BILL NUMBER: AB 1762 CHAPTERED
BILL TEXT
CHAPTER 230
FILED WITH SECRETARY OF STATE AUGUST 11, 2003
APPROVED BY GOVERNOR AUGUST 9, 2003
PASSED THE ASSEMBLY JULY 29, 2003
PASSED THE SENATE JULY 27, 2003
AMENDED IN SENATE JULY 27, 2003
AMENDED IN SENATE JUNE 23, 2003
INTRODUCED BY Committee on Budget (Oropeza (Chair), Bermudez, Chan,
Chu, Diaz, Dutra, Dymally, Goldberg, Hancock, Jackson, Liu,
Montanez, Nakano, Pavley, Reyes, Simitian, and Wolk)
MARCH 11, 2003
An act to amend Sections 6254 and 16531.1 of, and to repeal
Section 13967 of, the Government Code, to amend Sections 1266,
104465, 104898.5, 120955, 124555, 124710, and 127280.1 of, to amend
and repeal Section 1316.5 of, to add Sections 104181.6, 104466,
123853, and 125191 to, to add Article 7.5 (commencing with Section
1324) to Chapter 2 of Division 2 of, and to add Chapter 16
(commencing with Section 121345) to Part 4 of Division 105 of, the
Health and Safety Code, to amend Sections 12693.43, 12693.70,
12693.73, 12693.91, 12693.98, 12695.04, 12695.06, 12695.08, 12696.7,
12697, 12698.05, 12698.30, 12699.50, 12699.51, 12699.52, 12699.53,
12699.54, 12699.56, 12699.58, 12699.60, 12699.61, and 12699.62 of, to
amend the heading of Part 6.4 (commencing with Section 12699.50) of
Division 2 of, to add Section 12693.765 to, to add and repeal Section
12693.275 of, and to repeal Sections 12693.99 and 12698.10 of, the
Insurance Code, to amend Section 1026.2 of the Penal Code, to amend
Sections 4094.2, 4433, 4512, 4631.5, 4640.6, 4643, 4685.5, 4781.5,
5775, 14011.7, 14019.3, 14105.37, 14124.79, 14126.02, 14132.88,
14154, and 16809 of, to amend and repeal Sections 14005.81 and
14110.65 of, to add Sections 4620.2, 4648.4, 4681.5, 4691.6, 14044,
14087.101, 14087.103, 14087.105, 14105.06, 14105.21, 14105.22,
14105.395, 14105.48, 14105.49, 14105.51, 14105.86, 14124.795,
14132.27, 14159, and 14684.1 to, to add Article 5.5 (commencing with
Section 14464.5) to Chapter 8 of Part 3 of Division 9 of, and to add
and repeal Section 14105.19 of, the Welfare and Institutions Code,
and to repeal Section 13 of Chapter 9 of the Statutes of the First
Extraordinary Session of 2003, relating to health, making an
appropriation therefor, and declaring the urgency thereof, to take
effect immediately.
LEGISLATIVE COUNSEL'S DIGEST
AB 1762, Committee on Budget. Health.
Existing law establishes a Restitution Fund to assist residents of
the state in obtaining compensation for certain injuries suffered by
victims of crime and derivative victims, as defined.
Existing law requires that the Governor's Budget specify the
estimated amount in the Restitution Fund that is in excess of the
amount needed to pay claims against the Restitution Fund and
administer the program. It authorizes use of moneys appropriated in
the annual Budget Act in accordance with this provision to be used to
fund programs and activities operated by the State Department of
Mental Health that address the problem of unequal protection for, and
unequal services to, crime victims with disabilities, as specified.
This bill would repeal this authorization and the related Governor'
s Budget requirements.
Existing law creates the continuously appropriated Medical
Providers Interim Payment Fund, for the purposes of paying Medi-Cal
providers, providers of drug-treatment services for persons infected
with HIV, and providers of services for the developmentally disabled,
during any portion of a fiscal year, prior to September 1 of that
year, in which a budget has not yet been enacted, and would
appropriate, for each fiscal year in which these payments were
necessary, up to $1,000,000,000 from the General Fund, in the form of
loans, and $1,000,000,000 from the Federal Trust Fund to the Medical
Providers Interim Payment Fund.
This bill would revise the application of that provision to also
permit payments from the fund to the providers described above during
the period in which Medi-Cal has a deficiency, thus constituting an
appropriation.
Existing law provides for the licensing and regulation of health
facilities by the State Department of Health Services. A violation
of those provisions is a misdemeanor.
Existing law sets forth the licensing and renewal fee to be
charged certain health facilities, as defined. The annual fee is
waived for any health facility conducted, maintained, or operated by
this state or any state department, authority, bureau, commission, or
officer, by the Regents of the University of California, or by a
local hospital district, city, county, or city and county. Existing
law requires that the fees be adjusted annually, as directed by the
Legislature in the annual Budget Act. Existing law requires that the
methodology and calculations used to determine the fee amounts
result in fee levels in an amount sufficient to provide revenues
equal to the sum of various expenditures.
This bill would revise these licensing and renewal fee provisions.
The bill would require, if the Budget Act provides for expenditures
that differ by 5% from the Governor's proposed budget, the
Department of Finance to adjust the fees to reflect that difference
and to instruct the State Department of Health Services to publish
those fees as prescribed. By increasing health facility
requirements, this bill would change the definition of a crime, and
would result in a state-mandated local program.
This bill would require that, as a condition of participation in
the Medi-Cal program, there be imposed a quality assurance fee on
certain intermediate care facilities. The bill would require that
the fee shall be placed in the General Fund and allocated to
intermediate care facilities to support their quality improvement
efforts, and distributed to each facility based on the number of
Medi-Cal patients at the eligible facility. The bill would require
the department to seek federal approval for the implementation of the
fee. By increasing health facility requirements, this bill would
change the definition of a crime, and would result in a
state-mandated local program.
Existing law, until January 1, 2007, requires each health facility
owned and operated by the state offering care or services within the
scope of practice of a psychologist to establish rules and medical
staff bylaws that include provisions for medical staff membership and
clinical privileges for clinical psychologists within the scope of
their licensure as psychologists, subject to any rules and medical
staff bylaws governing medical staff membership or privileges the
facility shall establish. Existing law requires, among other things,
that the rules and medical staff bylaws of the health facility not
discriminate on the basis of whether the staff member holds an M.D.,
D.O., D.D.S., D.P.M., or doctoral degree in psychology, within the
scope of the member's respective licensure.
Existing law further provides that on January 1, 2007, provisions
that relate to staff privileges for clinical psychologists, that do
not contain the above requirements, shall become operative.
This bill would delete the January 1, 2007, repeal date for the
above requirements, thereby extending the operation of these
provisions indefinitely. It would also repeal the new provisions
that would take effect on January 1, 2007. Because this bill would
extend criminal penalties for violation of these provisions past the
January 1, 2007, repeal date, this bill would create a state-mandated
local program.
Existing law provides that an appropriation is available for
encumbrance during the period specified therein, or, if not otherwise
limited by law, for 3 years after the date upon which it first
became available for encumbrance. Subdivision (a) of Section 2.00 of
the Budget Act of 2002 provides that appropriations in the act,
unless otherwise provided, are appropriated for the use and support
of the state for the 2002-03 fiscal year.
Existing law provides for a Cancer Research Program administered
by the State Department of Health Services. Existing law prohibits
the department, in awarding grants under this program, from
encumbering money allocated in any fiscal year other than the fiscal
year in which the appropriation was made.
This bill would provide that, notwithstanding any other provision
of law, commencing with the appropriation for the 2002-03 fiscal
year, and for each fiscal year thereafter, the amount appropriated to
the department for the Cancer Research Program is available for that
program, for encumbrance for one fiscal year beyond the year of
appropriation, and for expenditure for 3 fiscal years beyond the year
of encumbrance, thereby making an appropriation.
Existing law provides for a tobacco use prevention program under
which grants are awarded and administered by the State Department of
Health Services and the State Department of Education for projects
directed at the prevention of tobacco-related diseases and tobacco
use.
Existing law requires the State Department of Health Services to
annually set aside a certain amount appropriated for the competitive
grants programs established under these provisions to support
designated media campaign efforts.
This bill, instead, would authorize the department to make that
annual set-aside. The bill would also provide that, commencing with
the appropriation for the 2002-03 fiscal year, and for each fiscal
year thereafter, any amount appropriated to the department to
implement designated tobacco use programs shall be available for
encumbrance and expenditure for 3 fiscal years beyond the date of the
appropriation, thereby making an appropriation.
Under existing law, states' attorneys general and various tobacco
product manufacturers have entered into a Master Settlement
Agreement, in settlement of various lawsuits, that provides for the
allocation of money to the states and certain territories. The state
has entered into a memorandum of understanding providing for the
allocation of the state's share of moneys to be received under the
Master Settlement Agreement among the state and counties and certain
cities in the state.
Existing law establishes the Tobacco Settlement Fund in the State
Treasury and requires that designated amounts of the state's share of
funds received under the Master Settlement Agreement be deposited in
the fund. Existing law authorizes an annual transfer from the
General Fund to the Tobacco Settlement Fund of not to exceed
$250,000,000, out of funds not otherwise appropriated, as a loan to
cover appropriations from the fund when moneys from the agreement
have not been received by the state.
This bill would decrease the maximum amount that may be
transferred and loaned under this provision from $250,000,000 to
$100,000,000.
Existing law provides, to the extent that state and federal funds
are appropriated in the annual Budget Act, for the establishment and
administration of a program to provide drug treatments to persons
infected with human immunodeficiency virus (HIV), the etiologic agent
of acquired immunodeficiency syndrome (AIDS).
This bill would provide that if the Director of Health Services
makes a formal determination that, in any fiscal year, funds
appropriated for the program will be insufficient to provide all of
those drug treatments to existing eligible persons for the fiscal
year and that a suspension of the implementation of the program is
necessary, the director may suspend eligibility determinations and
enrollment for the period of time necessary to meet the needs of
existing eligible persons in the program.
This bill would also authorize the Director of the Office of AIDS
to provide funding for the coverage of therapeutic monitoring assays
for HIV disease through the State HIV Therapeutic Monitoring Program.
Existing law authorizes the department, under the Medi-Cal
program, to enter into specified contracts for various products and
services. Under these provisions, the department is considered the
purchaser, but not the dispenser or distributor, of prescribed drugs.
This bill would provide similar authority to the department under
the Genetically Handicapped Person's Program and the California
Children's Services Program, with respect to factor replacement
therapies and various product-type health care services and
laboratory services.
Existing law requires the State Department of Health Services to
grant funds for up to 3 years per grant, to eligible private,
nonprofit, community-based primary care clinics for the purpose of
establishing and maintaining a health services program for seasonal
agricultural and migratory workers and their families and specified
rural health services and development projects.
This bill would require that the grants shall be for a minimum of
3 years, and would make the application of the grant extension
retroactive to funds appropriated in the 2002 Budget Act.
This bill would authorize the department to pay any grantee whose
grant expired on June 30, 2003, until June 30, 2004, as if the grant
had been extended, provided that funds are appropriated for this
purpose in the Budget Act of 2003 and the grantee agrees in writing
to expend the money as if the grant had been extended.
Unless otherwise specified, funds appropriated in the Budget Act
are available for expenditure in the year for which the Budget Act is
enacted. By extending the period of the grants for which funds have
been appropriated, this bill would result in an appropriation.
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. Existing
law authorizes 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 for that purpose.
This bill would delete reference to the 2002-03 fiscal year,
thereby extending indefinitely the authority to expend $200,000 of
the fees collected as described above.
Existing law establishes the Healthy Families Program,
administered by the Managed Risk Medical Insurance Board, to arrange
for the provision of health, dental, and vision services to eligible
children pursuant to a federal program, entitled the State Children's
Health Insurance Program. Eligibility requirements include being a
child in a family with a household income equal to or less than 200%
of the federal poverty level.
This bill would, as an alternative to this eligibility
requirement, provide eligibility, as prescribed, for a child under
the age of 2 years delivered by a mother enrolled in the Access for
Infants and Mothers Program. The bill would provide that a child
eligible under this provision shall be deemed eligible at birth, and
would provide that these provisions may only be implemented to the
extent funds are appropriated in the annual Budget Act or other
statute.
Existing law authorizes the board to, among other things,
determine the requirements of health, dental, and vision plans that
participate in the Healthy Families Program.
This bill would provide that, notwithstanding any other provision
of law, the rates for these plans, in effect on July 1, 2003, shall
remain in effect through June 30, 2005.
Existing law, until July 1, 2003, authorizes the department, in
conjunction with the Managed Risk Medical Insurance Board, the County
Medical Services Program Board, and the Rural Health Policy
Council, to develop and administer up to 5 demonstration projects in
rural areas that are likely to contain a significant level of
uninsured children, including seasonal and migratory worker
dependents.
This bill would delete the July 1, 2003, inoperative date, thereby
extending the operation of this provision indefinitely.
Existing law establishes the Medi-Cal-to-Healthy Families Bridge
Benefits Program to provide any child who meets certain criteria with
2 months of health care benefits in order to provide the child with
an opportunity to apply for the Healthy Families Program.
This bill would decrease the health care benefits under this
provision from 2 months to one month, and would restore the benefits
to a 2-month period commencing on the implementation of the Healthy
Families Program waiver required to be sought from the federal
government, under existing law.
Existing law specifies that the provisions establishing the
Healthy Families Program shall be repealed on January 1, 2004.
This bill would repeal this provision, thereby extending the
Healthy Families Program indefinitely.
Existing law creates the Healthy Families Fund, which is
continuously appropriated to the board for the purposes of funding
the Healthy Families Program. Because this bill would continue
expenditures from this continuously appropriated fund by extending
the Healthy Families Program indefinitely, this bill would make an
appropriation.
Existing law establishes the Access for Infants and Mothers (AIM)
Program, administered by the Managed Risk Medical Insurance Board.
Existing law requires the board to contract with a variety of
health plans and types of health care service delivery systems in
order to offer subscribers a choice of plans, providers, and types of
service delivery and to negotiate or arrange for stop-loss insurance
coverage.
This bill, instead, would authorize the board to perform these
activities.
Existing law provides that participating health plans contracting
with the board under the AIM Program are required to provide benefits
and coverage only as determined by the board pursuant to its
authority and exempts these plans from complying with certain other
provisions.
This bill would delete the exemption provided for participating
health plans contracting with the board.
Existing law establishes the Major Risk Medical Insurance Board
Access for Infants and Mothers Advisory Panel to advise the board on
all policies, regulations, operations, and implementation of the AIM
Program.
This bill would change the name of the panel to the Managed Risk
Medical Insurance Board Access for Infants and Mothers Advisory
Panel.
Existing law provides that a person is not eligible to participate
in the AIM Program if the person is a Medi-Cal or Medicare
beneficiary at the time of application.
This bill would, instead, provide that a person is not eligible to
participate in the AIM Program if the person is eligible for
Medi-Cal without a share of cost or Medicare at the time of
application.
Existing law authorizes coverage under the AIM Program for any of
a subscriber's children at a monthly premium sufficient to fully
cover the cost of coverage for these children, as determined by the
board. Existing law provides a minimum coverage to AIM Program
subscribers during one pregnancy, and for 60 days thereafter, and to
children less than 2 years of age who were born of a pregnancy
covered under the program.
This bill would limit the coverage of the latter category to
children less than 2 years of age who were born of a pregnancy
covered under the program to a woman enrolled in the program before
July 1, 2004. This bill would delete the provision authorizing
coverage for any of a subscriber's children, as prescribed.
Existing law creates the Children's Health Initiative Matching
Fund in the State Treasury, which is administered by the Managed Risk
Medical Insurance Board, in collaboration with the State Department
of Health Services, for the purpose of providing matching state funds
and local funds received by the fund through intergovernmental
transfers to a county agency, a local initiative, or a county
organized health system to provide health insurance coverage to
certain children in low-income households who do not qualify for
health care benefits through the Healthy Families Program or
Medi-Cal. Existing law, the California Public Records Act, exempts
certain records and information from being disclosed.
This bill would instead create the County Health Initiative
Matching Fund in the State Treasury for those purposes. The bill
would authorize the board to enter into contracts and to issue rules
and regulations on an emergency basis. The bill would require the
Governor to apply for waivers or file state plan amendments in order
to obtain federal financial participation for specified projects.
The bill would exempt records of the board related to the fund from
disclosure. The bill would make related changes.
Existing law establishes procedures for making an application for
the release of a person who has been committed to a state hospital or
other treatment facility upon the ground that sanity has been
restored.
This bill would specify that any person to whom those procedures
apply and who petitions or is recommended for restoration of sanity
may not be placed in a forensic conditional release program for one
year, and a finding of restoration of sanity may be made without the
person being in a forensic conditional release program for one year.
The bill would also provide that if a finding of restoration of
sanity is made, the person shall be transferred to the custody of the
California Department of Corrections to serve the term of
imprisonment remaining or shall be transferred to the appropriate
court for imposition of the sentence that is pending, whichever is
applicable.
Existing law contains provisions relating to the setting of
reimbursement rates for community treatment facilities, as defined.
Existing law authorizes up to 400 community treatment facility
beds statewide pursuant to the above provisions of law, and
anticipates a phased-in implementation of community treatment
facilities, with an average monthly community treatment facility
caseload, by fiscal year, as specified.
