this care. The evaluation
shall include a review of the pilot program by an independent
agency.
(2) Participation in the pilot program shall include 10 health
facilities provided that the facilities meet all eligibility
requirements. The facilities shall be approved by the department, in
consultation with the State Department of Developmental Services and
the appropriate regional center agencies, and shall meet the
requirements of subdivision (e). Priority shall be given to
facilities with four to six beds, to the extent those facilities meet
all other eligibility requirements.
(d) Under the pilot program established in this section, a
developmentally disabled individual is eligible to receive continuous
skilled nursing care if all of the following conditions are met:
(1) The developmentally disabled individual meets the criteria as
specified in the federal waiver.
(2) The developmentally disabled individual resides in a health
facility that meets the provider participation criteria as specified
in the federal waiver.
(3) The continuous skilled nursing care services are provided in
accordance with the federal waiver.
(4) The continuous skilled nursing care services provided to the
developmentally disabled individual do not result in costs that
exceed the fiscal limit established in the federal waiver.
(e) A health facility seeking to participate in the pilot program
shall provide care for developmentally disabled individuals who
require the availability of continuous skilled nursing care, in
accordance with the terms of the pilot program. During participation
in the pilot program, the health facility shall comply with all the
terms and conditions of the federal waiver described in subdivision
(b), and shall not be subject to licensure or inspection under
Chapter 2 (commencing with Section 1250) of Division 2 of the Health
and Safety Code. Upon termination of the pilot program and
verification of compliance with Section 1265 of the Health and Safety
Code, the department shall immediately reinstate the participating
health facility's previous license for the balance of time remaining
on the license when the health facility began participation in the
pilot program.
(f) The department shall implement this pilot program only to the
extent it can demonstrate fiscal neutrality, as required under the
terms of the federal waiver, and only if the department has obtained
the necessary approvals to implement the pilot program and receives
federal financial participation from the federal Health Care
Financing Administration.
(g) In implementing this article, the department may enter into
contracts for the provision of essential administration and other
services. Contracts entered into under this section may be on a
noncompetitive bid basis and shall be exempt from the requirements of
Chapter 2 (commencing with Section 10290) of Part 2 of Division 2 of
the Public Contract Code.
(h) This section shall remain in effect only until January 1,
2006, and as of that date is repealed, unless a later enacted statute
that becomes effective on or before January 1, 2006, deletes or
extends that date.
SEC. 90. Section 16809 of the Welfare and Institutions Code, as
amended by Section 45 of Chapter 171 of the Statutes of 2001, is
amended to read:
16809. (a) (1) The board of supervisors of a county that
contracted with the department pursuant to Section 16709 during the
1990-91 fiscal year and any county with a population under 300,000,
as determined in accordance with the 1990 decennial census, by
adopting a resolution to that effect, may elect to participate in the
County Medical Services Program. The County Medical Services
Program shall have responsibilities for specified health services to
county residents certified eligible for those services by the county.
(2) If the County Medical Services Program Governing Board
contracts with the department to administer the County Medical
Services Program, that contract shall include, but need not be
limited to, all of the following:
(A) Provisions for the payment to participating counties for
making eligibility determinations based on the formula used by the
County Medical Services Program for the 1993-94 fiscal year.
(B) Provisions for payment of expenses of the County Medical
Services Program Governing Board.
(C) Provisions relating to the flow of funds from counties'
vehicle license fees, sales taxes, and participation fees and the
procedures to be followed if a county does not pay those funds to the
program.
(D) Those provisions, as applicable, contained in the 1993-94
fiscal year contract with counties under the County Medical Services
Program.
(3) The contract between the department and the County Medical
Services Program Governing Board shall require that the County
Medical Services Program Governing Board shall reimburse three
million five hundred thousand dollars ($3,500,000) for the state
costs of providing administrative support to the County Medical
Services Program. The department may decline to implement decisions
made by the governing board that would require a greater level of
administrative support than that for the 1993-94 fiscal year. The
department may implement decisions upon compensation by the governing
board to cover that increased level of support.
(4) The contract between the department and the County Medical
Services Program Governing Board may include provisions for the
administration of a pharmacy benefit program and, pursuant to these
provisions, the department may negotiate, on behalf of the County
Medical Services Program, rebates from manufacturers that agree to
participate. The governing board shall reimburse the department for
staff costs associated with this paragraph.
(5) The department shall administer the County Medical Services
Program pursuant to the provisions of the 1993-94 fiscal year
contract with the counties and regulations relating to the
administration of the program until the County Medical Services
Program Governing Board executes a contract for the administration of
the County Medical Services Program and adopts regulations for that
purpose.
(6) The department shall not be liable for any costs related to
decisions of the County Medical Services Program Governing Board that
are in excess of those set forth in the contract between the
department and the County Medical Services Program Governing Board.
(b) Each county intending to participate in the County Medical
Services Program pursuant to this section shall submit to the
Governing Board of the County Medical Services Program a notice of
intent to contract adopted by the board of supervisors no later than
April 1 of the fiscal year preceding the fiscal year in which the
county will participate in the County Medical Services Program.
(c) A county participating in the County Medical Services Program
pursuant to this section shall not be relieved of its indigent health
care obligation under Section 17000.
(d) (1) The County Medical Services Program Account is established
in the County Health Services Fund. The County Medical Services
Program Account is continuously appropriated, notwithstanding Section
13340 of the Government Code, without regard to fiscal years. The
following amounts may be deposited in the account:
(A) Any interest earned upon money deposited in the account.
(B) Moneys provided by participating counties or appropriated by
the Legislature to the account.
(C) Moneys loaned pursuant to subdivision (q).
(2) The methods and procedures used to deposit funds into the
account shall be consistent with the methods used by the program
during the 1993-94 fiscal year.