This bill would increase that community treatment facility
caseload number to 175 for the 2003-04 fiscal year.
Existing law requires the State Department of Developmental
Services to contract, for a maximum contract term of 3 years, with a
nonprofit agency or agencies to provide clients' rights advocacy
services.
This bill would extend the maximum contract term to 5 years.
Under the Lanterman Developmental Disabilities Services Act,
administered by the State Department of Developmental Services,
services are provided to persons with developmental disabilities.
This bill would define "substantial disability" for purposes of
the act. It would provide that any reassessment of substantial
disability, for purposes of continuing eligibility, shall utilize the
same criteria under which the individual was originally made
eligible.
Existing law requires the State Department of Developmental
Services to enter into contracts with nonprofit entities to operate
regional centers for the provision of services and supports to
persons with developmental disabilities.
This bill would require the department, after consultation with
stakeholder groups, to develop a system of enrollment fees,
copayments, or both, to be assessed against the parents of each child
between the ages of 3 and 17 years, who lives in the parent's home
and receives services purchased through a regional center.
The bill would also require the department, after consultation
with stakeholder groups to submit a detailed plan that meets certain
criteria to the Legislature, on or before April 1, 2004, for
implementing a parental copayment system applicable to certain
families who have children receiving services purchased through a
regional center, and would prohibit the plan from being implemented
without subsequent statutory authorization by the Legislature.
Existing law requires, until July 1, 2004, the State Department of
Developmental Services to determine the amount of unallocated
reduction that each regional center shall make in its
purchase-of-service budget, and requires each regional center to take
specified actions upon the department's determination.
This bill would extend this provision to July 1, 2005.
Existing law requires that regional centers contracting with the
State Department of Developmental Services to provide services for
certain adults with developmental disabilities shall be required to
establish specified service coordinator-to-consumer ratios. To
ensure that caseload ratios are maintained under this provision, each
regional center is required to provide services coordinator caseload
data that includes certain information to the department in
September and March of each fiscal year.
This bill would revise the service coordinator-to-consumer ratios,
as prescribed. The bill would also require that the services
coordinator caseload data be provided, instead, annually in each
fiscal year and would revise the information that the data is
required to include.
Existing law provides for initial intake and assessment services
by regional centers to determine the level of service for which an
applicant is eligible, and requires that, if assessment is needed, it
shall be performed within a certain time period. If assessment is
needed, prior to July 1, 2003, the assessment is required to be
performed within 120 days following initial intake.
This bill would extend that date to July 1, 2004.
Existing law requires the Director of Developmental Services to
establish a process for setting rates or establish rates of state
payment for various services purchased by regional centers.
The bill would prohibit a regional center, during the 2003-04
fiscal year, from approving any service level for a residential
service provider if the approval would result in an increase in the
rate to be paid to the provider that is greater than the rate that is
in effect on or after June 30, 2003, unless certain conditions are
met.
The bill would also prohibit, for the 2003-04 fiscal year, a
regional center from paying providers of certain services
reimbursement rates that exceed the rates in effect on June 30, 2003,
except under specified circumstances.
The bill would also prohibit the department, during the 2003-04
fiscal year, from establishing any permanent payment rate for a
community-based day program or in-home respite service agency
provider that has a temporary payment rate in effect on June 30,
2003, if the rate would be greater than the rate in effect on June
30, 2003, except under specified circumstances.
Existing law, until January 1, 2004, requires the State Department
of Developmental Services to conduct a pilot project under which
funds are allocated for local self-determination pilot programs that
will enhance the ability of a consumer and his or her family to
control the decisions and resources required to meet all or some of
the objectives in his or her individual program plan. Under these
provisions, the department is required to allocate funds for pilot
programs in 3 regional center catchment areas and, to the extent
possible, test a variety of mechanisms provided for in existing law.
This bill would delete the January 1, 2004, repeal date, thereby
extending the operation of this provision indefinitely. This bill
would, instead, require the department to allow the continuation of
the existing pilot project in 5 specified regional center catchment
areas and to expand the pilot project to other regional center
catchment areas when consistent with federal approval of a
self-determination waiver.
Existing law also provides that 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, with certain exceptions.
This bill would extend that limitation to include the 2003-04
fiscal year.
The federal medicaid program provides for federal financial
participation for state medical assistance programs that meet federal
standards. This state's version of the medicaid program is known as
the California Medical Assistance Program, or the Medi-Cal program.
Federal law permits the payment of federal medicaid funds to
participating states for benefits provided to recipients by, among
other methods, enrollment in managed care plans, including mental
health plans.
Existing law requires the State Department of Mental Health to
implement mental health managed care services for Medi-Cal
beneficiaries. Existing law requires the department to adopt
emergency regulations to implement provisions relating to sanctions
that the department may impose under these provisions.
This
bill would delete those provisions regarding emergency regulations,
and would specify that certain emergency regulations would remain in
effect only until July 1, 2004, unless made permanent by the
department.
Existing law provides for the Medi-Cal program, administered by
the State Department of Health Services, pursuant to which medical
benefits are provided to public assistance recipients and certain
other low-income persons.
Under existing law, the state is required to provide an additional
12-month period of transitional Medi-Cal eligibility to persons aged
19 years and older who have received 12 months of transitional
Medi-Cal eligibility and who continue to meet specified transitional
Medi-Cal eligibility requirements.
This bill would terminate these benefits on October 1, 2003, but
would provide that persons receiving these benefits on September 30,
2003, shall be provided with notice of this termination and have
their Medi-Cal eligibility redetermined.
By requiring each county to redetermine the Medi-Cal eligibility
of certain Medi-Cal recipients, the bill would create a
state-mandated local program.
Existing law requires the department to 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
program.
This bill would authorize the department to also use the
electronic application developed pursuant to these provisions as a
means to enroll newborns into the Medi-Cal program.
Existing law provides that the 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 is paid to the provider in certain circumstances where the
services were rendered prior to the receipt of the beneficiary's
Medi-Cal card and was reimbursed to the provider by the Medi-Cal
program, as specified.
This bill would limit that requirement to medically necessary
health care services. It would apply, instead, to certain
circumstances where the services were rendered during the 90-day
period prior to the beneficiary's application for his or her Medi-Cal
card or after application for, but prior to receipt of the Medi-Cal
card. It would require the department to ensure payment to a
beneficiary by a provider, and would specify enforcement action the
department shall take if the provider fails to or refuses to
reimburse the beneficiary.
Existing law authorizes the department, by regulation, to adopt
measures to prevent or curtail Medi-Cal fraud and abuse.
This bill would authorize the department to limit, for 18 months
or less, the codes for which any provider may bill, or for which
reimbursement to any person or entity may be made by, the Medi-Cal
program or other health care programs administered by the department
if the department determines that excessive services or billings, or
abuse, has occurred or a health professional is precluded, by the
imposition of certain limitations, from performing services
reimbursed by the Medi-Cal program or other health care programs
administered by the department.
Existing law authorizes the department to prescribe the policies
for the administration of the Medi-Cal program and limit the rates of
payment for health care services, consistent with state law.
This bill would require, commencing January 1, 2004, and until
January 1, 2007, Medi-Cal payments and payments under other specified
programs for certain services to be reduced by 5%.
Existing law requires the department to implement a
facility-specific ratesetting system by August 1, 2004, subject to
federal approval, that reflects the cost and staffing levels
associated with quality of care for residents in nursing facilities.
This bill would, instead, require the department to implement this
system by August 1, 2005.
The bill would also specify that, to the extent consistent with
federal law, Medi-Cal reimbursement rates in effect on August 1,
2003, for specified nursing facility providers, subacute care
programs, and adult day health care centers shall remain in effect
through July 31, 2005.
This bill would require the department to establish a list of
covered services and maximum allowable reimbursement rates for
prosthetic and orthotic appliances and durable medical equipment and
publish the list in provider manuals. The bill would require the
repeal of related nonconforming regulations. It would also authorize
the department to implement utilization controls through the
establishment of guidelines, protocols, algorithms, or criteria for
medical equipment, and enteral formulas, and to publish this
information in the pharmacy and medical provider manuals.
This bill would require the department to establish a list of
hearing aids and hearing aid accessories, and determine the maximum
allowable product cost for each hearing aid product provided as a
benefit under the Medi-Cal program. It would also require the
department to establish capped rental reimbursement for specific
items of durable medical equipment covered under the Medi-Cal
program, in accordance with specified requirements.
This bill would prohibit an assistive device and sickroom supply
dealer from billing the Medi-Cal program for prosthetic and orthotic
appliances, and would prohibit a pharmacy from doing so unless the
pharmacy is certified by the National Community of Pharmacists
Association and the appliances have been approved by the department.
This bill would specify the maximum reimbursement for clinical
laboratory or laboratory services, durable medical equipment, certain
prosthetic and orthotic appliances, and blood factors.
Existing law establishes a schedule of benefits that may be
provided under the Medi-Cal program.
This bill would require the department to apply for a waiver of
federal law to test the efficacy of providing a disease management
benefit to specified beneficiaries under the Medi-Cal program.
Existing law provides for the payment of providers under the
Medi-Cal program.
Under existing law, specified dental services are included as
covered benefits under the Medi-Cal program, subject to utilization
controls.
Existing law provides that the department shall require
documentation on claims to establish the necessity for dental
restorations.
This bill would, instead, specify that the department shall
require, under specified circumstances, pretreatment radiograph
documentation on posttreatment claims for dental restorations.
Existing law establishes the Health Care Deposit Fund, as an
appropriated fund, from which are made expenditures of state, county,
and federal funds for health care and administration under the
Medi-Cal program.
This bill would provide that, commencing with the 2004-05 fiscal
year, expenditures for Medi-Cal services and for state and county
administration costs included in the department's budget shall be
charged against the appropriation for the fiscal year in which the
billing is paid. The bill would also provide that, commencing July
1, 2004, all 2002-03 fiscal year and prior accrued obligations of the
Health Care Deposit Fund shall become obligations of the 2004-05
fiscal year and all moneys available from the 2002-03 fiscal year and
prior appropriations shall be reappropriated for the 2004-05 fiscal
year for that purpose.
Existing law authorizes the Director of Health Services to enter
into contracts with managed care plans to provide services under the
Medi-Cal program.
This bill would authorize the State Department of Health Services
to impose, annually, a quality improvement fee on the capitation
payments paid to a Medi-Cal managed care plan, with the fees to be
used to provide capitation rate increases for Medi-Cal managed care
plan's quality improvement. This provision would only be implemented
if approval for federal financial participation is obtained.
Existing law provides for the development of Medi-Cal mental
health plans and requires the State Department of Mental Health to
ensure that these plans contain certain processes and components.
This bill would require the department to establish a process for
second level treatment authorization request appeals to review and
resolve disputes between mental health plans and hospitals.
The Medi-Cal program is partially governed and funded pursuant to
the federal medicaid program.
Pursuant to an inoperative provision that is repealed on January
1, 2007, the department is required, upon federal approval of a
medicaid state plan amendment, to provide a supplemental rate
adjustment to the Medi-Cal reimbursement rate for specific nursing
facilities, intermediate care facilities/developmentally disabled,
intermediate care facilities/developmentally disabled-habilitative,
intermediate care facilities/developmentally disabled-nursing, and
pediatric subacute units which have a collectively bargained contract
or a comparable legally binding, written commitment to increase
salaries, wages, or benefits for nonmanagerial, nonadministrative,
and noncontract staff.
This bill would, instead, express the intent of the Legislature
that this provision be implemented immediately, and would require the
department, for the period commencing February 1, 2002, to July 31,
2004, inclusive, to pay any supplemental rate adjustment permitted
under this provision to the extent that a facility submits a rate
adjustment request in accordance with specified requirements and the
request is approved by the department.
This bill would specify that amounts appropriated in the 2003
Budget Act for purposes of this provision may be expended for
supplemental rate adjustments relating to periods in the 2002-03
fiscal year.
This bill would make these provisions inoperative on August 1,
2004.
Existing law requires the department to establish and maintain a
plan whereby costs for county administration of the determination of
eligibility for benefits under the Medi-Cal program will be
effectively controlled within the amounts annually appropriated for
that administration.
Existing law requires counties, in administering the Medi-Cal
eligibility process, to meet certain performance standards, including
the performance of timely annual redeterminations, and requires that
90% of the annual redeterminations be commenced by the anniversary
date.
This bill, instead, would require that 90% of the annual
redetermination forms be mailed to the beneficiary by the anniversary
date.
Existing law provides for the payment of providers under the
Medi-Cal program.
Existing law establishes the Health Care Deposit Fund, as an
appropriated fund, from which are made expenditures of state, county,
and federal funds for health care and administration under the
Medi-Cal program.
This bill would provide that, commencing with the 2004-05 fiscal
year, expenditures for Medi-Cal services and for state and county
administration costs included in the department's budget shall be
charged against the appropriation for the fiscal year in which the
billing is paid. The bill would also provide that, commencing July
1, 2004, all 2002-03 fiscal year and prior accrued obligations of the
Health Care Deposit Fund shall become obligations of the 2004-05
fiscal year and all moneys available from the 2002-03 fiscal year and
prior appropriations shall be reappropriated for the 2004-05 fiscal
year for that purpose.
Existing law authorizes the Director of Health Services to enter
into contracts with managed care plans to provide services under the
Medi-Cal program.
This bill would authorize the State Department of Health Services
to impose, annually, a quality improvement fee on the capitation
payments paid to a Medi-Cal managed care plan, with the fees to be
used to provide capitation rate increases for Medi-Cal managed care
plan's quality improvement. This provision would only be implemented
if approval for federal financial participation is obtained.
Existing law provides for the development of Medi-Cal mental
health plans and requires the State Department of Mental Health to
ensure that these plans contain certain processes and components.
This bill would require the department to establish a process for
second level treatment authorization request appeals to review and
resolve disputes between mental health plans and hospitals.
Existing law provides that 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, by adopting a resolution
to that effect, may elect to participate in the County Medical
Services Program for state administration of health care services to
eligible persons in the county.
This bill would revise, for the 2003-04 fiscal year, state and
counties financial responsibilities for certain increases in costs in
the County Medical Services Program.
This bill would reallocate certain amounts appropriated in the
Budget Act of 2003 from the Cigarette and Tobacco Products Surtax
Fund.
This bill would authorize the Managed Risk Medical Insurance Board
to adopt emergency regulations to implement various provisions of
the bill.
This bill would prohibit the State Department of Health Services
from implementing limits on laboratory services as prescribed.
This bill would require the State Department of Health Services to
require contractors and grantees under the Office of Family
Planning, Male Involvement Program, and Information and Education
Program, to establish, as prescribed, a clinical service linkage to
the Family PACT Waiver Program.
The bill would authorize the State Department of Health Services
to adopt emergency regulations to implement applicable provisions of
the bill.
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 with regard to certain mandates no
reimbursement is required by this act for a specified reason.
With regard to any other mandates, this bill would provide that,
if the Commission on State Mandates determines that the bill contains
costs so mandated by the state, reimbursement for those costs shall
be made pursuant to the statutory provisions noted above.
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 6254 of the Government Code is amended to read:
6254. Except as provided in Sections 6254.7 and 6254.13, nothing
in this chapter shall be construed to require disclosure of records
that are any of the following:
(a) Preliminary drafts, notes, or interagency or intra-agency
memorandums that are not retained by the public agency in the
ordinary course of business, provided that the public interest in
withholding those records clearly outweighs the public interest in
disclosure.
(b) Records pertaining to pending litigation to which the public
agency is a party, or to claims made pursuant to Division 3.6
(commencing with Section 810), until the pending litigation or claim
has been finally adjudicated or otherwise settled.
(c) Personnel, medical, or similar files, the disclosure of which
would constitute an unwarranted invasion of personal privacy.
(d) Contained in or related to any of the following:
(1) Applications filed with any state agency responsible for the
regulation or supervision of the issuance of securities or of
financial institutions, including, but not limited to, banks, savings
and loan associations, industrial loan companies, credit unions, and
insurance companies.
(2) Examination, operating, or condition reports prepared by, on
behalf of, or for the use of, any state agency referred to in
paragraph (1).
(3) Preliminary drafts, notes, or interagency or intra-agency
communications prepared by, on behalf of, or for the use of, any
state agency referred to in paragraph (1).
(4) Information received in confidence by any state agency
referred to in paragraph (1).
(e) Geological and geophysical data, plant production data, and
similar information relating to utility systems development, or
market or crop reports, that are obtained in confidence from any
person.
(f) Records of complaints to, or investigations conducted by, or
records of intelligence information or security procedures of, the
office of the Attorney General and the Department of Justice, and any
state or local police agency, or any investigatory or security files
compiled by any other state or local police agency, or any
investigatory or security files compiled by any other state or local
agency for correctional, law enforcement, or licensing purposes,
except that state and local law enforcement agencies shall disclose
the names and addresses of persons involved in, or witnesses other
than confidential informants to, the incident, the description of any
property involved, the date, time, and location of the incident, all
diagrams, statements of the parties involved in the incident, the
statements of all witnesses, other than confidential informants, to
the victims of an incident, or an authorized representative thereof,
an insurance carrier against which a claim has been or might be made,
and any person suffering bodily injury or property damage or loss,
as the result of the incident caused by arson, burglary, fire,
explosion, larceny, robbery, carjacking, vandalism, vehicle theft, or
a crime as defined by subdivision (c) of Section 13960, unless the
disclosure would endanger the safety of a witness or other person
involved in the investigation, or unless disclosure would endanger
the successful completion of the investigation or a related
investigation. However, nothing in this division shall require the
disclosure of that portion of those investigative files that reflect
the analysis or conclusions of the investigating officer.