(e) Moneys in the program account shall be used by the department,
pursuant to its contract with the County Medical Services Program
Governing Board, to pay for health care services provided to the
persons meeting the eligibility criteria established pursuant to
subdivision (j) and to pay for the expense of the governing board as
set forth in the contract between the board and the department. In
addition, moneys in this account may be used to reimburse the
department for state costs pursuant to paragraph (3) of subdivision
(a).
(f) (1) Moneys in this account shall be administered on an accrual
basis and notwithstanding any other provision of law, except as
provided in this section, shall not be transferred to any other fund
or account in the State Treasury except for purposes of investment as
provided in Article 4 (commencing with Section 16470) of Chapter 3
of Part 2 of Division 4 of Title 2 of the Government Code.
(2) (A) All interest or other increment resulting from the
investment shall be deposited in the program account, at the end of
the 1982-83 fiscal year and every six months thereafter,
notwithstanding Section 16305.7 of the Government Code.
(B) All interest deposited pursuant to subparagraph (A) shall be
available to reimburse program-covered services, County Medical
Services Program Governing Board expenses, or for expenditures to
augment the program's rates, benefits, or eligibility criteria
pursuant to subdivision (j).
(g) A separate County Medical Services Program Reserve Account is
established in the County Health Services Fund. Six months after the
end of each fiscal year, any projected savings in the program
account shall be transferred to the reserve account, with final
settlement occurring no more than 12 months later. Moneys in this
account shall be
utilized when expenditures for health services made pursuant to
subdivision (j) for a fiscal year exceed the amount of funds
available in the program account for that fiscal year. When funds in
the reserve account are estimated to exceed 10 percent of the budget
for health services for all counties electing to participate in the
County Medical Services Program under this section for the fiscal
year, the additional funds shall be available for expenditure to
augment the rates, benefits, or eligibility criteria pursuant to
subdivision (j) or for reducing the participation fees as determined
by the County Medical Services Program Governing Board pursuant to
subdivision (i). Nothing in this section shall preclude the CMSP
Governing Board from establishing other reserves.
(h) Moneys in the program account and the reserve account, except
for moneys provided by the state in excess of the amount required to
fund the state risk specified in subdivision (j), and any funds
loaned pursuant to subdivision (q) shall not be transferred to any
other fund or account in the State Treasury except for purposes of
investment as provided in Article 4 (commencing with Section 16470)
of Chapter 3 of Part 2 of Division 4 of Title 2 of the Government
Code. All interest or other increment resulting from investment
shall be deposited in the program account, notwithstanding Section
16705.7 of the Government Code.
(i) (1) Counties shall pay participation fees as established by
the County Medical Services Program Governing Board and their
jurisdictional risk amount in a method that is consistent with that
established in the 1993-94 fiscal year.
(2) A county may request, due to financial hardship, the payments
under paragraph (1) be delayed. The request shall be subject to
approval by the CMSP Governing Board.
(3) Payments made pursuant to this subdivision shall be deposited
in the program account.
(4) Payments may be made as part of the deposits authorized by the
county pursuant to Sections 17603.05 and 17604.05.
(j) (1) (A) For the 1991-92 fiscal year and all preceding fiscal
years, the state shall be at risk for any costs in excess of the
amounts deposited in the reserve fund.
(B) (i) Beginning in the 1992-93 fiscal year and for each fiscal
year thereafter, counties and the state shall share the risk for cost
increases of the County Medical Services Program not funded through
other sources. The state shall be at risk for any cost that exceeds
the cumulative annual growth in dedicated sales tax and vehicle
license fee revenue, up to the amount of twenty million two hundred
thirty-seven thousand four hundred sixty dollars ($20,237,460) per
fiscal year, except for the 1999-2000, 2000-01, 2001-02, and 2002-03
fiscal years. Counties shall be at risk up to the cumulative annual
growth in the Local Revenue Fund created by Section 17600, according
to the table specified in paragraph (2), to the County Medical
Services Program, plus the additional cost increases in excess of
twenty million two hundred thirty-seven thousand four hundred sixty
dollars ($20,237,460) per fiscal year, except for the 1999-2000,
2000-01, 2001-02, and 2002-03 fiscal years. In the 1994-95 fiscal
year, the amount of the state risk shall be twenty million two
hundred thirty-seven thousand four hundred sixty dollars
($20,237,460) per fiscal year, in addition to the cost of
administrative support pursuant to paragraph (3) of subdivision (a).
(ii) For the 1999-2000, 2000-01, 2001-02, and 2002-03 fiscal
years, the state shall not be at risk for any cost that exceeds the
cumulative annual growth in dedicated sales tax and vehicle license
fee revenue. Counties shall be at risk up to the cumulative annual
growth in the Local Revenue Fund created by Section 17600, according
to the table specified in paragraph (2), to the County Medical
Services Program, plus any additional cost increases for the
1999-2000, 2000-01, 2001-02, and 2002-03 fiscal years.
(C) The CMSP Governing Board, after consultation with the
department, shall establish uniform eligibility criteria and benefits
for the County Medical Services Program.
(2) For the 1991-92 fiscal year, jurisdictional risk limitations
shall be as follows:
Jurisdiction Amount
Alpine ......................... $ 13,150
Amador ......................... 620,264
Butte .......................... 5,950,593
Calaveras ...................... 913,959
Colusa ......................... 799,988
Del Norte ...................... 781,358
El Dorado ...................... 3,535,288
Glenn .......................... 787,933
Humboldt ....................... 6,883,182
Imperial ....................... 6,394,422
Inyo ........................... 1,100,257
Kings .......................... 2,832,833
Lassen ......................... 687,113
Madera ......................... 2,882,147
Marin .......................... 7,725,909
Mariposa ....................... 435,062
Modoc .......................... 469,034
Mono ........................... 369,309
Napa ........................... 3,062,967
Nevada ......................... 1,860,793
Plumas ......................... 905,192
San Benito ..................... 1,086,011
Shasta ......................... 5,361,013
Sierra ......................... 135,888
Siskiyou ....................... 1,372,034
Solano ......................... 6,871,127
Sonoma ......................... 13,183,359
Sutter ......................... 2,996,118
Tehama ......................... 1,912,299
Trinity ........................ 611,497
Tuolumne ....................... 1,455,320
Yuba ........................... 2,395,580
(3) Beginning in the 1991-92 fiscal year and in subsequent fiscal
years, the jurisdictional risk limitation for the counties that did
not contract with the department pursuant to Section 16709 during the
1990-91 fiscal year shall be the amount specified in paragraph (A)
plus the amount determined pursuant to paragraph (B), minus the
amount specified by the County Medical Services Program Governing
Board as participation fees.
(A)
Jurisdiction Amount
Lake ........................... $1,022,963
Mendocino ...................... 1,654,999
Merced ......................... 2,033,729
Placer ......................... 1,338,330
San Luis Obispo ................ 2,000,491
Santa Cruz ..................... 3,037,783
Yolo ........................... 1,475,620
(B) The amount of funds necessary to fully fund the anticipated
costs for the county shall be determined by the CMSP Governing Board
before a county is permitted to participate in the County Medical
Services Program.
(4) For the 1994-95 and 1995-96 fiscal years, the specific amounts
and method of apportioning risk to each participating county may be
adjusted by the CMSP Governing Board.
(k) The Legislature hereby determines that an expedited contract
process for contracts under this section is necessary. Contracts
under this section shall be exempt from Part 2 (commencing with
Section 10100) of Division 2 of the Public Contract Code. Contracts
of the department pursuant to this section shall have no force or
effect unless they are approved by the Department of Finance.
(l) The state shall not incur any liability except as specified in
this section.
(m) Third-party recoveries for services provided under this
section pursuant to Article 3.5 (commencing with Section 14124.70) of
Chapter 7 of Part 3 may be pursued.
(n) Under the program provided for in this section, the department
may reimburse hospitals for inpatient services at the rates
negotiated for the Medi-Cal program by the California Medical
Assistance Commission, pursuant to Article 2.6 (commencing with
Section 14081) of Chapter 7 of Part 3, if the California Medical
Assistance Commission determines that reimbursement to the hospital
at the contracted rate will not have a detrimental fiscal impact on
either the Medi-Cal program or the program provided for in this
section. In negotiating and renegotiating contracts with hospitals,
the commission may seek terms which allow reimbursement for patients
receiving services under this section at contracted Medi-Cal rates.
(o) Any hospital which has a contract with the state for inpatient
services under the Medi-Cal program and which has been approved by
the commission to be reimbursed for patients receiving services under
this section shall not deny services to these patients.
(p) Participating counties may conduct an independent program
review to identify ways through which program savings may be
generated. The counties and the department may collectively pursue
identified options for the realization of program savings.
(q) The Department of Finance may authorize a loan of up to thirty
million dollars ($30,000,000) for deposit into the program account
to ensure that there are sufficient funds available to reimburse
providers and counties pursuant to this section.
(r) Regulations adopted by the department pursuant to this section
shall remain operative and shall be used to operate the County
Medical Services Program until a contract with the County Medical
Services Program Governing Board is executed and regulations, as
appropriate, are adopted by the County Medical Services Program
Governing Board. Notwithstanding Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code, those regulations adopted under the County Medical Services
Program shall become inoperative until January 1, 1998, except those
regulations that the department, in consultation with the County
Medical Services Program Governing Board, determines are needed to
continue to administer the County Medical Services Program. The
department shall notify the Office of Administrative Law as to those
regulations the department will continue to use in the implementation
of the County Medical Services Program.
(s) Moneys appropriated from the General Fund to meet the state
risk as set forth in subparagraph (B) of paragraph (1) of subdivision
(j) shall not be available for those counties electing to disenroll
from the County Medical Services Program.
(t) This section shall remain in effect only until January 1,
2008, and as of that date is repealed, unless a later enacted
statute, that is enacted on or before January 1, 2008, deletes or
extends that date.
SEC. 91. Section 16809 of the Welfare and Institutions Code, as
amended by Section 2 of Chapter 669 of the Statutes of 1997, is
amended to read:
16809. (a) The board of supervisors of a county that contracted
with the department pursuant to Section 16709 during the 1990-91
fiscal year and any county with a population under 300,000, as
determined in accordance with the 1990 decennial census, may enter
into a contract with the department and the department may enter into
a contract with that county under which the department agrees to
administer the program responsibilities for specified health services
to county residents certified eligible for those services by the
county.
(b) Each county intending to contract with the department pursuant
to this section shall submit to the department a notice of intent to
contract adopted by the board of supervisors no later than April 1
of the fiscal year preceding the fiscal year for which the agreement
will be in effect in accordance with procedures established by the
department.
(c) A county contracting with the department pursuant to this
section shall not be relieved of its indigent health care obligation
under Section 17000.
(d) The department shall establish the County Medical Services
Program Account in the County Health Services Fund. The County
Medical Services Program Account is continuously appropriated,
notwithstanding Section 13340 of the Government Code, without regard
to fiscal years. The following amounts may be deposited in the
account:
(1) Any interest earned upon money deposited in the account.
(2) Moneys provided by participating counties or appropriated by
the Legislature to the account.
(3) Moneys loaned pursuant to subdivision (q).
(e) Moneys in the program account shall be used by the department
to pay for health care services provided to the persons meeting the
eligibility criteria established pursuant to subdivision (j).
(f) (1) Moneys in this account shall be administered on an accrual
basis and notwithstanding any other provision of law, except as
provided in this section, shall not be transferred to any other fund
or account in the State Treasury except for purposes of investment as
provided in Article 4 (commencing with Section 16470) of Chapter 3
of Part 2 of Division 4 of Title 2 of the Government Code.
(2) (A) All interest or other increment resulting from the
investment shall be deposited in the program account, at the end of
the 1982-83 fiscal year and every six months thereafter,
notwithstanding Section 16305.7 of the Government Code.