Notwithstanding any other provision of this subdivision, state and
local law enforcement agencies shall make public the following
information, except to the extent that disclosure of a particular
item of information would endanger the safety of a person involved in
an investigation or would endanger the successful completion of the
investigation or a related investigation:
(1) The full name and occupation of every individual arrested by
the agency, the individual's physical description including date of
birth, color of eyes and hair, sex, height and weight, the time and
date of arrest, the time and date of booking, the location of the
arrest, the factual circumstances surrounding the arrest, the amount
of bail set, the time and manner of release or the location where the
individual is currently being held, and all charges the individual
is being held upon, including any outstanding warrants from other
jurisdictions and parole or probation holds.
(2) Subject to the restrictions imposed by Section 841.5 of the
Penal Code, the time, substance, and location of all complaints or
requests for assistance received by the agency and the time and
nature of the response thereto, including, to the extent the
information regarding crimes alleged or committed or any other
incident investigated is recorded, the time, date, and location of
occurrence, the time and date of the report, the name and age of the
victim, the factual circumstances surrounding the crime or incident,
and a general description of any injuries, property, or weapons
involved. The name of a victim of any crime defined by Section 220,
261, 261.5, 262, 264, 264.1, 273a, 273d, 273.5, 286, 288, 288a, 289,
422.6, 422.7, 422.75, or 646.9 of the Penal Code may be withheld at
the victim's request, or at the request of the victim's parent or
guardian if the victim is a minor. When a person is the victim of
more than one crime, information disclosing that the person is a
victim of a crime defined by Section 220, 261, 261.5, 262, 264,
264.1, 273a, 273d, 286, 288, 288a, 289, 422.6, 422.7, 422.75, or
646.9 of the Penal Code may be deleted at the request of the victim,
or the victim's parent or guardian if the victim is a minor, in
making the report of the crime, or of any crime or incident
accompanying the crime, available to the public in compliance with
the requirements of this paragraph.
(3) Subject to the restrictions of Section 841.5 of the Penal Code
and this subdivision, the current address of every individual
arrested by the agency and the current address of the victim of a
crime, where the requester declares under penalty of perjury that the
request is made for a scholarly, journalistic, political, or
governmental purpose, or that the request is made for investigation
purposes by a licensed private investigator as described in Chapter
11.3 (commencing with Section 7512) of Division 3 of the Business and
Professions Code, except that the address of the victim of any crime
defined by Section 220, 261, 261.5, 262, 264, 264.1, 273a, 273d,
273.5, 286, 288, 288a, 289, 422.6, 422.7, 422.75, or 646.9 of the
Penal Code shall remain confidential. Address information obtained
pursuant to this paragraph shall not be used directly or indirectly
to sell a product or service to any individual or group of
individuals, and the requester shall execute a declaration to that
effect under penalty of perjury.
(g) Test questions, scoring keys, and other examination data used
to administer a licensing examination, examination for employment, or
academic examination, except as provided for in Chapter 3
(commencing with Section 99150) of Part 65 of the Education Code.
(h) The contents of real estate appraisals or engineering or
feasibility estimates and evaluations made for or by the state or
local agency relative to the acquisition of property, or to
prospective public supply and construction contracts, until all of
the property has been acquired or all of the contract agreement
obtained. However, the law of eminent domain shall not be affected
by this provision.
(i) Information required from any taxpayer in connection with the
collection of local taxes that is received in confidence and the
disclosure of the information to other persons would result in unfair
competitive disadvantage to the person supplying the information.
(j) Library circulation records kept for the purpose of
identifying the borrower of items available in libraries, and library
and museum materials made or acquired and presented solely for
reference or exhibition purposes. The exemption in this subdivision
shall not apply to records of fines imposed on the borrowers.
(k) Records, the disclosure of which is exempted or prohibited
pursuant to federal or state law, including, but not limited to,
provisions of the Evidence Code relating to privilege.
(l) Correspondence of and to the Governor or employees of the
Governor's office or in the custody of or maintained by the Governor'
s legal affairs secretary, provided that public records shall not be
transferred to the custody of the Governor's Legal Affairs Secretary
to evade the disclosure provisions of this chapter.
(m) In the custody of or maintained by the Legislative Counsel,
except those records in the public database maintained by the
Legislative Counsel that are described in Section 10248.
(n) Statements of personal worth or personal financial data
required by a licensing agency and filed by an applicant with the
licensing agency to establish his or her personal qualification for
the license, certificate, or permit applied for.
(o) Financial data contained in applications for financing under
Division 27 (commencing with Section 44500) of the Health and Safety
Code, where an authorized officer of the California Pollution Control
Financing Authority determines that disclosure of the financial data
would be competitively injurious to the applicant and the data is
required in order to obtain guarantees from the United States Small
Business Administration. The California Pollution Control Financing
Authority shall adopt rules for review of individual requests for
confidentiality under this section and for making available to the
public those portions of an application that are subject to
disclosure under this chapter.
(p) Records of state agencies related to activities governed by
Chapter 10.3 (commencing with Section 3512), Chapter 10.5 (commencing
with Section 3525), and Chapter 12 (commencing with Section 3560) of
Division 4 of Title 1, that reveal a state agency's deliberative
processes, impressions, evaluations, opinions, recommendations,
meeting minutes, research, work products, theories, or strategy, or
that provide instruction, advice, or training to employees who do not
have full collective bargaining and representation rights under
these chapters. Nothing in this subdivision shall be construed to
limit the disclosure duties of a state agency with respect to any
other records relating to the activities governed by the employee
relations acts referred to in this subdivision.
(q) Records of state agencies related to activities governed by
Article 2.6 (commencing with Section 14081), Article 2.8 (commencing
with Section 14087.5), and Article 2.91 (commencing with Section
14089) of Chapter 7 of Part 3 of Division 9 of the Welfare and
Institutions Code, that reveal the special negotiator's deliberative
processes, discussions, communications, or any other portion of the
negotiations with providers of health care services, impressions,
opinions, recommendations, meeting minutes, research, work product,
theories, or strategy, or that provide instruction, advice, or
training to employees.
Except for the portion of a contract containing the rates of
payment, contracts for inpatient services entered into pursuant to
these articles, on or after April 1, 1984, shall be open to
inspection one year after they are fully executed. In the event that
a contract for inpatient services that is entered into prior to
April 1, 1984, is amended on or after April 1, 1984, the amendment,
except for any portion containing the rates of payment, shall be open
to inspection one year after it is fully executed. If the
California Medical Assistance Commission enters into contracts with
health care providers for other than inpatient hospital services,
those contracts shall be open to inspection one year after they are
fully executed.
Three years after a contract or amendment is open to inspection
under this subdivision, the portion of the contract or amendment
containing the rates of payment shall be open to inspection.
Notwithstanding any other provision of law, the entire contract or
amendment shall be open to inspection by the Joint Legislative Audit
Committee. The committee shall maintain the confidentiality of the
contracts and amendments until the time a contract or amendment is
fully open to inspection by the public.
(r) Records of Native American graves, cemeteries, and sacred
places maintained by the Native American Heritage Commission.
(s) A final accreditation report of the Joint Commission on
Accreditation of Hospitals that has been transmitted to the State
Department of Health Services pursuant to subdivision (b) of Section
1282 of the Health and Safety Code.
(t) Records of a local hospital district, formed pursuant to
Division 23 (commencing with Section 32000) of the Health and Safety
Code, or the records of a municipal hospital, formed pursuant to
Article 7 (commencing with Section 37600) or Article 8 (commencing
with Section 37650) of Chapter 5 of Division 3 of Title 4 of this
code, that relate to any contract with an insurer or nonprofit
hospital service plan for inpatient or outpatient services for
alternative rates pursuant to Section 10133 or 11512 of the Insurance
Code. However, the record shall be open to inspection within one
year after the contract is fully executed.
(u) (1) Information contained in applications for licenses to
carry firearms issued pursuant to Section 12050 of the Penal Code by
the sheriff of a county or the chief or other head of a municipal
police department that indicates when or where the applicant is
vulnerable to attack or that concerns the applicant's medical or
psychological history or that of members of his or her family.
(2) The home address and telephone number of peace officers,
judges, court commissioners, and magistrates that are set forth in
applications for licenses to carry firearms issued pursuant to
Section 12050 of the Penal Code by the sheriff of a county or the
chief or other head of a municipal police department.
(3) The home address and telephone number of peace officers,
judges, court commissioners, and magistrates that are set forth in
licenses to carry firearms issued pursuant to Section 12050 of the
Penal Code by the sheriff of a county or the chief or other head of a
municipal police department.
(v) (1) Records of the Major Risk Medical Insurance Program
related to activities governed by Part 6.3 (commencing with Section
12695) and Part 6.5 (commencing with Section 12700) of Division 2 of
the Insurance Code, and that reveal the deliberative processes,
discussions, communications, or any other portion of the negotiations
with health plans, or the impressions, opinions, recommendations,
meeting minutes, research, work product, theories, or strategy of the
board or its staff, or records that provide instructions, advice, or
training to employees.
(2) (A) Except for the portion of a contract that contains the
rates of payment, contracts for health coverage entered into pursuant
to Part 6.3 (commencing with Section 12695) or Part 6.5 (commencing
with Section 12700) of Division 2 of the Insurance Code, on or after
July 1, 1991, shall be open to inspection one year after they have
been fully executed.
(B) In the event that a contract for health coverage that is
entered into prior to July 1, 1991, is amended on or after July 1,
1991, the amendment, except for any portion containing the rates of
payment, shall be open to inspection one year after the amendment has
been fully executed.
(3) Three years after a contract or amendment is open to
inspection pursuant to this subdivision, the portion of the contract
or amendment containing the rates of payment shall be open to
inspection.
(4) Notwithstanding any other provision of law, the entire
contract or amendments to a contract shall be open to inspection by
the Joint Legislative Audit Committee. The committee shall maintain
the confidentiality of the contracts and amendments thereto, until
the contract or amendments to a contract is open to inspection
pursuant to paragraph (3).
(w) (1) Records of the Major Risk Medical Insurance Program
related to activities governed by Chapter 14 (commencing with Section
10700) of Part 2 of Division 2 of the Insurance Code, and that
reveal the deliberative processes, discussions, communications, or
any other portion of the negotiations with health plans, or the
impressions, opinions, recommendations, meeting minutes, research,
work product, theories, or strategy of the board or its staff, or
records that provide instructions, advice, or training to employees.
(2) Except for the portion of a contract that contains the rates
of payment, contracts for health coverage entered into pursuant to
Chapter 14 (commencing with Section 10700) of Part 2 of Division 2 of
the Insurance Code, on or after January 1, 1993, shall be open to
inspection one year after they have been fully executed.
(3) Notwithstanding any other provision of law, the entire
contract or amendments to a contract shall be open to inspection by
the Joint Legislative Audit Committee. The committee shall maintain
the confidentiality of the contracts and amendments thereto, until
the contract or amendments to a contract is open to inspection
pursuant to paragraph (2).
(x) Financial data contained in applications for registration, or
registration renewal, as a service contractor filed with the Director
of the Department of Consumer Affairs pursuant to Chapter 20
(commencing with Section 9800) of Division 3 of the Business and
Professions Code, for the purpose of establishing the service
contractor's net worth, or financial data regarding the funded
accounts held in escrow for service contracts held in force in this
state by a service contractor.
(y) (1) Records of the Managed Risk Medical Insurance Board
related to activities governed by Part 6.2 (commencing with Section
12693) or Part 6.4 (commencing with Section 12699.50) of Division 2
of the Insurance Code, and that reveal the deliberative processes,
discussions, communications, or any other portion of the negotiations
with health plans, or the impressions, opinions, recommendations,
meeting minutes, research, work product, theories, or strategy of the
board or its staff, or records that provide instructions, advice, or
training to employees.
(2) (A) Except for the portion of a contract that contains the
rates of payment, contracts entered into pursuant to Part 6.2
(commencing with Section 12693) or Part 6.4 (commencing with Section
12699.50) of Division 2 of the Insurance Code, on or after January 1,
1998, shall be open to inspection one year after they have been
fully executed.
(B) In the event that a contract entered into pursuant to Part 6.2
(commencing with Section 12693) or Part 6.4 (commencing with Section
12699.50) of Division 2 of the Insurance Code is amended, the
amendment shall be open to inspection one year after the amendment
has been fully executed.
(3) Three years after a contract or amendment is open to
inspection pursuant to this subdivision, the portion of the contract
or amendment containing the rates of payment shall be open to
inspection.
(4) Notwithstanding any other provision of law, the entire
contract or amendments to a contract shall be open to inspection by
the Joint Legislative Audit Committee. The committee shall maintain
the confidentiality of the contracts and amendments thereto until the
contract or amendments to a contract are open to inspection pursuant
to paragraph (2) or (3).
(5) The exemption from disclosure provided pursuant to this
subdivision for the contracts, deliberative processes, discussions,
communications, negotiations with health plans, impressions,
opinions, recommendations, meeting minutes, research, work product,
theories, or strategy of the board or its staff shall also apply to
the contracts, deliberative processes, discussions, communications,
negotiations with health plans, impressions, opinions,
recommendations, meeting minutes, research, work product, theories,
or strategy of applicants pursuant to Part 6.4 (commencing with
Section 12699.50) of Division 2 of the Insurance Code.
(z) Records obtained pursuant to paragraph (2) of subdivision (c)
of Section 2891.1 of the Public Utilities Code.
(aa) A document prepared by a local agency that assesses its
vulnerability to terrorist attack or other criminal acts intended to
disrupt the public agency's operations and that is for distribution
or consideration in a closed session.
Nothing in this section prevents any agency from opening its
records concerning the administration of the agency to public
inspection, unless disclosure is otherwise prohibited by law.
Nothing in this section prevents any health facility from
disclosing to a certified bargaining agent relevant financing
information pursuant to Section 8 of the National Labor Relations
Act.
SEC. 2. Section 13967 of the Government Code is repealed.
SEC. 3. Section 16531.1 of the Government Code is amended to read:
16531.1. (a) Notwithstanding any other provision of law and
without regard to fiscal year, if the annual State Budget is not
enacted by June 30 of any fiscal year preceding the fiscal year to
which the budget would apply or there is a deficiency in the Medi-Cal
budget during any fiscal year, both of the following shall occur:
(1) The Controller shall annually transfer from the General Fund,
in the form of one or more loans, an amount not to exceed a
cumulative total of one billion dollars ($1,000,000,000) in any
fiscal year, to the Medical Providers Interim Payment Fund, which is
hereby created in the State Treasury. Notwithstanding Section 13340
of the Government Code, the Medical Providers Interim Payment Fund is
hereby continuously appropriated for the purpose of making payments
to Medi-Cal providers, providers of services under Chapter 6
(commencing with Section 120950) of Part 4 of Division 105 of the
Health and Safety Code, and providers of services under Division 4.5
(commencing with Section 4500) of the Welfare and Institutions Code,
for services provided on or after July 1 of the fiscal year for which
no budget has been enacted and before September 1 of that year or
for the purpose of making payments to Medi-Cal providers, providers
of services under Chapter 6 (commencing with Section 120950) of Part
4 of Division 105 of the Health and Safety Code, and providers of
services under Division 4.5 (commencing with Section 4500), during
the period in which the Medi-Cal Program has a deficiency. Payments
shall be made pursuant to this subdivision if both of the following
conditions have been met:
(A) An invoice has been submitted for the services.
(B) Payment for the services is due and payable and the State
Department of Health Services determines that payment would be valid.
(2) For any fiscal year to which this subdivision applies, there
is hereby appropriated the sum of one billion dollars
($1,000,000,000) from the Federal Trust Fund to the Medical Providers
Interim Payment Fund.
(b) Upon the enactment of the annual Budget Act or a deficiency
bill in any fiscal year to which subdivision (a) applies, the
Controller shall transfer all expenditures and unexpended funds in
the Medical Providers Interim Payment Fund to the appropriate Budget
Act item.
(c) The amount of any loan made pursuant to subdivision (a) and
for which moneys were expended from the Medical Providers Interim
Payment Fund shall be repaid by debiting the appropriate Budget Act
item in accordance with the procedure prescribed by the Department of
Finance.
SEC. 4. Section 1266 of the Health and Safety Code is amended to
read:
1266. (a) Each new and renewal application for a license for the
health facilities listed below shall be accompanied by an annual fee
as set forth below.
(1) The annual fee for a general acute care hospital, acute
psychiatric hospital, special hospital, and chemical dependency
recovery hospital, based on the number of licensed beds, is as
follows:
1-49 beds $460 plus $8 per bed
50-99 beds $850 plus $8 per bed
100 or more beds $1,175 plus $8 per bed
(2) The annual fee for a skilled nursing facility, intermediate
care facility, and intermediate care facility/developmentally
disabled, based on the number of licensed beds, is as follows:
1-59 beds $2,068 plus $26 per bed
60-99 beds $2,543 plus $26 per bed
100 or more beds $3,183 plus $26 per bed
(3) The fees provided in this subdivision shall be adjusted,
commencing July 1, 1983, as proposed in the state department's
1983-84 fiscal year Health Facility License Fee Report to the
Legislature. Commencing July 1, 1984, fees provided in this
subdivision shall be adjusted annually, as directed by the
Legislature in the annual Budget Act.
(b) (1) By March 17 of each year, the State Department of Health
Services shall make available to interested parties, upon request,
information regarding the methodology and calculations used to
determine the fee amounts specified in this section, the staffing and
systems analysis required under subdivision (e), program costs
associated with the licensing provisions of this division, and the
actual numerical fee charges to be implemented on July 1 of that
year. This information shall specifically identify federal funds
received, but not previously budgeted for, the licensing provisions
of this division that are used to offset the amount of General Fund
money to be recovered through license fees. The information shall
also identify the purpose of federal funds received for any
additional activities under the licensing provisions of this division
that are not used to offset the amount of General Fund money.
(2) The methodology and calculations used to determine the fee
amounts shall result in fee levels in an amount sufficient to provide
revenues equal to the sum of the following:
(A) The General Fund expenditures for the fiscal year beginning on
July 1 of that year, as specified in the Governor's proposed budget,
less license fees estimated to be collected in that fiscal year by
the licensing provisions of this division, excluding licensing fees
collected pursuant to this section.
(B) The amount of federal funds budgeted for the fiscal year
ending June 30 of that year for the licensing provisions of the
division, less federal funds received or credited, or anticipated to
be received or
credited, during that fiscal year for that purpose.
The methodology for calculating the fee levels shall include an
adjustment that takes into consideration the actual amount of license
fee revenue collected pursuant to this section for that prior fiscal
year.
(3) If the Budget Act provides for expenditures that differ by 5
percent from the Governor's proposed budget, the Department of
Finance shall adjust the fees to reflect that difference and shall
instruct the State Department of Health Services to publish those
fees in accordance with subdivision (d).
(c) The annual fees determined pursuant to this section shall be
waived for any health facility conducted, maintained, or operated by
this state or any state department, authority, bureau, commission, or
officer, or by the Regents of the University of California, or by a
local hospital district, city, county, or city and county.
(d) The department shall, within 30 calendar days of the enactment
of the Budget Act, publish a list of actual numerical fee charges as
adjusted pursuant to this section. This adjustment of fees, any
adjustment by the Department of Finance, and the publication of the
fee list shall not be subject to the rulemaking requirements of
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code. If the published list of fees is
higher than that made available to interested parties pursuant to
subdivision (b), the affected health facilities may choose to pay the
fee in the amount presented at the public hearing and to defer
payment of the additional increment until 60 days after publication
of the list of fees pursuant to this subdivision.
(e) Prior to the establishment of the annual fee, the department
shall prepare a staffing and systems analysis to ensure efficient and
effective utilization of fees collected, proper allocation of
departmental resources to licensing and certification activities,
survey schedules, complaint investigations, enforcement and appeal
activities, data collection and dissemination, surveyor training, and
policy development.
The analysis under this subdivision shall be included in the
information made available pursuant to subdivision (b), and shall
include all of the following:
(1) The number of surveyors and administrative support personnel
devoted to the licensing and certification of health care facilities.
(2) The percentage of time devoted to licensing and certification
activities for the various types of health facilities.
(3) The number of facilities receiving full surveys and the
frequency and number of followup visits.
(4) The number and timeliness of complaint investigations.
(5) Data on deficiencies and citations issued, and numbers of
citation review conferences and arbitration hearings.
(6) Training courses provided for surveyors.
(7) Other applicable activities of the licensing and certification
division.
The analysis shall also include recommendations for administrative
changes to streamline and prioritize the survey process, complaint
investigations, management information systems, word processing
capabilities and effectiveness, consumer information system, and
surveyor training.
The annual staffing and systems analysis shall be presented to the
Health Care Advisory Committee and the Legislature prior to the
establishment and adoption of the annual fee.
(f) The annual fee for a congregate living health facility shall
initially, and until adjusted by the Legislature in a Budget Act, be
based on the number of licensed beds as follows:
1-3 beds $ 800
4-6 beds $1,000
7-10 beds $1,200
11-15 beds $1,500
16 or more beds $1,700
Commencing July 1, 1991, fees provided in this subdivision shall be
adjusted annually, as directed by the Legislature in the annual
budget.
(g) The annual fee for a pediatric day health and respite care
facility, as defined in Section 1760.2, shall initially, and until
adjusted by the Legislature in a Budget Act, be based on the number
of licensed beds as follows:
1-3 beds or clients $ 800
4-6 beds or clients $1,000
7-10 beds or clients $1,200
11-15 beds or clients $1,500
16 or more beds or clients $1,700 plus $50 for
each
additional bed or
client
over 16 beds or clients
Commencing July 1, 1993, fees provided in this subdivision shall be
adjusted annually, as directed by the Legislature in the annual
Budget Act.
(h) The department shall, in consultation with affected provider
representatives, develop a specific proposal by July 1, 1995, to do
all of the following:
(1) Revise the health facility licensure fee methodologies in a
manner that addresses the fee methodology and subsidy issues
described in the State Auditor Report Number 93020, Issues 2 and 3.
(2) Ensure the validity and reliability of the data systems used
to calculate the license fee.
(3) Address the subsidy of licensing and certification activities
regarding health facilities for which the annual license fee is
waived.
(4) Develop a licensing and certification special fund into which
all fees collected by the state department, for health facility
licensing, certification, regulation, and inspection duties,
functions, and responsibilities, shall be deposited.
SEC. 4.5. Section 1316.5 of the Health and Safety Code, as amended
by Section 1 of Chapter 717 of the Statutes of 1998, is amended to
read:
1316.5. (a) (1) Each health facility owned and operated by the
state offering care or services within the scope of practice of a
psychologist shall establish rules and medical staff bylaws that
include provisions for medical staff membership and clinical
privileges for clinical psychologists within the scope of their
licensure as psychologists, subject to the rules and medical staff
bylaws governing medical staff membership or privileges as the
facility shall establish. The rules and regulations shall not
discriminate on the basis of whether the staff member holds an M.D.,
D.O., D.D.S., D.P.M., or doctoral degree in psychology within the
scope of the member's respective licensure. Each of these health
facilities owned and operated by the state shall establish a staff
comprised of physicians and surgeons, dentists, podiatrists,
psychologists, or any combination thereof, that shall regulate the
admission, conduct, suspension, or termination of the staff
appointment of psychologists employed by the health facility.
(2) With regard to the practice of psychology in health facilities
owned and operated by the state offering care or services within the
scope of practice of a psychologist, medical staff status shall
include and provide for the right to pursue and practice full
clinical privileges for holders of a doctoral degree of psychology
within the scope of their respective licensure. These rights and
privileges shall be limited or restricted only upon the basis of an
individual practitioner's demonstrated competence. Competence shall
be determined by health facility rules and medical staff bylaws that
are necessary and are applied in good faith, equally and in a
nondiscriminatory manner, to all practitioners, regardless of whether
they hold an M.D., D.O., D.D.S., D.P.M., or doctoral degree in
psychology.
(3) Nothing in this subdivision shall be construed to require a
health facility owned and operated by the state to offer a specific
health service or services not otherwise offered. If a health
service is offered in such a health facility that includes provisions
for medical staff membership and clinical privileges for clinical
psychologists, the facility shall not discriminate between persons
holding an M.D., D.O., D.D.S., D.P.M., or doctoral degree in
psychology who are authorized by law to perform the service within
the scope of the person's respective licensure.
(4) The rules and medical staff bylaws of a health facility owned
and operated by the state that include provisions for medical staff
membership and clinical privileges for medical staff and duly
licensed clinical psychologists shall not discriminate on the basis
of whether the staff member holds an M.D., D.O., D.D.S., D.P.M., or
doctoral degree in psychology within the scope of the member's
respective licensure. The health facility staff of these health
facilities who process, review, evaluate, and determine
qualifications for staff privileges for medical staff shall include,
if possible, staff members who are clinical psychologists.
(b) (1) The rules of a health facility not owned or operated by
this state may enable the appointment of clinical psychologists on
the terms and conditions that the facility shall establish. In these
health facilities, clinical psychologists may hold membership and
serve on committees of the medical staff and carry professional
responsibilities consistent with the scope of their licensure and
their competence, subject to the rules of the health facility.
(2) Nothing in this subdivision shall be construed to require a
health facility not owned or operated by this state to offer a
specific health service or services not otherwise offered. If a
health service is offered by a health facility with both licensed
physicians and surgeons and clinical psychologists on the medical
staff, which both licensed physicians and surgeons and clinical
psychologists are authorized by law to perform, the service may be
performed by either, without discrimination.
(3) This subdivision shall not prohibit a health facility that is
a clinical teaching facility owned or operated by a university
operating a school of medicine from requiring that a clinical
psychologist have a faculty teaching appointment as a condition for
eligibility for staff privileges at that facility.
(4) In any health facility that is not owned or operated by this
state that provides staff privileges to clinical psychologists, the
health facility staff who process, review, evaluate, and determine
qualifications for staff privileges for medical staff shall include,
if possible, staff members who are clinical psychologists.
(c) No classification of health facilities by the department, nor
any other classification of health facilities based on quality of
service or otherwise, by any person, body, or governmental agency of
this state or any subdivision thereof shall be affected by a health
facility's provision for use of its facilities by duly licensed
clinical psychologists, nor shall any classification of these
facilities be affected by the subjection of the psychologists to the
rules and regulations of the organized professional staff. No
classification of health facilities by any governmental agency of
this state or any subdivision thereof pursuant to any law, whether
enacted prior or subsequent to the effective date of this section,
for the purposes of ascertaining eligibility for compensation,
reimbursement, or other benefit for treatment of patients shall be
affected by a health facility's provision for use of its facilities
by duly licensed clinical psychologists, nor shall any classification
of these facilities be affected by the subjection of the
psychologists to the rules and regulations of the organized
professional staff which govern the psychologists' use of the
facilities.
(d) "Clinical psychologist," as used in this section, means a
psychologist licensed by this state who meets both of the following
requirements:
(1) Possesses an earned doctorate degree in psychology from an
educational institution meeting the criteria of subdivision (b) of
Section 2914 of the Business and Professions Code.
(2) Has not less than two years clinical experience in a
multidisciplinary facility licensed or operated by this or another
state or by the United States to provide health care, or, is listed
in the latest edition of the National Register of Health Service
Providers in Psychology, as adopted by the Council for the National
Register of Health Service Providers in Psychology.
(e) Nothing in this section is intended to expand the scope of
licensure of clinical psychologists. Notwithstanding the Ralph C.
Dills Act (Chapter 10.3 (commencing with Section 3512) of Division 4
of Title 1 of the Government Code), the Public Employment Relations
Board is precluded from creating any additional bargaining units for
the purpose of exclusive representation of state psychologist
employees that might result because of medical staff membership
and/or privilege changes for psychologists due to the enactment of
provisions by Assembly Bill No. 3141 of the 1995-96 Regular Session.
(f) The State Department of Mental Health, the State Department of
Developmental Services, and the Department of Corrections shall
report to the Legislature no later than January 1, 2006, on the
impact of medical staff membership and privileges for clinical
psychologists on quality of care, and on cost-effectiveness issues.
SEC. 4.6. Section 1316.5 of the Health and Safety Code, as amended
by Section 2 of Chapter 717 of the Statutes of 1998, is repealed.
SEC. 5. Article 7.5 (commencing with Section 1324) is added to
Chapter 2 of Division 2 of the Health and Safety Code, to read:
Article 7.5. Intermediate Care Facilities' Quality Assurance
Fees
1324. For purposes of this article, the following definitions
shall apply:
(a) (1) "Gross receipts" means gross receipts paid as compensation
for services provided to residents of a designated intermediate care
facility.
(2) "Gross receipts" does not mean charitable contributions.
(3) For state and local government owned facilities, "gross
receipts" shall include any contributions from government sources or
General Fund expenditures for the care of residents of a designated
intermediate care facility.
(b) "Eligible facility" means a designated intermediate care
facility that has paid the fee as described in Section 1324.2, for a
particular state fiscal year.
(c) "Designated intermediate care facility" or "facility" means a
facility as defined in subdivision (e), (g), or (h) of Section 1250.
1324.2. (a) As a condition for participation in the Medi-Cal
program, there shall be imposed each state fiscal year upon the
entire gross receipts of a designated intermediate care facility a
quality assurance fee, as calculated in accordance with subdivision
(b).
(b) The quality assurance fee to be paid pursuant to subdivision
(c) of Section 1324.4 shall be an amount determined each quarter of
the state fiscal year by multiplying the facility's gross receipts in
the preceding quarter by 6 percent. For reporting purposes, the
quality assurance fee is considered to be on a cash basis of
accounting.
1324.4. (a) On or before August 31 of each year, each designated
intermediate care facility subject to Section 1324.2 shall report to
the department, in a prescribed form, the facility's gross receipts
for the preceding state fiscal year.
(b) On or before the last day of each calendar quarter, each
designated intermediate care facility shall file a report with the
department, in a prescribed form, showing the facility's gross
receipts for the preceding quarter.
(c) A newly licensed care facility, as defined by the department,
shall be exempt from the requirements of subdivision (a) for its year
of operation, but shall complete all requirements of subdivision (b)
for any portion of the quarter in which it commences operations.
(d) The quality assurance fee, as calculated pursuant to
subdivision (b) of Section 1324.2, shall be paid to the department on
or before the last day of the quarter following the quarter for
which the fee is imposed.
(e) The payment of the quality assurance fee a designated
intermediate care facility shall be reported as an allowable cost for
Medi-Cal reimbursement purposes.
(f) The department shall make retrospective adjustments, as
necessary, to the amounts calculated pursuant to subdivision (b) of
Section 1324.2 in order to assure that the facility's aggregate
quality assurance fee for any particular state fiscal year does not
exceed 6 percent of the facility's aggregate annual gross receipts
for that year.
1324.6. (a) The Director of Health Services, or his or her
designee, shall administer this article.
(b) The director may adopt regulations as are necessary to
implement this article. These regulations may be adopted as
emergency regulations 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). For purposes of this article, the adoption of regulations
shall be deemed an emergency and necessary for the immediate
preservation of the public peace, health and safety, or general
welfare. The regulations shall include, but not be limited to, any
regulations necessary for either of the following purposes:
(1) The administration of this article, including the proper
imposition and collection of the quality assurance fee.
(2) The development of any forms necessary to obtain required
information from facilities subject to the quality assurance fee.
(c) As an alternative to subdivision (b), and notwithstanding
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code, the director may implement this
article by means of a provider bulletin, or other similar
instructions, without taking regulatory action.
1324.8. The quality assurance fee assessed and collected pursuant
to this article shall be deposited in the General Fund.
1324.10. In addition to the rate of payment that an eligible
facility would otherwise receive for intermediate care facility
services provided to Medi-Cal beneficiaries, an eligible facility
shall receive quarterly supplemental Medi-Cal reimbursement, in an
amount determined by the department.
The supplemental Medi-Cal reimbursement provided by this section
shall be paid to support the facility's quality improvement efforts
and shall be distributed under a payment methodology based on
intermediate care services provided to Medi-Cal patients at the
eligible facility, either on a per diem basis, or on any other
federally permissible basis.
1324.12. (a) (1) The department shall seek approval from the
federal Centers for Medicare and Medicaid Services for the
implementation of this article.
(2) If after seeking federal approval, federal approval is not
obtained, this article shall not be implemented.
(3) The Director of Health Services may alter the methodology
specified in this article to the extent necessary to meet the
requirements of federal law or regulations, or to obtain federal
approval.
(b) If there is a final judicial determination by any court of
appellate jurisdiction or a final determination by the Administrator
of the federal Center for Medicare and Medicaid Services that the
supplemental reimbursement provided by this article shall be made to
any facility not described in this article, this article shall
immediately become inoperative.
1324.14. In implementing this article, the department may utilize
the services of the Medi-Cal fiscal intermediary through a change
order to the fiscal intermediary contract to administer this program,
consistent with the requirements of Sections 14104.6, 14104.7,
14104.8, and 14104.9 of the Welfare and Institutions Code.
SEC. 6. Section 104181.6 is added to the Health and Safety Code,
to read:
104181.6. Notwithstanding subdivision (a) of Section 2.00 of the
Budget Act of 2002 and any other provision of law, commencing with
the appropriation for the 2002-03 fiscal year, and for each fiscal
year thereafter, any amount appropriated to the department for the
Cancer Research Program shall be available, for purposes of that
program, for encumbrance for one fiscal year beyond the year of
appropriation and for expenditure for three fiscal years beyond the
year of encumbrance.
SEC. 7. Section 104465 of the Health and Safety Code is amended to
read:
104465. (a) The department may annually set aside three million
dollars ($3,000,000) appropriated for the purposes of the competitive
grants program established pursuant to this article in order to
support efforts to link the statewide media campaign to local
communities and to provide regional public and community relations or
media initiatives.
(b) Local community initiatives may include, but are not limited
to, all of the following:
(1) Encouraging volunteer efforts.
(2) Local media programming.
(3) Provision of assistance in, and facilitation of, public and
community events.
(c) The efforts described in subdivision (b) shall be directed
principally to the target communities described in Section 104360.
(d) Regular application procedures for competitive grants under
this article shall apply to applications for grants under this
section.