(B) All interest deposited pursuant to subparagraph (A) shall be
available to reimburse program-covered services, or for expenditures
to augment the program's rates, benefits, or eligibility criteria
pursuant to subdivision (j).
(g) The department shall establish a separate County Medical
Services Program Reserve Account in the County Health Services Fund.
Six months after the end of each fiscal year, any projected savings
in the program account shall be transferred to the reserve account,
with final settlement occurring no more than 12 months later. Moneys
in this account shall be utilized when expenditures for health
services made pursuant to subdivision (j) for a fiscal year exceed
the amount of funds available in the program account for that fiscal
year. When funds in the reserve account are estimated to exceed 10
percent of the budget for health services for all counties electing
to contract with the department under this section for the fiscal
year, the additional funds shall be available for expenditure to
augment the rates, benefits, or eligibility criteria pursuant to
subdivision (j) or for reducing the participation fees required by
Section 16809.3.
(h) Moneys in the program account and the reserve account, except
for moneys provided by the state in excess of the amount required to
fund the state risk specified in subdivision (j), and any funds
loaned pursuant to subdivision (q), shall not be transferred to any
other fund or account in the State Treasury except for purposes of
investment as provided in Article 4 (commencing with Section 16470)
of Chapter 3 of Part 2 of Division 4 of Title 2 of the Government
Code. All interest or other increment resulting from investment
shall be deposited in the program account, notwithstanding Section
16705.7 of the Government Code.
(i) (1) Counties shall pay by the 15th of each month the
agreed-upon contract amount. In the event a county does not make the
agreed-upon monthly payment, the department may terminate the county'
s participation in the program.
(2) A county may request, due to financial hardship, the payments
under paragraph (1) be delayed. The request shall be subject to
approval by the Small County Advisory Committee.
(3) Payments made pursuant to this subdivision shall be deposited
in the program account.
(4) Payments may be made as part of the deposits authorized by the
county pursuant to Sections 17603.05 and 17604.05.
(j) (1) (A) For the 1991-92 fiscal year and all preceding fiscal
years, the state shall be at risk for any costs in excess of the
amounts deposited in the reserve fund.
(B) Beginning in the 1992-93 fiscal year and for each fiscal year
thereafter, counties and the state shall share the risk for cost
increases of the County Medical Services Program not funded through
other sources. The state shall be at risk for any cost that exceeds
the cumulative annual growth in dedicated sales tax and vehicle
license fee revenue, up to the amount of twenty million two hundred
thirty-seven thousand four hundred sixty dollars ($20,237,460) per
fiscal year, except for the 2002-03 fiscal year. Counties shall be
at risk up to the cumulative annual growth in the Local Revenue Fund
created by Section 17600 according to the table specified in
paragraph (2) to the County Medical Services Program, plus additional
cost increases in excess of twenty million two hundred thirty-seven
thousand four hundred sixty dollars ($20,237,460) per fiscal year.
(C) As a condition of the state assuming this risk, the department
may require uniform eligibility criteria and benefits to be provided
which shall be mutually established by participating counties in
conjunction with the department. The County Medical Services Program
Governing Board may revise these eligibility criteria and benefits
or alter rates of payment in order to assure that expenditures do not
exceed the funds available in the program account.
(2) For the 1991-92 fiscal year, jurisdictional risk limitations
shall be as follows:
Jurisdiction Amount
Alpine ........................... $ 13,150
Amador ........................... 620,264
Butte ............................ 5,950,593
Calaveras ........................ 913,959
Colusa ........................... 799,988
Del Norte ........................ 781,358
El Dorado ........................ 3,535,288
Glenn ............................ 787,933
Humboldt ......................... 6,883,182
Imperial ......................... 6,394,422
Inyo ............................. 1,100,257
Kings ............................ 2,832,833
Lassen ........................... 687,113
Madera ........................... 2,882,147
Marin ............................ 7,725,909
Mariposa ......................... 435,062
Modoc ............................ 469,034
Mono ............................. 369,309
Napa ............................. 3,062,967
Nevada ........................... 1,860,793
Plumas ........................... 905,192
San Benito ....................... 1,086,011
Shasta ........................... 5,361,013
Sierra ........................... 135,888
Siskiyou ......................... 1,372,034
Solano ........................... 6,871,127
Sonoma ........................... 13,183,359
Sutter ........................... 2,996,118
Tehama ........................... 1,912,299
Trinity .......................... 611,497
Tuolumne ......................... 1,455,320
Yuba ............................. 2,395,580
(3) Beginning in the 1991-92 fiscal year and in subsequent fiscal
years, the jurisdictional risk limitation for the counties that did
not contract with the department pursuant to Section 16709 during the
1990-91 fiscal year shall be the amount specified in paragraph (A)
plus the amount determined pursuant to paragraph (B), minus the
amount specified in Section 16809.3.
(A)
Jurisdiction Amount
Lake ............................. 1,022,963
Mendocino ........................ 1,654,999
Merced ........................... 2,033,729
Placer ........................... 1,338,330
San Luis Obispo .................. 2,000,491
Santa Cruz ....................... 3,037,783
Yolo ............................. 1,475,620
(B) The amount of funds necessary to fully fund the anticipated
costs for the county shall be determined by the department. This
amount shall be subject to the approval of both the Department of
Finance and the Small County Advisory Committee before a county is
permitted to contract back with the department.
(4) For the 1992-93 fiscal year and fiscal years thereafter, the
amounts of the jurisdictional risk limitations shall be adjusted
according to the provisions of paragraph (2).
(k) The Legislature hereby determines that an expedited contract
process for contracts under this section is necessary. Contracts
under this section shall be exempt from the provisions of Chapter 2
(commencing with Section 10290) of Part 2 of Division 2 of the Public
Contract Code. Contracts shall have no force and effect unless
approved by the Department of Finance.