(e) Funds awarded pursuant to this section shall be awarded in the
same manner as other competitive grants under this article.
SEC. 8. Section 104466 is added to the Health and Safety Code, to
read:
104466. Notwithstanding subdivision (a) of Section 2.00 of the
Budget Act of 2002 and any other provision of law, commencing with
the appropriation for the 2002-03 fiscal year, and for each fiscal
year thereafter, any amount appropriated to the department to
implement the following tobacco use prevention programs shall be
available for encumbrance and expenditure for three fiscal years
beyond the date of the appropriation:
(a) The program to evaluate tobacco control programs provided for
in subdivisions (b) and (c) of Section 104375.
(b) The tobacco use prevention media campaign provided for in
subdivision (e) of Section 104375.
(c) The competitive grant program provided for in Section 104385.
(d) The local lead agency tobacco use prevention programs provided
for in Section 104400.
(e) The tobacco use prevention program directed at schools
provided for in Sections 104420, 104425, 104430, and 104435.
SEC. 9. Section 104898.5 of the Health and Safety Code is amended
to read:
104898.5. (a) Notwithstanding any other provision of law, there
shall be transferred annually from the General Fund to the Tobacco
Settlement Fund an amount, not to exceed one hundred million dollars
($100,000,000) out of funds not otherwise appropriated, as a loan to
cover appropriations from the fund when moneys from the Master
Settlement Agreement have not been received by the state.
(b) This loan from the General Fund shall be repaid on or before
June 30 of each year, without interest, from the funds received
pursuant to the Master Settlement Agreement.
SEC. 10. Section 120955 of the Health and Safety Code is amended
to read:
120955. (a) (1) 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). If the director makes a formal determination that, in any
fiscal year, funds appropriated for the program will be insufficient
to provide all of those drug treatments to existing eligible persons
for the fiscal year and that a suspension of the implementation of
the program is necessary, the director may suspend eligibility
determinations and enrollment in the program for the period of time
necessary to meet the needs of existing eligible persons in the
program.
(2) The director shall develop, maintain, and update as necessary
a list of drugs to be provided under this program.
(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. Chapter 16 (commencing with Section 121345) is added to
Part 4 of Division 105 of the Health and Safety Code, to read:
CHAPTER 16. THERAPEUTIC MONITORING PROGRAM
121345. (a) The Legislature finds and declares that therapeutic
monitoring is necessary to make appropriate life-prolonging and
cost-effective treatment decisions in the management of HIV disease.
(b) The Director of the Office of AIDS may provide funding for the
coverage of therapeutic monitoring assays for HIV disease through
the State HIV Therapeutic Monitoring Program.
(c) (1) The purpose of the program under this chapter shall be to
provide the therapeutic assays for HIV-positive people who could not
otherwise afford them.
(2) The scope of the program shall be determined by the federal
and state guidelines for standards of HIV care and availability of
funding.
(3) Priority for funding under the State HIV Therapeutic
Monitoring Program shall be given to the state-funded Early
Intervention Program sites.
(d) Therapeutic monitoring under this chapter shall include, but
not be limited to, viral load and resistance assays.
(e) Coverage awards shall be made to counties on the basis of
need. The determination of awards shall be made by the Office of
AIDS, depending on the availability of state and federal funding for
the program. Counties may cover those assays that are determined to
be necessary and are not covered under the state program.
SEC. 12. Section 123853 is added to the Health and Safety Code, to
read:
123853. (a) The department may enter into contracts with one or
more manufacturers on a negotiated or bid basis as the purchaser, but
not the dispenser or distributor, of factor replacement therapies
under the California Children's Services Program for the purpose of
enabling the department to obtain the full range of available
therapies and services required for clients with hematological
disorders at the most favorable price and to enable the department,
notwithstanding any other provision of state law, to obtain
discounts, rebates, or refunds from the manufacturers based upon the
large quantities purchased under the program. Nothing in this
subdivision shall interfere with the usual and customary distribution
practices of factor replacement therapies. In order to achieve
maximum cost savings, the Legislature hereby determines that an
expedited contract process under this section is necessary.
Therefore, a contract under this subdivision may be on a negotiated
basis and shall be exempt from Chapter 2 (commencing with Section
10290) of Part 2 of Division 2 of the Public Contract Code and
Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3
of the Government Code.
(b) The department may enter into contracts on a bid or negotiated
basis with manufacturers, distributors, dispensers, or suppliers of
pharmaceuticals, appliances, durable medical equipment, medical
supplies, and other product-type health care services and
laboratories for the purpose of obtaining the most favorable prices
to the state and to assure adequate access and quality of the product
or service. In order to achieve maximum cost savings, the
Legislature hereby determines that an expedited contract process
under this subdivision is necessary. Therefore, contracts under this
subdivision may be on a negotiated basis and shall be exempt from
the provisions of Chapter 2 (commencing with Section 10290) of Part 2
of Division 2 of the Public Contract Code and Chapter 6 (commencing
with Section 14825), Part 5.5, Division 3 of the Government Code.
This subdivision shall not apply to pharmacies or suppliers that
provide blood, blood derivatives, or blood factor products, or any
product or service provided by those pharmacies or suppliers.
(c) The department may contract with one or more manufacturers of
each multisource prescribed product or supplier of outpatient
clinical laboratory services on a bid or negotiated basis. Contracts
for outpatient clinical laboratory services shall require that the
contractor be a clinical laboratory licensed or certified by the
State of California or certified under Section 263a of Title 42 of
the United States Code. Nothing in this subdivision shall be
construed as prohibiting the department from contracting with less
than all manufacturers or clinical laboratories, including just one
manufacturer or clinical laboratory, on a bid or negotiated basis.
SEC. 13. Section 124555 of the Health and Safety Code is amended
to read:
124555. (a) (1) It is the intent of the Legislature that funds
distributed under this section promote stability for participating
clinics, as a part of the state's health care safety net, and at the
same time be distributed in a manner that best promotes access to
health care to seasonal agricultural and migratory workers and their
families.
(2) The department shall grant funds, for a minimum of three years
per grant, retroactive to funds appropriated in the Budget Act of
2002 (Chapter 379 of the Statutes of 2002), to eligible, private,
nonprofit, community-based primary care clinics for the purpose of
establishing and maintaining a health services program for seasonal
agricultural and migratory workers and their families. The
department may continue to pay any grantee whose grant expired on
June 30, 2003, until June 30, 2004, as if the grant had been
extended, provided that funds are appropriated for this purpose in
the Budget Act of 2003 and the grantee agrees in writing to expend
the money as if the grant had been extended.
(b) In order to be eligible to receive funds under this program, a
clinic shall, at a minimum, meet all of the following conditions:
(1) The clinic shall be licensed under either paragraph (1) or (2)
of subdivision (a) of Section 1204.
(2) The clinic's patient population shall include at least 25
percent farmworkers and their dependents.
(3) The clinic shall operate in a medically underserved area,
including a Health Professional Shortage Area, or serve a medically
underserved population, as designated by the United States Department
of Health and Human Services, or shall be able to demonstrate that
at least 50 percent of its patients are persons with incomes at or
below 200 percent of the federal poverty level.
(c) The department shall seek input from stakeholders in designing
the methodology for distribution of funds under this section.
SEC. 14. Section 124710 of the Health and Safety Code is amended
to read:
124710. (a) (1) It is the intent of the Legislature that funds
distributed under this section promote stability for participating
clinics, as a part of the state's health care safety net, and at the
same time be distributed in a manner that best promotes access to
health care to geographically isolated populations.
(2) The department shall grant funds, for a minimum of three years
per grant, retroactive to funds appropriated in the Budget Act of
2002 (Chapter 379 of the Statutes of 2002), to eligible, private,
nonprofit, community-based primary care clinics for the purpose of
establishing and maintaining rural health services and development
projects as specified under this article. The department may
continue to pay any grantee whose grant expired on June 30, 2003,
until June 30, 2004, as if the grant had been extended, provided that
funds are appropriated for this purpose in the Budget Act of 2003
and the grantee agrees in writing to expend the money as if the grant
had been extended.
(b) In order to be eligible to receive funds under this program, a
clinic shall, at a minimum, meet all of the following conditions:
(1) The clinic shall be licensed under paragraph (1) or (2) of
subdivision (a) of Section 1204.
(2) The clinic shall operate in a "rural" Medical Study Service
Area, as defined by the Health Manpower Commission.
(3) The clinic shall operate in a medically underserved area,
including a Health Professional Shortage Area, or serve a medically
underserved population, as designated by the United States Department
of Health and Human Services, or shall be able to demonstrate that
at least 50 percent of its patients are persons with incomes at or
below 200 percent of the federal poverty level.
(c) The department shall seek input from stakeholders in designing
the methodology for distribution of funds under this section.
(d) If the funds that are available for purposes of this section
for any fiscal year are greater than funds that were available for
the prior fiscal year, the department shall establish a base funding
level that is applicable to all sites funded in the prior fiscal
year. To the extent that funds are available, the base funding level
shall not be less than seventy-five thousand dollars ($75,000) for
each site. To implement this section, the department shall not be
required to reduce funding for clinics that are above the minimum
awards.
SEC. 15. Section 125191 is added to the Health and Safety Code, to
read:
125191. (a) The department may enter into contracts with one or
more manufacturers on a negotiated or bid basis as the purchaser, but
not the dispenser or distributor, of factor replacement therapies
under the genetically handicapped persons program for the purpose of
enabling the department to obtain the full range of available
therapies and services required for clients with hematological
disorders at the most favorable price and to enable the department,
notwithstanding any other provision of state law, to obtain
discounts, rebates, or refunds from the manufacturers based upon the
large quantities purchased under the program. Nothing in this
subdivision shall interfere with the usual and customary distribution
practices of factor replacement therapies. In order to achieve
maximum cost savings, the Legislature hereby determines that an
expedited contract process under this section is necessary.
Therefore, a contract under this subdivision may be on a negotiated
basis and shall be exempt from Chapter 2 (commencing with Section
10290) of Part 2 of Division 2 of the Public Contract Code and
Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3
of the Government Code.
(b) The department may enter into contracts on a bid or negotiated
basis with manufacturers, distributors, dispensers, or suppliers of
pharmaceuticals, appliances, durable medical equipment, medical
supplies, and other product-type health care services and
laboratories for the purpose of obtaining the most favorable prices
to the state and to assure adequate access and quality of the product
or service. In order to achieve maximum cost savings, the
Legislature hereby determines that an expedited contract process
under this subdivision is necessary. Therefore, contracts under this
subdivision may be on a negotiated basis and shall be exempt from
the provisions of Chapter 2 (commencing with Section 10290) of Part 2
of Division 2 of the Public Contract Code and Chapter 6 (commencing
with Section 14825), Part 5.5, Division 3 of the Government Code.
This subdivision shall not apply to pharmacies or suppliers that
provide blood, blood derivatives, or blood factor products, or any
product or service provided by those pharmacies or suppliers.
(c) The department may contract with one or more manufacturers of
each multisource prescribed product or supplier of outpatient
clinical laboratory services on a bid or negotiated basis. Contracts
for outpatient clinical laboratory services shall require that the
contractor be a clinical laboratory licensed or certified by the
State of California or certified under Section 263a of Title 42 of
the United States Code. Nothing in this subdivision shall be
construed as prohibiting the department from contracting with less
than all manufacturers or clinical laboratories, including just one
manufacturer or clinical laboratory, on a bid or negotiated basis.
SEC. 16. Section 127280.1 of the Health and Safety Code is amended
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 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. 16.5. Section 12693.275 is added to the Insurance Code, to
read:
12693.275. (a) The Legislature finds and declares that the state
faces a fiscal crisis that requires that unprecedented measures be
taken to reduce General Fund expenditures.
(b) Notwithstanding any other provision of law or regulation, the
rates in effect on July 1, 2003, for health, dental, and vision plans
participating in the Healthy Families Program shall remain in effect
through June 30, 2005.
(c) 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. 17. 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 and for
applicants on behalf of children described in clause (ii) of
subparagraph (A) of paragraph (6) of subdivision (a) of Section
12693.70.
(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 and for
applicants on behalf of children described in clause (ii) of
subparagraph (A) of paragraph (6) of subdivision (a) of Section
12693.70.
(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. 18. 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 either of the following:
(i) In a family with an annual or monthly household income equal
to or less than 200 percent of the federal poverty level.
(ii) When implemented by the board, subject to subdivision (b) of
Section 12693.765 and pursuant to this section, a child under the age
of two years who was delivered by a mother enrolled in the Access
for Infants and Mothers Program as described in Part 6.3 (commencing
with Section 12695). For purposes of this clause, any infant born to
a woman whose enrollment in the Access for Infants and Mothers
Program begins after June 30, 2004, shall be automatically enrolled
in the Healthy Families Program. This enrollment shall cover the
first 12 months of the infant's life. At the end of the 12 months,
as a condition of continued eligibility, the applicant shall provide
income information. The infant shall be disenrolled if the gross
annual household income exceeds the income eligibility standard that
was in effect in the Access for Infants and Mothers Program at the
time the infant's mother became eligible, or following the two-month
period established in Section 12693.981 if the infant is eligible for
Medi-Cal with no share of cost. At the end of the second year,
infants shall again be screened for program eligibility pursuant to
this section, with income eligibility evaluated pursuant to clause
(i), subparagraphs (B) and (C), and paragraph (2) of subdivision (a).
(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. 19. Section 12693.73 of the Insurance Code is amended to
read:
12693.73. Notwithstanding any other provision of law, children
excluded from coverage under Title XXI of the Social Security Act are
not eligible for coverage under the program, except as specified in
clause (ii) of subparagraph (A) of paragraph (6) of subdivision (a)
of Section 12693.70 and Section 12693.76.
SEC. 20. Section 12693.765 is added to the Insurance Code, to
read:
12693.765. (a) Notwithstanding any other provision of law and
subject to subdivision (b), a child described in clause (ii) of
subparagraph (A) of paragraph (6) of subdivision (a) of Section
12693.70 shall be deemed eligible to participate in the program at
birth.
(b) Notwithstanding any other provision of law, subdivision (a)
and clause (ii) of subparagraph (A) of paragraph (6) of subdivision
(a) of Section 12693.70 may only be implemented to the extent that
funds are appropriated for that purpose in the annual Budget Act or
other statute.
SEC. 21. Section 12693.91 of the Insurance Code is amended to
read:
12693.91. (a) The State Department of Health Services, in
conjunction with the Managed Risk Medical Insurance Board, the County
Medical Services Program board, and the Rural Health Policy Council,
may develop and administer up to five demonstration projects in
rural areas that are likely to contain a significant level of
uninsured children, including seasonal and migratory worker
dependents. In addition to any other funds provided pursuant to this
section the grants for demonstration projects may include funds
pursuant to subdivision (d).
(b) The purpose of the demonstration projects shall be to fund
rural collaborative health care networks to alleviate unique problems
of access to health care in rural areas.
(c) The State Department of Health Services, in conjunction with
the Managed Risk Medical Insurance Board and Rural Health Policy
Council, shall establish the criteria and standards for eligibility
to be used in requests for proposals or requests for application, the
application review process, determining the maximum amount and
number of grants to be awarded, preference and priority of projects,
and compliance monitoring after receiving comment from the public.
(d) The grants may include funds for purchasing equipment, making
capital expenditures, and providing infrastructure, including, but
not limited to, salaries and payment of leaseholds. The funds under
this subdivision may only be awarded to qualified eligible health
care entities as determined by the State Department of Health
Services. Title to any equipment or capital improvement purchased or
acquired with grant funds shall vest in the grantee for the public
good and not the state. Capital expenditures shall not include the
acquisition of land. Notwithstanding subdivision (e), this
subdivision shall be implemented only when funds are appropriated in
the annual Budget Act or another statute to fund the cost of
implementing this subdivision.
(e) This section shall only become operative upon federal approval
of the state plan or subsequent amendments for the program and
approval of federal financial participation.
SEC. 22. Section 12693.98 of the Insurance Code is amended to
read:
12693.98. (a) (1) The Medi-Cal-to-Healthy Families Bridge
Benefits Program is hereby established to provide any child who meets
the criteria set forth in subdivision (b) with a one calendar-month
period of health care benefits in order to provide the child with an
opportunity to apply for the Healthy Families Program established
under Chapter 16 (commencing with Section 12693).
(2) The Medi-Cal-to-Healthy Families Bridge Benefits Program shall
be administered by the board.
(b) (1) Any child who meets all of the following requirements
shall be eligible for one calendar month of Healthy Families benefits
funded by Title XXI of the Social Security Act, known as the State
Children's Health Insurance Program:
(A) He or she has been receiving, but is no longer eligible for,
full-scope Medi-Cal benefits without a share of cost.
(B) He or she is eligible for full-scope Medi-Cal benefits with a
share of cost.
(C) He or she is under 19 years of age at the time he or she is no
longer eligible for full-scope Medi-Cal benefits without a share of
cost.
(D) He or she has family income at or below 200 percent of the
federal poverty level.
(E) He or she is not otherwise excluded under the definition of
targeted low-income child under subsections (b)(1)(B)(ii), (b)(1)(C),
and (b)(2) of Section 2110 of the Social Security Act (42 U.S.C.
Secs. 1397jj(b)(1)(B)(ii), 1397jj(b)(1)(C), and 1397jj(b)(2)).
(2) The one calendar month of benefits under this chapter shall
begin on the first day of the month following the last day of the
receipt of benefits without a share of cost.
(c) The income methodology for determining a child's family
income, as required by paragraph (1) of subdivision (b) shall be the
same methodology used in determining a child's eligibility for the
full scope of Medi-Cal benefits.
(d) The one calendar-month period of Healthy Families benefits
provided under this chapter shall be identical to the scope of
benefits that the child was receiving under the Medi-Cal program
without a share of cost.
(e) The one calendar-month period of Healthy Families benefits
provided under this chapter shall only be made available through a
Medi-Cal provider or under a Medi-Cal managed care arrangement or
contract.
(f) Except as provided in subdivision (j), nothing in this
section shall be construed to provide Healthy Families benefits for
more than a one calendar-month period under any circumstances,
including the failure to apply for benefits under the Healthy
Families Program or the failure to be made aware of the availability
of the Healthy Families Program, unless the circumstances described
in subdivision (b) reoccur.
(g) (1) This section shall become operative on the first day of
the second month following the effective date of this section,
subject to paragraph (2).
(2) Under no circumstances shall this section become operative
until, and shall be implemented only to the extent that, all
necessary federal approvals, including approval of any amendments to
the State Child Health Plan have been sought and obtained and federal
financial participation under the federal State Children's Health
Insurance Program, as set forth in Title XXI of the Social Security
Act, has been approved.
(h) 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
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.
(i) If the State Child Health Insurance Program waiver described
in Section 12693.755 is approved, and at the time the waiver is
implemented, the benefits described in this section shall also be
available to persons who meet the eligibility requirements of the
program and are parents of, or, as defined by the board, adults
responsible for, children enrolled to receive coverage under this
part or enrolled to receive full scope Medi-Cal services with no
share of cost.
(j) The one month of benefits provided in this section shall be
increased to two months commencing on implementation of the waiver
referred to in Section 12693.755.
SEC. 23. Section 12693.99 of the Insurance Code is repealed.
SEC. 24. Section 12695.04 of the Insurance Code is amended to
read:
12695.04. "Advisory panel" means the Managed Risk Medical
Insurance Board Access for Infants and Mothers Advisory Panel created
pursuant to Section 12696.5.
SEC. 25. Section 12695.06 of the Insurance Code is amended to
read:
12695.06. "Applicant" means an individual who applies for
coverage through the program.
SEC. 26. Section 12695.08 of the Insurance Code is amended to
read:
12695.08. "Board" means the Managed Risk Medical Insurance Board
created pursuant to Section 12710.
SEC. 27. Section 12696.7 of the Insurance Code is amended to read:
12696.7. (a) The board may contract with a variety of health
plans and types of health care service delivery systems in order to
offer subscribers a choice of plans, providers, and types of service
delivery.
(b) Participating health plans contracting with the board pursuant
to this part shall provide benefits or coverage to subscribers only
as determined by the board pursuant to subdivision (b) of Section
12696.05.
SEC. 28. Section 12697 of the Insurance Code is amended to read:
12697. The board may negotiate or arrange for stop-loss insurance
coverage that limits the program's fiscal responsibility for the
total costs of health services provided to program subscribers, or
arrange for participating health plans to share or assume the
financial risk for a portion of the total cost of health care
services to program subscribers, or both.
SEC. 29. Section 12698.05 of the Insurance Code is amended to
read:
12698.05. A person shall not be eligible to participate in the
program if the person is eligible for Medi-Cal without a share of
cost or eligible for Medicare at the time of application.
SEC. 30. Section 12698.10 of the Insurance Code is repealed.
SEC. 31. Section 12698.30 of the Insurance Code is amended to
read:
12698.30. (a) At a minimum, coverage shall be provided to
subscribers during one pregnancy, and for 60 days thereafter, and to
children less than two years of age who were born of a pregnancy
covered under this program to a woman enrolled in the program before
July 1, 2004.
(b) Coverage provided pursuant to this part shall include, at a
minimum, those services required to be provided by health care
service plans approved by the Secretary of Health and Human Services
as a federally qualified health care service plan pursuant to Section
417.101 of Title 42 of the Code of Federal Regulations.
(c) Coverage shall include health education services related to
tobacco use.
(d) Medically necessary prescription drugs shall be a required
benefit in the coverage provided under this part.
SEC. 32. The heading of Part 6.4 (commencing with Section
12699.50) of Division 2 of the Insurance Code is amended to read:
PART 6.4. COUNTY HEALTH INITIATIVE MATCHING FUND
SEC. 33. Section 12699.50 of the Insurance Code is amended to
read:
12699.50. This part shall be known and may be cited as the County
Health Initiative Matching Fund.
SEC. 34. Section 12699.51 of the Insurance Code is amended to
read:
12699.51. For the purposes of this part, the following
definitions shall apply:
(a) "Administrative costs" means those expenses that are described
in Section 1397ee(a)(1)(D) of Title 42 of the United States Code.
(b) "Applicant" means a county, county agency, a local initiative,
or a county organized health system.
(c) "Board" means the Managed Risk Medical Insurance Board.
(d) "Child" means a person under 19 years of age.
(e) "Comprehensive health insurance coverage" means the coverage
described in Section 12693.60.
(f) "County organized health system" means a health system
implemented pursuant to Article 2.8 (commencing with Section 14087.5)
of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code and Article 1 (commencing with Section 101675) of Chapter 3 of
Part 4 of Division 101 of the Health and Safety Code.
(g) "Fund" means the County Health Initiative Matching Fund.
(h) "Local initiative" has the same meaning as set forth in
Section 12693.08.
SEC. 35. Section 12699.52 of the Insurance Code is amended to
read:
12699.52. (a) The County Health Initiative Matching Fund is
hereby created within the State Treasury. The fund shall accept
intergovernmental transfers as the nonfederal matching fund
requirement for federal financial participation through the State
Children's Health Insurance Program (Subchapter 21 (commencing with
Section 1397aa) of Chapter 7 of Title 42 of the United States Code).
(b) Amounts deposited in the fund shall be used only for the
purposes specified by this part.
(c) The board shall administer this fund and the provisions of
this part in collaboration with the State Department of Health
Services for the express purpose of allowing local funds to be used
to facilitate increasing the state's ability to utilize federal funds
available to California. These federal funds shall be used prior to
the expiration of their authority for programs designed to improve
and expand access for uninsured persons.
(d) The board shall authorize the expenditure of money in the fund
to cover program expenses, including cost to the state to administer
the program.
SEC. 36. Section 12699.53 of the Insurance Code is amended to
read:
12699.53. (a) An applicant that will provide an intergovernmental
transfer may submit a proposal to the board for funding for the
purpose of providing comprehensive health insurance coverage to any
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 whose family income is at or
below 300 percent of the federal poverty level in specific geographic
areas, as published quarterly in the Federal Register by the
Department of Health and Human Services, and who does not qualify for
either the Healthy Families Program (Part 6.2 (commencing with
Section 12693) or Medi-Cal with no share of cost pursuant to the
Medi-Cal Act (Chapter 7 (commencing with Section 14000) of Part 3 of
Division 9 of the Welfare and Institutions Code).
(b) The proposal shall guarantee at least one year of
intergovernmental transfer funding by the applicant at a level that
ensures compliance with the requirements of an approved federal
waiver and shall, on an annual basis, either commit to fully funding
the necessary intergovernmental amount to meet the conditions of the
waiver or withdraw from the program. The board may identify specific
geographical areas that, in comparison to the national level, have a
higher cost of living or housing or a greater need for additional
health services, using data obtained from the most recent federal
census, the federal Consumer Expenditure Survey, or from other
sources. The proposal may include an administrative mechanism for
outreach and eligibility.
(c) The applicant may include in its proposal reimbursement of
medical, dental, vision, or mental health services delivered to
children who are eligible under the State Children's Health Insurance
Program (Subchapter 21 (commencing with Section 1397aa) of Chapter 7
of Title 42 of the United States Code), if these services are part
of an overall program with the measurable goal of enrolling served
children in the Healthy Families Program.
(d) If a child is determined to be eligible for benefits for the
treatment of an eligible medical condition under the California
Children's Services Program pursuant to Article 5 (commencing with
Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health
and Safety Code, the health, dental, or vision plan providing
services to the child pursuant to this part shall not be responsible
for the provision of, or payment for, those authorized services for
that child. The proposal from an applicant shall contain provisions
to ensure that a child whom the health, dental, or vision plan
reasonably believes would be eligible for services under the
California Children's Services Program is referred to that program.
The California Children's Services Program shall provide case
management and authorization of services if the child is found to be
eligible for the California Children's Services Program. Diagnosis
and treatment services that are authorized by the California Children'
s Services Program shall be performed by paneled providers for that
program and approved special care centers of that program and
approved by the California Children's Services Program. All other
services provided under the proposal from the applicant shall be made
available pursuant to this part to a child who is eligible for
services under the California Children's Services Program.
SEC. 37. Section 12699.54 of the Insurance Code is amended to
read:
12699.54. (a) The board, in consultation with the State
Department of Health Services, the Healthy Families Advisory
Committee, and other appropriate parties, shall establish the
criteria for evaluating an applicant's proposal, which shall include,
but not be limited to, the following:
(1) The extent to which the program described in the proposal
provides comprehensive coverage including health, dental, and vision
benefits.
(2) Whether the proposal includes a promotional component to
notify the public of its provision of health insurance to eligible
children.
(3) The simplicity of the proposal's procedures for applying to
participate and for determining eligibility for participation in its
program.
(4) The extent to which the proposal provides for coordination and
conformity with benefits provided through Medi-Cal and the Healthy
Families Program.
(5) The extent to which the proposal provides for coordination and
conformity with existing Healthy Families Program administrative
entities in order to prevent administrative duplication and
fragmentation.
(6) The ability of the health care providers designated in the
proposal to serve the eligible population and the extent to which the
proposal includes traditional and safety net providers, as defined
in regulations adopted pursuant to the Healthy Families Program.
(7) The extent to which the proposal intends to work with the
school districts and county offices of education.
(8) The total amount of funds available to the applicant to
implement the program described in its proposal, and the percentage
of this amount proposed for administrative costs as well as the cost
to the state to administer the proposal.
(9) The extent to which the proposal seeks to minimize the
substitution of private employer health insurance coverage for health
benefits provided through a governmental source.
(10) The extent to which local resources may be available after
the depletion of federal funds to continue any current program
expansions for persons covered under local health care financing
programs or for expanded benefits.
(b) The board may, in its discretion, approve or disapprove
projects for funding pursuant to this part on an annual basis.
(c) To the extent that an applicant's proposal pursuant to this
part provides for health plan or administrative services under a
contract entered into by the board or at rates negotiated for the
applicant by the board, a contract entered into by the board or by an
applicant shall be exempt from any provision of law relating to
competitive bidding, and shall be exempt from the review or approval
of any division of the Department of General Services to the same
extent as contracts entered into pursuant to Part 6.2 (commencing
with Section 12693). The board and the applicant shall not be
required to specify the amounts encumbered for each contract, but may
allocate funds to each contract based on the projected or actual
subscriber enrollments to a total amount not to exceed the amount
appropriated for the project including family contributions.
SEC. 38. Section 12699.56 of the Insurance Code is amended to
read:
12699.56. (a) Upon its approval of a proposal, the board, in
collaboration with the State Department of Health Services, may
provide the applicant reimbursement in an amount equal to the amount
that the applicant will contribute to implement the program described
in its proposal, plus the appropriate and allowable amount of
federal funds under the State Children's Health Insurance Program
(Subchapter 21 (commencing with Section 1397aa) of Chapter 7 of Title
42 of the United States Code). Not more than 10 percent of the
County Health Initiative Matching Fund and matching federal funds
shall be expended in any one fiscal year for administrative costs,
including the costs to the state to administer the proposal, unless
the board permits the expenditure consistent with the availability of
federal matching funds not needed for the purposes described in
paragraph (3) of subdivision (a) of Section 12699.62. The board, in
collaboration with the State Department of Health Services, may audit
the expenses incurred by the applicant in implementing its program
to ensure that the expenditures comply with the provisions of this
part. No reimbursement may be made to an applicant that fails to
meet its financial participation obligation under this part. The
state's reasonable startup costs and ongoing costs for administering
the program shall be reimbursed by those entities applying for
funding.
(b) Each applicant that is provided funds under this part shall
submit to the board a plan to limit initial and continuing enrollment
in its program in the event the amount of moneys for its program is
insufficient to maintain health insurance coverage for those
participating in the program.
SEC. 39. Section 12699.58 of the Insurance Code is amended to
read:
12699.58. (a) The board, in collaboration with the State
Department of Health Services, shall administer the provisions of
this part and may do all of the following:
(1) Administer the expenditure of moneys from the fund.
(2) Issue rules and regulations as necessary.
(3) Enter into contracts.
(4) Sue and be sued.
(5) Employ necessary staff.
(6) Exercise all powers reasonably necessary to carry out the
powers and responsibilities expressly granted or imposed by this
part.
(b) The adoption and readoption of regulations pursuant to this
section shall be deemed to be an emergency and necessary for the
immediate preservation of public peace, health, and safety, or
general welfare and shall be exempt from review by the Office of
Administrative Law. Any emergency 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 shall remain in effect for not more than 180
days. The regulation shall become effective immediately upon filing
with the Secretary of State.
SEC. 40. Section 12699.60 of the Insurance Code is amended to
read:
12699.60. Nothing in this part creates a right or an entitlement
to the provision of health insurance coverage or health care
benefits. No costs shall accrue to the state for the provision of
these services. The state shall not be liable beyond the assets of
the fund for any obligation incurred or liabilities sustained by
applicants in the operation of the fund or of the projects authorized
by this part.
SEC. 41. Section 12699.61 of the Insurance Code is amended to
read:
12699.61. To the extent necessary to obtain federal financial
participation for projects approved pursuant to this part, the
Governor, in collaboration with the Managed Risk Medical Insurance
Board and the State Department of Health Services, shall apply for
one or more waivers or shall file state plan amendments pursuant to
the federal State Children's Health Insurance Program (Subchapter 21
(commencing with Section 1397aa) of Chapter 7 of Title 42 of the
United States Code) in coordination with the Managed Risk Medical
Insurance Board and the State Department of Health Services to allow
a county agency, local initiative, or county organized health system
to apply for matching funds through the federal State Children's
Health Insurance Program (Subchapter 21 (commencing with Section
1397aa) of Chapter 7 of Title 42 of the United States Code) using
local funds for the state matching funds.
SEC. 42. Section 12699.62 of the Insurance Code is amended to
read:
12699.62. (a) The provisions of this part shall be implemented
only if all of the following conditions are met:
(1) Federal financial participation is available for this purpose.
(2) Federal participation is approved.
(3) The Managed Risk Medical Insurance Board determines that
federal State Children's Health Insurance Program (Subchapter 21
(commencing with Section 1397aa) of Chapter 7 of Title 42 of the
United States Code) funds remain available after providing funds for
all current enrollees and eligible children and parents that are
likely to enroll in the Healthy Families Program and, to the extent
funded through the federal State Children's Health Insurance Program,
the Access for Infants and Mothers Program and Medi-Cal program, as
determined by a Department of Finance estimate.
(4) Funds are appropriated specifically for this purpose.
(b) The State Department of Health Services and the Managed Risk
Medical Insurance Board may accept funding necessary for the
preparation of the federal waiver applications or state plan
amendments described in Section 12699.61 from a not-for-profit group
or foundation.
SEC. 43. Section 1026.2 of the Penal Code is amended to read:
1026.2. (a) An application for the release of a person who has
been committed to a state hospital or other treatment facility, as
provided in Section 1026, upon the ground that sanity has been
restored, may be made to the superior court of the county from which
the commitment was made, either by the person, or by the medical
director of the state hospital or other treatment facility to which
the person is committed or by the community program director where
the person is on outpatient status under Title 15 (commencing with
Section 1600). The court shall give notice of the hearing date to
the prosecuting attorney, the community program director or a
designee, and the medical director or person in charge of the
facility providing treatment to the committed person at least 15
judicial days in advance of the hearing date.
(b) Pending the hearing, the medical director or person in charge
of the facility in which the person is confined shall prepare a
summary of the person's programs of treatment and shall forward the
summary to the community program director or a designee and to the
court. The community program director or a designee shall review the
summary and shall designate a facility within a reasonable distance
from the court in which the person may be detained pending the
hearing on the application for release. The facility so designated
shall continue the program of treatment, shall provide adequate
security, and shall, to the greatest extent possible, minimize
interference with the person's program of treatment.
(c) A designated facility need not be approved for 72-hour
treatment and evaluation pursuant to the Lanterman-Petris-Short Act
(Part 1 (commencing with Section 5000) of Division 5 of the Welfare
and Institutions Code). However, a county jail may not be designated
unless the services specified in subdivision (b) are provided and
accommodations are provided which ensure both the safety of the
person and the safety of the general population of the jail. If
there is evidence that the treatment program is not being complied
with or accommodations have not been provided which ensure both the
safety of the committed person and the safety of the general
population of the jail, the court shall order the person transferred
to an appropriate facility or make any other appropriate order,
including continuance of the proceedings.
(d) No hearing upon the application shall be allowed until the
person committed has been confined or placed on outpatient status for
a period of not less than 180 days from the date of the order of
commitment.