(l) The state shall not incur any liability except as specified in
this section.
(m) The department may pursue third-party recoveries for services
provided under this section pursuant to Article 3.5 (commencing with
Section 14124.70) of Chapter 7 of Part 3.
(n) Under the program provided for in this section, the department
shall reimburse hospitals for inpatient services at the rates
negotiated for the Medi-Cal program by the California Medical
Assistance Commission, pursuant to Article 2.6 (commencing with
Section 14081) of Chapter 7 of Part 3, if the California Medical
Assistance Commission determines that reimbursement to the hospital
at the contracted rate will not have a detrimental fiscal impact on
either the Medi-Cal program or the program provided for in this
section. In negotiating and renegotiating contracts with hospitals,
the commission may seek terms which allow reimbursement for patients
receiving services under this section at contracted Medi-Cal rates.
(o) Any hospital which has a contract with the state for inpatient
services under the Medi-Cal program and which has been approved by
the commission to be reimbursed for patients receiving services under
this section shall not deny services to these patients.
(p) Participating counties may conduct an independent program
review to identify ways through which program savings may be
generated. The counties and the department shall collectively pursue
identified options for the realization of program savings.
(q) The Department of Finance may authorize a loan of up to thirty
million dollars ($30,000,000) for deposit into the program account
to ensure that there are sufficient funds available to reimburse
providers and counties pursuant to this section.
(r) This section shall become operative January 1, 2008.
SEC. 91.5. Section 16809.4 of the Welfare and Institutions Code is
amended to read:
16809.4. (a) Counties voluntarily participating in the County
Medical Services Program pursuant to Section 16809 may establish the
County Medical Services Program Governing Board pursuant to
procedures contained in this section. The board shall govern the
CMSP program.
(b) The membership of the board shall be comprised of all of the
following:
(1) Three members who shall each be a member of a county board of
supervisors.
(2) Three members who shall be county administrative officers.
(3) Two members who shall be county welfare directors.
(4) Two members who shall be county health officials.
(5) One member who shall be the Secretary of the Health and
Welfare Agency, or his or her designee, and who shall serve as an ex
officio, nonvoting member.
(c) The board may establish its own bylaws and operating
procedures.
(d) The voting membership of the board shall meet all of the
following requirements:
(1) All of the members shall hold office or employment in counties
that participate in the CMSP program.
(2) The initial CMSP Governing Board shall be composed of the
incumbent members of the Small County Advisory Committee holding
office on the effective date of this section. Those members shall
choose one additional county supervisor and one additional county
administrative officer. The initial CMSP Governing Board shall hold
office until April 1, 1995.
(3) The initial CMSP Governing Board shall be succeeded on April
1, 1995, by a board chosen in the following order so as to ensure
that no two representatives shall be from the same county.
Following the effective date of this section:
(A) The three county supervisor members shall be elected by the
CMSP counties acting prior to February 1, 1995, with each county
having one vote and convened at the call of the Chair of the CMSP
Governing Board.
(B) The three county administrative officers shall be elected by
the administrative officers of the CMSP counties convened at the call
of the Chair of the CMSP Governing Board prior to February 15, 1995.
(C) The two county health officials shall be selected by the
health officials of the CMSP counties convened at the call of the
Chair of the CMSP Governing Board prior to March 1, 1995.
(D) The two county welfare directors shall be elected by the
welfare directors of the CMSP counties convened at the call of the
Chair of the CMSP Governing Board prior to March 15, 1995.
(4) Board members shall serve three-year terms.
(5) No two persons from the same county may serve as members of
the board at the same time.
(e) (1) The board shall convene its first meeting at the call of
the Chair of the Small County Advisory Committee, who shall serve as
interim chairperson of the board.
(2) The board may elect a permanent chair.
(f) (1) The CMSP Governing Board is hereby established with the
following powers:
(A) Determine program eligibility and benefit levels.
(B) Establish reserves and participation fees.
(C) Establish procedures for the entry into, and disenrollment of
counties from the County Medical Services Program. Disenrollment
procedures shall be fair and equitable.
(D) Establish cost containment and case management procedures,
including, but not limited to, alternative methods for delivery of
care and alternative methods and rates for those authorized by the
department.
(E) Sue and be sued in the name of the CMSP Governing Board.
(F) Apportion jurisdictional risk to each county.
(G) Utilize procurement policies and procedures of any of the
participating counties as selected by the governing board.
(H) Make rules and regulations.
(I) Make and enter into contracts or stipulations of any nature
with a public agency or person for the purposes of governing or
administering the CMSP.
(J) Purchase supplies, equipment, materials, property, or
services.
(K)
Appoint and employ staff to assist the CMSP Governing Board.
(L) Establish rules for its proceedings.
(M) Accept gifts, contributions, grants, or loans from any public
agency or person for the purposes of this program.
(N) Negotiate and set rates, charges, or fees with service
providers, including alternative methods of payment to those used by
the department.
(O) Establish methods of payment that are compatible with the
administrative requirements of the department's fiscal intermediary
during the term of any contract with the department for the
administration of the CMSP.
(P) Use generally accepted accounting procedures.
(2) The Legislature finds and declares that the amendment of
subparagraph (N) of paragraph (1) in 1995 is declaratory of existing
law.
(g) (1) The CMSP Governing Board shall be considered a "public
entity" for purposes of Division 3.6 (commencing with Section 810) of
Title 1 of the Government Code, and a "local public entity" for
purposes of Part 3 (commencing with Section 900) of Division 3.6 of
Title 1 of the Government Code, but shall not be considered a "state
agency" for purposes of Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code and shall
be exempt from that chapter. No participating county shall have any
liability for civil judgments awarded against the County Medical
Services Program or the board. Nothing in this paragraph shall be
construed to expand the liability of the state with respect to the
County Medical Services Program beyond that set forth in Section
16809. Nothing in this paragraph shall be construed to relieve any
county of the obligation to provide health care to indigent persons
pursuant to Section 17000.
(2) Before initiating any proceeding to challenge rates of
payment, charges, or fees set by the board, to seek reimbursement or
release of any funds from the County Medical Services Program, or to
challenge any other action by the board, any prospective claimant
shall first notify the board, in writing, of the nature and basis of
the challenge and the amount claimed. The board shall consider the
matter within 60 days after receiving the notice and shall promptly
thereafter provide written notice of the board's decision. This
paragraph shall have no application to provider audit appeals
conducted pursuant to Article 1.5 (commencing with Section 51016) of
Chapter 3 of Division 3 of Title 22 of the California Code of
Regulations and shall apply to all claims not reviewed pursuant to
Sections 51003 or 51015 of Title 22 of the California Code of
Regulations.
(3) All regulations adopted by the CMSP Governing Board shall
clearly specify by reference the statute, court decision, or other
provision of law that the governing board is seeking to implement,
interpret, or make specific by adopting, amending, or repealing the
regulation.
(4) No regulation adopted by the governing board is valid and
effective unless the regulation meets the standards of necessity,
authority, clarity, consistency, and nonduplication, as defined in
paragraph (4).
(5) The following definitions govern the interpretation of this
subdivision:
(A) "Necessity" means the record of the regulatory proceeding that
demonstrates by substantial evidence the need for the regulation.
For purposes of this standard, evidence includes, but is not limited
to, facts, studies, and expert opinion.
(B) "Authority" means the provision of law that permits or
obligates the CMSP Governing Board to adopt, amend, or repeal a
regulation.
(C) "Clarity" means that the regulation is written or displayed so
that the meaning of the regulation can be easily understood by those
persons directly affected by it.
(D) "Consistency" means being in harmony with, and not in conflict
with, or contradictory to, existing statutes, court decisions, or
other provisions of law.
(E) "Nonduplication" means that a regulation does not serve the
same purpose as a state or federal statute or another regulation.
This standard requires that the governing board identify any state or
federal statute or regulation that is overlapped or duplicated by
the proposed regulation and justify any overlap or duplication. This
standard is not intended to prohibit the governing board from
printing relevant portions of enabling legislation in regulations
when the duplication is necessary to satisfy the clarity standard in
subparagraph (C). This standard is intended to prevent the
indiscriminate incorporation of statutory language in a regulation.
(h) The requirements of the Ralph M. Brown Act (Chapter 9
(commencing with Section 54950) of Part 1 of Division 2 of Title 5 of
the Government Code) shall apply to the meetings of the CMSP
Governing Board, except as otherwise provided in this subdivision.
The board may meet in closed session to consider and take action on
matters pertaining to contracts and contract negotiations with
providers of health care services. The governing board shall comply
with the following procedures for public meetings held to eliminate
or reduce the level of services, restrict eligibility for services,
or adopt regulations:
(1) Provide prior public notice of those meetings.
(2) Provide that notice not less than 30 days prior to those
meetings.
(3) Publish that notice in a newspaper of general circulation in
each participating CMSP county.
(4) Include in the notice, at a minimum, the amount and type of
each proposed change, the expected savings, and the number of persons
affected.
(5) Hold those meetings in the county seats of at least four
regionally distributed CMSP participating counties.
(6) Locate those meetings so as to provide that each hearing will
be within a four-hour one-way drive of one quarter of the target
population so that the four meetings shall be held at locations in
the state that will ensure that each member of the target population
may reach at least one of the meetings by a one-way drive that does
not exceed four hours.
(i) Records of the County Medical Services Program and of the CMSP
Governing Board that relate to rates of payment or to the board's
negotiations with providers of health care services or to the board's
deliberative processes regarding either shall not be subject to
disclosure pursuant to the Public Records Act (Chapter 5 (commencing
with Section 6250) of Division 7 of Title 1 of the Government Code).
(j) The following definitions shall govern the construction of
this part, unless the context requires otherwise:
(1) "CMSP Governing Board" means the County Medical Services
Program Governing Board established pursuant to this section.
(2) "Board" means the County Medical Services Program Governing
Board established pursuant to this section.
(3) "CMSP" means the program by which health care services are
provided to eligible persons in those counties electing to
participate in the CMSP pursuant to Section 16809.
(4) "CMSP county" means a county that has elected to participate
pursuant to Section 16809 in the CMSP.
(k) Any references to the "County Medical Services Program" or
"CMSP county" in this code shall be defined as set forth in this
section.
(l) This section shall remain in effect only until January 1,
2008, and as of that date is repealed, unless a later enacted
statute, that is enacted on or before January 1, 2008, deletes or
extends that date.
SEC. 92. Section 18925 of the Welfare and Institutions Code is
amended to read:
18925. (a) The State Department of Health Services, in
conjunction with the State Department of Social Services, shall
implement a simplified eligibility process as part of the Food Stamp
Program to expedite Medi-Cal program and Healthy Families Program
enrollment for Food Stamp Program recipients, including children and
their eligible parents or caretaker relatives who are not enrolled in
those programs.
(b) Each county welfare department shall develop a data list of
family members residing in eligible food stamp households who are not
enrolled in the Medi-Cal program or the Healthy Families Program.
(c) The county welfare department shall develop a notice informing
individuals identified pursuant to subdivision (b) that they may be
entitled to receive benefits under the Medi-Cal program or the
Healthy Families Program.
(d) At the time of the food stamp household's annual
recertification, the county welfare department shall send the notice
specified in subdivision (c) to the individuals identified in
subdivision (b). The notice shall include a request for permission
to use the information in the food stamp recipient's case file to
make a determination of eligibility for the Medi-Cal program and the
Healthy Families Program.
(e) The notice shall be written in culturally and linguistically
appropriate language and at an appropriate literacy level. The
notice shall include information on the Medi-Cal program and the
Healthy Families Program, and a telephone number that food stamp
recipients may call for additional information.