(e) The court shall hold a hearing to determine whether the person
applying for restoration of sanity would be a danger to the health
and safety of others, due to mental defect, disease, or disorder, if
under supervision and treatment in the community. If the court at
the hearing determines the applicant will not be a danger to the
health and safety of others, due to mental defect, disease, or
disorder, while under supervision and treatment in the community, the
court shall order the applicant placed with an appropriate forensic
conditional release program for one year. All or a substantial
portion of the program shall include outpatient supervision and
treatment. The court shall retain jurisdiction. The court at the
end of the one year, shall have a trial to determine if sanity has
been restored, which means the applicant is no longer a danger to the
health and safety of others, due to mental defect, disease, or
disorder. The court shall not determine whether the applicant has
been restored to sanity until the applicant has completed the one
year in the appropriate forensic conditional release program, unless
the community program director sooner makes a recommendation for
restoration of sanity and unconditional release as described in
subdivision (h). The court shall notify the persons required to be
notified in subdivision (a) of the hearing date.
(f) If the applicant is on parole or outpatient status and has
been on it for one year or longer, then it is deemed that the
applicant has completed the required one year in an appropriate
forensic conditional release program and the court shall, if all
other applicable provisions of law have been met, hold the trial on
restoration of sanity as provided for in this section.
(g) Before placing an applicant in an appropriate forensic
conditional release program, the community program director shall
submit to the court a written recommendation as to what forensic
conditional release program is the most appropriate for supervising
and treating the applicant. If the court does not accept the
community program director's recommendation, the court shall specify
the reason or reasons for its order on the court record. Sections
1605 to 1610, inclusive, shall be applicable to the person placed in
the forensic conditional release program unless otherwise ordered by
the court.
(h) If the court determines that the person should be transferred
to an appropriate forensic conditional release program, the community
program director or a designee shall make the necessary placement
arrangements, and, within 21 days after receiving notice of the court
finding, the person shall be placed in the community in accordance
with the treatment and supervision plan, unless good cause for not
doing so is made known to the court.
During the one year of supervision and treatment, if the community
program director is of the opinion that the person is no longer a
danger to the health and safety of others due to a mental defect,
disease, or disorder, the community program director shall submit a
report of his or her opinion and recommendations to the committing
court, the prosecuting attorney, and the attorney for the person.
The court shall then set and hold a trial to determine whether
restoration of sanity and unconditional release should be granted.
The trial shall be conducted in the same manner as is required at the
end of one full year of supervision and treatment.
(i) If at the trial for restoration of sanity the court rules
adversely to the applicant, the court may place the applicant on
outpatient status, pursuant to Title 15 (commencing with Section
1600) of Part 2, unless the applicant does not meet all of the
requirements of Section 1603.
(j) If the court denies the application to place the person in an
appropriate forensic conditional release program or if restoration of
sanity is denied, no new application may be filed by the person
until one year has elapsed from the date of the denial.
(k) In any hearing authorized by this section, the applicant shall
have the burden of proof by a preponderance of the evidence.
(l) If the application for
the release is not made by the medical director of the state
hospital or other treatment facility to which the person is committed
or by the community program director where the person is on
outpatient status under Title 15 (commencing with Section 1600), no
action on the application shall be taken by the court without first
obtaining the written recommendation of the medical director of the
state hospital or other treatment facility or of the community
program director where the person is on outpatient status under Title
15 (commencing with Section 1600).
(m) This subdivision shall apply only to persons who, at the time
of the petition or recommendation for restoration of sanity, are
subject to a term of imprisonment with prison time remaining to serve
or are subject to the imposition of a previously stayed sentence to
a term of imprisonment. Any person to whom this subdivision applies
who petitions or is recommended for restoration of sanity may not be
placed in a forensic conditional release program for one year, and a
finding of restoration of sanity may be made without the person being
in a forensic conditional release program for one year. If a
finding of restoration of sanity is made, the person shall be
transferred to the custody of the California Department of
Corrections to serve the term of imprisonment remaining or shall be
transferred to the appropriate court for imposition of the sentence
that is pending, whichever is applicable.
SEC. 44. 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, the 2002-03 fiscal year, and the
2003-04 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, by fiscal year, will be as follows:
(1) During the 2001-02 fiscal year, approximately 100.
(2) During the 2002-03 fiscal year, approximately 140.
(3) During the 2003-04 fiscal year, approximately 175.
(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. 45. Section 4433 of the Welfare and Institutions Code is
amended to read:
4433. (a) The Legislature finds and declares all of the
following:
(1) The State of California accepts its responsibility to ensure
and uphold the rights of persons with developmental disabilities and
an obligation to ensure that laws, regulations, and policies on the
rights of persons with developmental disabilities are observed and
protected.
(2) Persons with developmental disabilities are vulnerable to
abuse, neglect, and deprivations of their rights.
(3) Clients' rights advocacy services provided by the regional
centers, the advocacy services currently provided by the department
at the state hospitals, and the services provided by the department's
Office of Human Rights may have conflicts of interest, or the
appearance of a conflict of interest.
(4) The services provided to individuals with developmental
disabilities and their families are of such a special and unique
nature that they cannot satisfactorily be provided by state agencies
or regional centers and must be contracted out pursuant to paragraph
(3) of subdivision (b) of Section 19130 of the Government Code.
(b) (1) To avoid the potential for a conflict of interest or the
appearance of a conflict of interest, beginning January 1, 1998, the
department shall contract for clients' rights advocacy services. The
department shall solicit a single statewide contract with a
nonprofit agency that results in at least three responsive bids that
meet all of the criteria specified in paragraph (2) to perform the
services specified in subdivision (d). If three responsive bids are
not received, the department may rebid the contract on a regional
basis, not to exceed three regional contracts and one contract for
developmental centers and headquarters.
(2) Any contractor selected shall meet the following requirements:
(A) The contractor can demonstrate the capability to provide
statewide advocacy services to individuals with developmental
disabilities living in developmental centers and in the community.
(B) The contractor does not directly or indirectly provide
services to individuals with developmental disabilities, except
advocacy services.
(C) The contractor has knowledge of the service system,
entitlements, and service rights of persons receiving services from
regional centers and in state hospitals.
(D) The contractor can demonstrate the capability of coordinating
services with the protection and advocacy agency specified in
Division 4.7 (commencing with Section 4900) and the area boards.
(E) The contractor has not provided any services, except advocacy
services, to, or been employed by, any regional center or the
Association of Regional Center Agencies during the two-year period
prior to the effective date of the contract.
(c) For the purposes of this section, the Legislature further
finds and declares that because of a potential conflict of interest
or the appearance of a conflict of interest, the goals and purposes
of the regional center clients' rights advocacy services, the state
hospitals, and the services of the Office of Human Rights, cannot be
accomplished through the utilization of persons selected pursuant to
the regular civil service system, nor can the services be provided
through the department's contracts with regional centers.
Accordingly, contracts into which the department enters pursuant to
this section are permitted and authorized by paragraphs (3) and (5)
of subdivision (b) of Section 19130 of the Government Code.
(d) The contractor shall do all of the following:
(1) Provide clients' rights advocacy services to persons with
developmental disabilities who are consumers of regional centers and
to individuals who reside in the state developmental centers and
hospitals, including ensuring the rights of persons with
developmental disabilities, and assisting persons with developmental
disabilities in pursuing administrative and legal remedies.
(2) Investigate and take action as appropriate and necessary to
resolve complaints from, or concerning persons with, developmental
disabilities residing in licensed health and community care
facilities regarding abuse, and unreasonable denial, or punitive
withholding, of rights guaranteed under this division.
(3) Provide consultation, technical assistance, supervision and
training, and support services for clients' rights advocates that
were previously the responsibility of the Office of Human Rights.
(4) Coordinate the provision of clients' rights advocacy services
in consultation with the department, stakeholder organizations, and
persons with developmental disabilities and their families
representing California's multicultural diversity.
(5) Provide at least two self-advocacy trainings for consumers and
family members.
(e) In order to ensure that individuals with developmental
disabilities have access to high quality advocacy services, the
contractor shall establish a grievance procedure and shall advise
persons receiving services under the contract of the availability of
other advocacy services, including the services provided by the
protection and advocacy agency specified in Division 4.7 (commencing
with Section 4900) and the area boards.
(f) The department shall contract on a multiyear basis for a
contract term of up to five years, subject to the annual
appropriation of funds by the Legislature.
(g) This section shall not prohibit the department and the
regional centers from advocating for the rights, including the right
to generic services, of persons with developmental disabilities.
SEC. 46. Section 4512 of the Welfare and Institutions Code is
amended to read:
4512. As used in this division:
(a) "Developmental disability" means a disability that originates
before an individual attains age 18 years, continues, or can be
expected to continue, indefinitely, and constitutes a substantial
disability for that individual. As defined by the Director of
Developmental Services, in consultation with the Superintendent of
Public Instruction, this term shall include mental retardation,
cerebral palsy, epilepsy, and autism. This term shall also include
disabling conditions found to be closely related to mental
retardation or to require treatment similar to that required for
individuals with mental retardation, but shall not include other
handicapping conditions that are solely physical in nature.
(b) "Services and supports for persons with developmental
disabilities" means specialized services and supports or special
adaptations of generic services and supports directed toward the
alleviation of a developmental disability or toward the social,
personal, physical, or economic habilitation or rehabilitation of an
individual with a developmental disability, or toward the achievement
and maintenance of independent, productive, normal lives. The
determination of which services and supports are necessary for each
consumer shall be made through the individual program plan process.
The determination shall be made on the basis of the needs and
preferences of the consumer or, when appropriate, the consumer's
family, and shall include consideration of a range of service options
proposed by individual program plan participants, the effectiveness
of each option in meeting the goals stated in the individual program
plan, and the cost-effectiveness of each option. Services and
supports listed in the individual program plan may include, but are
not limited to, diagnosis, evaluation, treatment, personal care, day
care, domiciliary care, special living arrangements, physical,
occupational, and speech therapy, training, education, supported and
sheltered employment, mental health services, recreation, counseling
of the individual with a developmental disability and of his or her
family, protective and other social and sociolegal services,
information and referral services, follow-along services, adaptive
equipment and supplies, advocacy assistance, including self-advocacy
training, facilitation and peer advocates, assessment, assistance in
locating a home, child care, behavior training and behavior
modification programs, camping, community integration services,
community support, daily living skills training, emergency and crisis
intervention, facilitating circles of support, habilitation,
homemaker services, infant stimulation programs, paid roommates, paid
neighbors, respite, short-term out-of-home care, social skills
training, specialized medical and dental care, supported living
arrangements, technical and financial assistance, travel training,
training for parents of children with developmental disabilities,
training for parents with developmental disabilities, vouchers, and
transportation services necessary to ensure delivery of services to
persons with developmental disabilities. Nothing in this subdivision
is intended to expand or authorize a new or different service or
support for any consumer unless that service or support is contained
in his or her individual program plan.
(c) Notwithstanding subdivisions (a) and (b), for any organization
or agency receiving federal financial participation under the
federal Developmental Disabilities Assistance and Bill of Rights Act,
as amended "developmental disability" and "services for persons with
developmental disabilities" means the terms as defined in the
federal act to the extent required by federal law.
(d) "Consumer" means a person who has a disability that meets the
definition of developmental disability set forth in subdivision (a).
(e) "Natural supports" means personal associations and
relationships typically developed in the community that enhance the
quality and security of life for people, including, but not limited
to, family relationships, friendships reflecting the diversity of the
neighborhood and the community, associations with fellow students or
employees in regular classrooms and workplaces, and associations
developed through participation in clubs, organizations, and other
civic activities.
(f) "Circle of support" means a committed group of community
members, who may include family members, meeting regularly with an
individual with developmental disabilities in order to share
experiences, promote autonomy and community involvement, and assist
the individual in establishing and maintaining natural supports. A
circle of support generally includes a plurality of members who
neither provide nor receive services or supports for persons with
developmental disabilities and who do not receive payment for
participation in the circle of support.
(g) "Facilitation" means the use of modified or adapted materials,
special instructions, equipment, or personal assistance by an
individual, such as assistance with communications, that will enable
a consumer to understand and participate to the maximum extent
possible in the decisions and choices that effect his or her life.
(h) "Family support services" means services and supports that are
provided to a child with developmental disabilities or his or her
family and that contribute to the ability of the family to reside
together.
(i) "Voucher" means any authorized alternative form of service
delivery in which the consumer or family member is provided with a
payment, coupon, chit, or other form of authorization that enables
the consumer or family member to choose his or her own service
provider.
(j) "Planning team" means the individual with developmental
disabilities, the parents or legally appointed guardian of a minor
consumer or the legally appointed conservator of an adult consumer,
the authorized representative, including those appointed pursuant to
subdivision (d) of Section 4548 and subdivision (e) of Section 4705,
one or more regional center representatives, including the designated
regional center service coordinator pursuant to subdivision (b) of
Section 4640.7, any individual, including a service provider, invited
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.
(k) "Stakeholder organizations" means statewide organizations
representing the interests of consumers, family members, service
providers, and statewide advocacy organizations.
(l) "Substantial disability" means the existence of significant
functional limitations in three or more of the following areas of
major life activity, as determined by a regional center, and as
appropriate to the age of the person:
(1) Self-care.
(2) Receptive and expressive language.
(3) Learning.
(4) Mobility.
(5) Self-direction.
(6) Capacity for independent living.
(7) Economic self-sufficiency.
Any reassessment of substantial disability for purposes of
continuing eligibility shall utilize the same criteria under which
the individual was originally made eligible.
SEC. 47. Section 4620.2 is added to the Welfare and Institutions
Code, to read:
4620.2. (a) The State Department of Developmental Services, after
consultation with stakeholder groups, shall develop a system of
enrollment fees, copayments, or both, to be assessed against the
parents of each child between the ages of three and 17 years who
lives in the parent's home and receives services purchased through a
regional center. This system shall be submitted to the Legislature
on or before April 1, 2004, immediately prior to the fiscal year in
which the system is to be implemented, and as a part of the Governor'
s proposed 2004-05 budget or subsequent legislation.
(b) The department, after consultation with stakeholder groups,
shall submit a detailed plan for implementing a parental copayment
system for children receiving services purchased through a regional
center. This plan shall be submitted to the Legislature by April 1,
2004.
(c) The plan submitted on or before April 1, 2004, pursuant to
subdivision (b), and any resources requested in the 2004-05 Governor'
s Budget and related authority may be subsequently modified during
the legislative review process.
(d) The parental copayment system shall only be applicable to
families that have adjusted gross family incomes of over 200 percent
of the federal poverty level and that have a child who meets all of
the following criteria:
(1) The child is receiving services purchased through a regional
center.
(2) The child is living at home.
(3) The child is not otherwise eligible to receive services
provided under the Medi-Cal program.
(4) The child is at least three years of age and not more than 17
years of age.
(e) The department's plan shall address, at a minimum all of the
following components for the development of a parental copayment
system:
(1) Description of the families and children affected, including
those families with more than one child as described under
subdivision (d).
(2) Privacy issues and potential safeguards regarding the families'
income, the children's regional center clinical records, and related
matters.
(3) Schedule of parental copayments and any other related
assessments, and criteria or service thresholds for which these
copayments and assessments are based.
(4) The options for a sliding scale for the schedule of parental
copayments based on family income and family size.
(5) Proposed limits on parental cost sharing.
(6) An exemption process for families who are experiencing
financial hardships and may need deferral or waiver of any copayments
or assessments.
(7) An appeal process for families who may dispute the level of
copayment or assessments for which they are billed.
(8) The specific methods and processes to be used by the
department, regional centers, or other responsible party, for the
collection of all parental copayments and assessments.
(9) Any potentials for the disruption of services to applicable
regional center consumers due to the implementation of a parental
copayment system.
(10) The estimated amount of revenues to be collected and any
applicable assumptions made for making this determination.
(11) Any estimate related to a slowing of the trend in the growth
for regional center services due to the implementation of a parental
copayment system.
(12) A comparison to how the State Department of Health Services
and other state agencies utilize personal information to manage the
delivery of benefits and assessment of copayments.
(13) A recommendation on whether the parental copayment system
should be centralized at the department or decentralized in the
regional centers and the basis for this recommendation.
(14) The estimated cost for implementing a parental copayment
system, including any costs associated with consultant contracts,
state personnel, revenue collection, computer system processing,
regional center operations, or any other cost factor that would need
to be included in order to capture all estimated costs for
implementation.
(15) The timeframe for which the parental copayment system is to
be implemented.
(f) (1) In order for the department to develop a detailed plan for
the implementation of a parental copayment system, the department
shall collect information from selected families. In order to be
cost efficient and prudent regarding the collection of information,
the department may conduct a survey of only those families known to
have children not eligible for the Medi-Cal program. The survey
instrument may only be used for the sole purpose of obtaining
information that is deemed necessary for the development of a
parental copayment system, including the following:
(A) A family's annual adjusted gross family income.
(B) The number of family members dependent on that income.
(C) The number of children who meet the criteria specified in
subdivision (d).
(2) Results of the survey in the aggregate shall be provided to
the Legislature as part of the department's plan as required by
subdivision (a).