(f) To apply for medical assistance under the Medi-Cal program,
the food stamp recipient shall sign, date, and return the notice
requesting that an eligibility determination be made. Upon receipt
of the notice, the county welfare department shall make an
eligibility determination by utilizing the information in the food
stamp recipient's case file or paper application. The Medi-Cal
application date shall be the date the notice is received by the
county welfare department. If the food stamp case file does not
include sufficient information to establish Medi-Cal program
eligibility, the county welfare department shall request, either
orally or in writing, additional information from the food stamp
recipient.
(g) If the food stamp recipient is determined to be eligible to
participate in the Medi-Cal program with a share of cost, or is
determined to be ineligible for Medi-Cal, information pertinent to
the food stamp recipient's eligibility for the Healthy Families
Program shall be forwarded by the county welfare department to the
Healthy Families Program statewide administrator for immediate
processing. If there is insufficient information to establish
Healthy Families Program eligibility, the administrator shall
request, either orally or in writing, additional information from the
food stamp recipient.
(h) Counties shall include the cost of implementing this section
in their annual administrative budget requests to the State
Department of Health Services.
(i) This section shall be implemented on or after July 1, 2003,
but only to the extent federal financial participation is available.
SEC. 93. The State Department of Health Services may adopt
emergency regulations to implement the applicable provisions of this
act in accordance with the rulemaking provisions of the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code).
The initial adoption of emergency regulations and one readoption of
the initial regulations shall be deemed to be an emergency and
necessary for the immediate preservation of the public peace, health,
or general welfare. Initial emergency regulations and the first
readoption of those regulations shall be exempt from review by the
Office of Administrative Law. The initial emergency regulations and
the first readoption of those regulations authorized by this section
shall be submitted to the Office of Administrative Law for filing
with the Secretary of State and publication in the California Code of
Regulations and each shall remain in effect for no more than 180
days.
SEC. 94. The department may not recoup any overpayment made to a
provider before October 1, 2002, pursuant to Section 14109 of the
Welfare and Institutions Code for ambulance transport services, if
the overpayment is not due to the fault of the provider.
SEC. 95. (a) The State Department of Health Services shall
complete the design and implementation of the Children's Medical
Services Network (CMS Net) Enhancement 47 project to ensure that all
system enhancements for CMS Net, the California Medicaid Management
Information System (CA-MMIS), and the California Dental Management
Information System (CD-MMIS) that are required to enable providers in
the California Children's Services (CCS) provider network to submit
electronic claims for reimbursement for services provided to CCS
eligible children are operational by August 1, 2004.
(b) The department shall work in cooperation with county CCS
programs that are not yet participating in CMS Net to take all
necessary action within available resources to expedite the
transition of these county programs to CMS Net for the provision of
automated case management and service authorization for all CCS
eligible children in their county caseload.
SEC. 96. (a) The California Health and Human Services Agency shall
develop a comprehensive plan describing the actions that California
may take to improve its long-term care system so that its residents
have available an array of community care options that allow them to
avoid unnecessary institutionalization. The plan shall respond to
the decision of the United States Supreme Court in Olmstead v. L.C.
(1999) 527 U.S. 581 and shall embody the six principles for an
"Olmstead Plan" as articulated by the federal Center for Medicaid and
Medicare Services. These principles include:
(1) A comprehensive, effectively working plan.
(2) A plan development and implementation process that provides
for the involvement of consumers and other stakeholders.
(3) The development of assessment procedures and practices that
prevent or correct current and future unjustified
institutionalization of persons with disabilities.
(4) An assessment of the current availability of
community-integrated services, identification of gaps in service
availability, and evaluation of changes that could be made to enable
consumers to be served in the most integrated setting possible.
(5) The inclusion in the plan of practices by which consumers are
afforded the opportunity to make informed choices among the services
available to them.
(6) Elements in the plan that ensure that services are provided in
the most integrated setting appropriate and that the quality of
services meets the needs of the consumers.
(b) The plan required under subdivision (a) shall be submitted to
the Legislature on or before April 1, 2003.
SEC. 97. It is the intent of the Legislature that a significant
portion of funds received in the 2003-04 fiscal year and subsequent
fiscal years, due to increased federal financial participation
attributable to the medicaid home- and community-based waiver program
under Section 1396n of Title 42 of the United States Code or other
similar initiatives, shall be used to increase the rates for
community-based providers serving individuals with developmental
disabilities and other actions related to expanding and improving
services and supports. The purpose of these fund adjustments shall
be to increase community living options, provide expanded consumer
choice, provide for increased health and physical safety, and improve
the overall stability of community-based services and supports.
SEC. 98. The State Department of Developmental Services shall
ensure that funds appropriated in Item 4300-101-0001 of the Budget
Act of 2002 to address concerns regarding the potential underfunding
of regional center operations shall be used by each regional center
toward achieving and maintaining service coordinator caseloads, as
contained in subdivision (c) of Section 4640.6 of the Welfare and
Institutions Code. In addition, these funds may be used to provide
for increased clinical staff as necessary to meet requirements under
the federal home- and community-based waiver program (42 U.S.C. Sec.
1396n).
SEC. 99. The State Department of Developmental Services shall
ensure that funds appropriated in Item 4300-101-0001 of the Budget
Act of 2002 for the purpose of funding a federal program coordinator
position at each regional center will be used only for that purpose.
This position shall address issues pertaining to federally funded
programs serving individuals with developmental disabilities as
appropriate, including the home- and community-based waiver program
(42 U.S.C. Sec. 1396n), as well as seeking increased federal
financial participation when practicable.
SEC. 100. (a) Of the amount appropriated in Item 4300-101-0001 of
the Budget Act of 2002, up to five million six hundred thousand
dollars ($5,600,000) may be used to provide one-time only grant
awards to community-based service providers to conduct resource
development activities for hard-to-serve populations, including dual
diagnosis, and medically and behaviorally challenged individuals who
have been identified through the community placement plan process as
being appropriate for community placement and whose needs cannot
otherwise be met within the existing array of service options in the
community.
(b) The grant awards shall be allocated pursuant to subdivision
(a) by the State Department of Developmental Services with the intent
to improve the quality of local services and to stabilize service
systems. Regional centers may serve as the fiscal agent for these
one-time grants.
SEC. 101. (a) Of the amount appropriated in Item 4260-111-0001 of
the Budget Act of 2002 from the Cigarette and Tobacco Products Surtax
Fund, twenty-four million eight hundred three thousand dollars
($24,803,000) shall be allocated in accordance with subdivision (b)
for the 2002-03 fiscal year from the following accounts:
(1) Nine million fifteen thousand dollars ($9,015,000) from the
Hospital Services Account.
(2) Two million three hundred twenty-eight thousand dollars
($2,328,000) from the Physician Services Account.
(3) Thirteen million four hundred sixty thousand dollars
($13,460,000) from the Unallocated Account.
(b) The funds specified in subdivision (a) shall be allocated
proportionately as follows:
(1) Twenty-two million three hundred twenty-four thousand dollars
($22,324,000) shall be administered and allocated for distribution
through the California Healthcare for Indigents Program (CHIP),
Chapter 5 (commencing with Section 16940) of Part 4.7 of Division 9
of the Welfare and Institutions Code.
(2) Two million four hundred seventy-nine thousand dollars
($2,479,000) shall be administered and allocated through the rural
health services program, Chapter 4 (commencing with Section 16930) of
Part 4.7 of Division 9 of the Welfare and Institutions Code.
(c) Funds allocated by this section from the Physician Services
Account and the Unallocated Account in the Cigarette and Tobacco
Products Surtax Fund shall be used only for the reimbursement of
uncompensated emergency services, as defined in Section 16953 of the
Welfare and Institutions Code. Funds shall be transferred to the
Physician Services Account in the county Emergency Medical Services
Fund established pursuant to Sections 16951 and 16952 of the Welfare
and Institutions Code.
(d) Funds allocated by this section from the Hospital Services
Account in the Cigarette and Tobacco Products Surtax Fund shall be
used only for reimbursement of uncompensated emergency services, as
defined in Section 16953 of the Welfare and Institutions Code,
provided in general acute care hospitals providing basic,
comprehensive, or standby emergency services. Reimbursement for
emergency services shall be consistent with Section 16952 of the
Welfare and Institutions Code.
SEC. 102. Notwithstanding any other provision of law, the
unencumbered balances, as of June 30, 2002, of the amounts
appropriated in Item 4260-001-0589 of Chapter 50 of the Statutes of
1999, Item 4260-001-0589 of Chapter 52 of the Statutes of 2000, and
Item 4260-001-0589 of Chapter 106 of the Statutes of 2001 are hereby
reappropriated for the purposes specified in those items, and shall
be available for encumbrance and expenditure until July 30, 2005.
SEC. 103. (a) In order to implement changes in the level of
funding for Medi-Cal services in the Budget Act of 2002, effective
August 1, 2002, the Director of Health Services shall eliminate all
provider rate increases that were provided, effective August 1, 2000,
for services rendered in the Medi-Cal program, except for the
supplemental rate for the California Children's Services Program,
home health services, shift nursing, nonemergency medical
transportation, and family planning physician services. The director
shall take this action pursuant to the rate-setting authority
provided under subdivision (a) of Section 14105 of the Welfare and
Institutions Code. The director shall also conform the rates for the
same services rendered by the same provider types in non-Medi-Cal
programs pursuant to Section 14105.18 of the Welfare and Institutions
Code to those paid in the Medi-Cal program, absent regulations
adopted pursuant to subdivision (c) of Section 14105.18 of the
Welfare and Institutions Code. The rates for managed health care
plans shall be reduced by the actuarial equivalent amount of the
provider rate reductions made by this section at the time of the plan'
s next rate determination.
(b) For purposes of this section, "provider" means any provider
participating in the Medi-Cal program that received a rate increase,
effective August 1, 2000, but does not include the following:
(1) A general acute care hospital as defined in subdivision (a) of
Section 1250 of the Health and Safety Code.
(2) A skilled nursing facility as defined in subdivision (c) of
Section 1250 of the Health and Safety Code.
(3) An intermediate care facility/developmentally disabled as
defined in subdivision (g) of Section 1250 of the Health and Safety
Code.
(4) An intermediate care facility/developmentally disabled
habilitative as defined in subdivision (e) of Section 1250 of the
Health and Safety Code.
(5) An intermediate care facility/developmentally disabled-nursing
as defined in subdivision (h) of Section 1250 of the Health and
Safety Code.
(6) An adult day health care center as defined in subdivision (b)
of Section 1570.7 of the Health and Safety Code.
SEC. 104. It is the intent of the Legislature that, in
implementing Section 14105.33 of the Welfare and Institutions Code
during the 2002-03 fiscal year, the Director of Health Services shall
direct the department to negotiate as aggressively as necessary to
achieve savings levels related to pharmaceutical contracting
identified in the Budget Act of 2002.
SEC. 105. Notwithstanding Section 17610 of the Government Code, if
the Commission on State Mandates determines that this act contains
costs mandated by the state, reimbursement to local agencies and
school districts for those costs shall be made pursuant to Part 7
(commencing with Section 17500) of Division 4 of Title 2 of the
Government Code. If the statewide cost of the claim for
reimbursement does not exceed one million dollars ($1,000,000),
reimbursement shall be made from the State Mandates Claims Fund.
SEC. 106. This act is an urgency statute necessary for the
immediate preservation of the public peace, health, or safety within
the meaning of Article IV of the Constitution and shall go into
immediate effect. The facts constituting the necessity are:
In order to make necessary statutory changes to implement the
Budget Act of 2002 at the earliest possible time, it is necessary
that this act go into immediate effect.