SEC. 48. Section 4631.5 of the Welfare and Institutions Code is
amended to read:
4631.5. (a) The Legislature finds and declares both of the
following:
(1) The state is facing a fiscal crisis that will require an
unallocated reduction in the 2003-04 fiscal year for regional centers'
purchase of service budgets of ten million dollars ($10,000,000).
(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, 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. 49. 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.
(3) Commencing January 1, 2004, to June 30, 2007, inclusive, the
following coordinator-to-consumer ratios shall apply:
(A) All consumers three years of age and younger and for consumers
enrolled on the Home and Community-based Services Waiver for persons
with developmental disabilities, an average service
coordinator-to-consumer ratio of 1 to 62.
(B) All consumers who have moved from a developmental center to
the community since April 14, 1993, and have lived continuously in
the community for at least 12 months, an average service
coordinator-to-consumer ratio of 1 to 62.
(C) All consumers who have not moved from the developmental
centers to the community since April 14, 1993, and who are not
described in subparagraph (A), an average service
coordinator-to-consumer ratio of 1 to 66.
(4) For purposes of paragraph (3), service coordinators may have a
mixed caseload of consumers three years of age and younger,
consumers enrolled on the Home and Community-based Services Waiver
program for persons with developmental disabilities, and other
consumers if the overall average caseload is weighted proportionately
to ensure that overall regional center average service
coordinator-to-consumer ratios as specified in paragraph (3) are met.
For purposes of paragraph (3), in no case shall a service
coordinator have an assigned caseload in excess of 84 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, annually for each fiscal
year. The data shall be submitted in the format, including the
content, 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
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.
(D) Consumers enrolled in the Home and Community-based Services
Waiver program.
(3) Not include positions that are vacant for more than 60 days or
new positions established within 60 days of the reporting month that
are still vacant.
(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. 50. Section 4643 of the Welfare and Institutions Code is
amended to read:
4643. (a) If assessment is needed, prior to July 1, 2004, 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, 2004, 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. 51. Section 4648.4 is added to the Welfare and Institutions
Code, to read:
4648.4. (a) The Legislature finds and declares that the state
faces a fiscal crisis requiring that unprecedented measures be taken
to reduce General Fund expenditures.
(b) Notwithstanding any other provision of law or regulation,
during the 2003-04 fiscal year, no regional center may pay any
provider of the following services or supports a rate that is greater
than the rate that is in effect on or after June 30, 2003, unless
the increase is required by a contract between the regional center
and the vendor that is in effect on June 30, 2003, or the regional
center demonstrates that the approval is necessary to protect the
consumer's health or safety and the department has granted prior
written authorization:
(1) Supported living services.
(2) Transportation, including travel reimbursement.
(3) Socialization training programs.
(4) Behavior intervention training.
(5) Community integration training programs.
(6) Community activities support services.
(7) Mobile day programs.
(8) Creative art programs.
(9) Supplemental day services program supports.
(10) Adaptive skills trainers.
(11) Independent living specialists.
SEC. 52. Section 4681.5 is added to the Welfare and Institutions
Code, to read:
4681.5. (a) The Legislature finds and declares that the state
faces a fiscal crisis requiring that unprecedented measures be taken
to reduce General Fund expenditures.
(b) Notwithstanding any other provision of law or regulation,
during the 2003-04 fiscal year, no regional center may approve any
service level for a residential service provider, as defined in
Section 56005 of Title 17 of the California Code of Regulations, if
the approval would result in an increase in the rate to be paid to
the provider that is greater than the rate that is in effect on or
after June 30, 2003, unless the regional center demonstrates to the
department that the approval is necessary to protect the consumer's
health or safety and the department has granted prior written
authorization.
SEC. 53. Section 4685.5 of the Welfare and Institutions Code is
amended to read:
4685.5. (a) Notwithstanding any other provision of law,
commencing January 1, 1999, the department shall conduct a pilot
project under which funds shall be allocated for local
self-determination pilot programs that will enhance the ability of a
consumer and his or her family to control the decisions and resources
required to meet all or some of the objectives in his or her
individual program plan.
(b) Local self-determination pilot programs funded pursuant to
this section may include, but not be limited to, all of the
following:
(1) Programs that provide for consumer and family control over
which services best meet their needs and the objectives in the
individual program plan.
(2) Programs that provide allowances or subsidies to consumers and
their families.
(3) Programs providing for the use of debit cards.
(4) Programs that provide for the utilization of parent vendors,
direct pay options, individual budgets for the procurement of
services and supports, alternative case management, and vouchers.
(5) Wraparound programs.
(c) The department shall allow the continuation of the existing
pilot project in five regional center catchment areas and shall
expand the pilot project to other regional center catchment areas
only when consistent with federal approval of a self-determination
waiver. The department may approve additional regional center
proposals to offer self-determination or self-directed services to
consumers that meet criteria established by the department and that
demonstrate purchase-of-services savings are achieved in the
aggregate and have no impact on the General Fund.
(d) Funds allocated to implement this section may be used for
administrative and evaluation costs. Purchase-of-services costs
shall be based on the estimated annual service costs associated with
each participating consumer and family. Each proposal shall include
a budget outlining administrative, service, and evaluation
components.
(e) Pilot projects shall be conducted in the following regional
center catchment areas:
(1) Tri-Counties Regional Center.
(2) Eastern Los Angeles Regional Center.
(3) Redwood Coast Regional Center.
(4) Kern Regional Center.
(5) San Diego Regional Center.
(f) Each pilot operating area receiving funding under this section
shall demonstrate joint regional center and area board support for
the local self-determination pilot program, and shall establish a
local advisory committee, appointed jointly by the regional center
and area board, made up of consumers, family members, advocates, and
community leaders and that shall reflect the multicultural diversity
and geographic profile of the catchment area. The local advisory
committee shall review the development and ongoing progress of the
local self-determination pilot program and may make ongoing
recommendations for improvement to the regional center.
SEC. 54. Section 4691.6 is added to the Welfare and Institutions
Code, to read:
4691.6. (a) The Legislature finds and declares that the state
faces a fiscal crisis requiring that unprecedented measures be taken
to reduce General Fund expenditures.
(b) Notwithstanding any other provision of law or regulation,
during the 2003-04 fiscal year, the department may not establish any
permanent payment rate for a community-based day program or in-home
respite service agency provider that has a temporary payment rate in
effect on June 30, 2003, if the permanent payment rate would be
greater than the temporary payment rate in effect on or after June
30, 2003, unless the regional center demonstrates to the department
that the permanent payment rate is necessary to protect the consumers'
health or safety.
(c) Notwithstanding any other provision of law or regulation,
during the 2003-04 fiscal year, neither the department nor any
regional center may approve any program design modification or
revendorization for a community-based day program or in-home respite
service agency provider that would result in an increase in the rate
to be paid to the vendor from the rate that is in effect on or after
June 30, 2003, unless the regional center demonstrates that the
program design modification or revendorization is necessary to
protect the consumers' health or safety and the department has
granted prior written authorization.
(d) Notwithstanding any other provision of law or regulation,
during the 2003-04 fiscal year, the department may not approve an
anticipated rate adjusted for a community-based day program or
in-home respite service agency provider that would result in an
increase in the rate to be paid to the vendor from the rate that is
in effect on or after June 30, 2003, unless the regional center
demonstrates that the anticipated rate adjustment is necessary to
protect the consumers' health or safety.
SEC. 55. Section 4781.5 of the Welfare and Institutions Code is
amended to read:
4781.5. For the 2002-03 and 2003-04 fiscal years 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. 56. Section 5775 of the Welfare and Institutions Code is
amended to read:
5775. (a) Notwithstanding any other provision of state law, the
State Department of Mental Health shall implement managed mental
health care for Medi-Cal beneficiaries through fee-for-service or
capitated rate contracts with mental health plans, including
individual counties, counties acting jointly, any qualified
individual or organization, or a nongovernmental entity. A contract
may be exclusive and may be awarded on a geographic basis.
(b) Two or more counties acting jointly may agree to deliver or
subcontract for the delivery of mental health services. The
agreement may encompass all or any portion of the mental health
services provided pursuant to this part. This agreement shall not
relieve the individual counties of financial responsibility for
providing these services. Any agreement between counties shall
delineate each county's responsibilities and fiscal liability.
(c) The department shall offer to contract with each county for
the delivery of mental health services to that county's Medi-Cal
beneficiary population prior to offering to contract with any other
entity, upon terms at least as favorable as any offered to a
noncounty contract provider. If a county elects not to contract with
the department, does not renew its contract, or does not meet the
minimum standards set by the department, the department may elect to
contract with any other governmental or nongovernmental entity for
the delivery of mental health services in that county and may
administer the delivery of mental health services until a contract
for a mental health plan is implemented. The county may not
subsequently contract to provide mental health services under this
part unless the department elects to contract with the county.
(d) If a county does not contract with the department to provide
mental health services, the county shall transfer the responsibility
for community Medi-Cal reimbursable mental health services and the
anticipated county matching funds needed for community Medi-Cal
mental health services in that county to the department. The amount
of the anticipated county matching funds shall be determined by the
department in consultation with the county, and shall be adjusted
annually. The amount transferred shall be based on historical cost,
adjusted for changes in the number of Medi-Cal beneficiaries and
other relevant factors. The anticipated county matching funds shall
be used by the department to contract with another entity for mental
health services, and shall not be expended for any other purpose but
the provision of those services and related administrative costs.
The county shall continue to deliver non-Medi-Cal reimbursable mental
health services in accordance with this division, and subject to
subdivision (i) of Section 5777.
(e) Whenever the department determines that a mental health plan
has failed to comply with this part or any regulations adopted
pursuant to this part that implement this part, the department may
impose sanctions, including, but not limited to, fines, penalties,
the withholding of payments, special requirements, probationary or
corrective actions, or any other actions deemed necessary to prompt
and ensure contract and performance compliance. If fines are imposed
by the department, they may be withheld from the state matching
funds provided to a mental health plan for Medi-Cal mental health
services.
(f) Notwithstanding any other provision of law, emergency
regulations adopted pursuant to Section 14680 to implement the second
phase of mental health managed care as provided in this part shall
remain in effect until July 1, 2004, or until the regulations are
made permanent, whichever occurs first, and shall not be subject to
subdivision (g) of Section 11346.1 of the Government Code until that
time.
(g) The department may adopt emergency regulations necessary to
implement Part 438 (commencing with Section 438.1) of Subpart A of
Subchapter C of Chapter IV of Title 42 of the Code of Federal
Regulations, in accordance with Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code.
The adoption of emergency regulations to implement this part, that
are filed with the Office of Administrative Law within one year of
the date on which the act that amended this subdivision in 2003 took
effect, shall be deemed to be an emergency and necessary for the
immediate preservation of the public peace, health, and safety, or
general welfare, and shall remain in effect for no more than 180
days.
SEC. 56.5. Section 14005.81 of the Welfare and Institutions Code
is amended to read:
14005.81. (a) Effective October 1, 1998, in addition to the two
six-month periods of transitional Medi-Cal benefits provided in
Section 14005.8, the state shall fund and provide one additional
12-month period of transitional Medi-Cal to persons age 19 years and
older who have received 12 months of transitional Medi-Cal under
Section 14005.8 and who continue to meet the requirements applicable
to the additional six-month extension period provided for in Section
14005.8, except that once a beneficiary has been determined eligible
for an additional 12 months of Medi-Cal benefits under this section,
the beneficiary shall not be required to submit the status reports
imposed by federal law. The benefits provided under this section
shall commence on the day following the last day of receipt of
benefits under Section 14005.8.
(b) In the case of an alien who has received 12 months of
transitional Medi-Cal under Section 14005.8, the benefits provided
under this section shall be limited to those benefits that would be
available to that person under Section 14005.8.
(c) It is the intent of the Legislature that the department seek a
mechanism for securing federal financial participation in connection
with pregnancy-related benefits provided under this section.
(d) The benefits described in this section shall become
unavailable on October 1, 2003. Individuals who are receiving
benefits under this section on September 30, 2003, shall be given
notice and
the eligibility of that person shall be redetermined. The department
shall implement this subdivision by means of all-county letters or
similar instructions without the need for adoption of regulations.
(e) This section shall become inoperative on October 1, 2003, and,
as of January 1, 2004, is repealed, unless a later enacted statute
that is enacted before January 1, 2004, deletes or extends the dates
on which it becomes inoperative and is repealed.
SEC. 57. Section 14011.7 of the Welfare and Institutions Code is
amended 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) (1) 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.
(2) The department may, at its option, also use the electronic
application developed pursuant to paragraph (1), as a means to enroll
newborns into the Medi-Cal program as is authorized under Section
1396a(e)(4) of Title 42 of the United States Code.
(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. 58. Section 14019.3 of the Welfare and Institutions Code is
amended to read:
14019.3. (a) A beneficiary or any person on behalf of a
beneficiary who has paid for medically necessary health care
services, otherwise covered by the Medi-Cal program, received by the
beneficiary shall be entitled to a return from a provider or directly
from the department of any part of the payment that meets all of the
following:
(1) Was rendered during the 90-day period prior to application
for, his or her Medi-Cal card, or after application for but prior to
the issuance of, his or her Medi-Cal card, for which the card
authorizes payment under Section 14018 or 14019, or was charged to
the beneficiary as excess copayment during the period after issuance
of his or her Medi-Cal card.
(2) Is not payable by a third party under contractual or other
legal entitlement.
(3) 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 a 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 a provider of the application of a 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, a 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 a beneficiary.
(e) A provider shall return any and all payments made by a
beneficiary, or any person on behalf of a beneficiary, other than a
third party obligated to pay charges by reason of a 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
a pharmacy provider from a nursing facility upon discontinuation of
the drug therapy or death of a beneficiary.
(g) The department shall ensure payment to a beneficiary from a
provider. A provider shall be notified in writing by the department
when a beneficiary has submitted a claim to the department for
reimbursement of services provided during the periods specified in
paragraph (1) of subdivision (a). If a provider is not currently
enrolled in the Medi-Cal program, the department shall assist in that
enrollment. Enrollment in the Medi-Cal program may be made
retroactive to the date the service was rendered.
(h) If a provider fails or refuses to reimburse a beneficiary for
services provided during the periods specified in paragraph (1) of
subdivision (a), within 90 days of receipt by the department of a
written request by a beneficiary or a representative of a
beneficiary, the department may take enforcement action that may
include, but shall not be limited to, any or all of the following:
(1) Withholding of future provider payments.
(2) Suspension of a provider from participation in the Medi-Cal
program.
(3) Recoupment of funds from a provider.
(i) If a provider fails or refuses to reimburse a beneficiary
within 90 days after receipt by the department of a written request
from a beneficiary or a representative of a beneficiary, the
department shall directly reimburse a beneficiary for medically
necessary health care expenses incurred during the periods specified
in paragraph (1) of subdivision (a). The department shall reimburse
a beneficiary only to the extent that federal financial participation
is available and only when the claim meets all of the following
criteria:
(1) The service was a covered benefit under the Medi-Cal program.
(2) The provider was an enrolled Medi-Cal provider at the time the
service was rendered.
(3) The service was ordered by a health care provider, within the
scope of his or her practice.
(4) The beneficiary is eligible for reimbursement, as specified in
subdivision (a).
(5) The reimbursement shall be the amount paid by the beneficiary,
not to exceed the rate established for that service under the
Medi-Cal program.
(j) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of the Government Code, this section may be
implemented with a provider bulletin or similar notification, without
any further regulatory action.
SEC. 59. Section 14044 is added to the Welfare and Institutions
Code, to read:
14044. (a) The department may limit, for 18 months or less, the
American Medical Association's Current Procedural Terminology Fourth
Edition (CPT-4) codes, the National Drug Codes (NDC), the Healthcare
Common Procedure Coding System (HCPCS) codes, or codes established
under Title II of the Health Insurance Portability & Accountability
Act of 1996 (42 U.S.C. Sec. 1320d et seq.) for which any provider may
bill, or for which reimbursement to any person or entity may be made
by, the Medi-Cal program or other health care programs administered
by the department if either of the following conditions exist:
(1) The department determines, by audit or other investigation,
that excessive services or billings, or abuse, has occurred.
(2) The Medical Board of California or other licensing authority
or a court of competent jurisdiction limits a licensee's practice of
medicine or the rendering of health care, and the limitation
precludes the licensee from performing services that could otherwise
be reimbursed by the Medi-Cal program or other health care programs
administered by the department.
(b) The department may impose a limitation pursuant to subdivision
(a) for one or more codes or any combination of codes after giving
the provider notice of the proposed limitation and, if applicable,
the opportunity to appeal pursuant to subdivision (c).
(c) (1) A provider who receives notice of a proposed limitation
based on paragraph (1) of subdivision (a) shall have 45 days from the
date of notice to appeal the limitation by providing to the
department reliable evidence that excessive services or billings, or
abuse, did not occur.
(2) The department shall review the evidence and issue a decision
within 45 days of receipt of the evidence.
(d) If a limitation is imposed pursuant to paragraph (1) of
subdivision (a), it shall take effect on the 46th day after notice of
the proposed limitation was given or, if the limitation is timely
appealed, 15 days after the department gives the provider notice of
its decision to impose the limitation. If a limitation is imposed
pursuant to paragraph (2) of subdivision (a), it shall take effect 15
days after notice of the proposed limitation was given.
(e) If the department's limitation could interfere with the
provider's or other prescriber's ability to provide health care
services to a beneficiary, the burden to transfer a patient's care to
another qualified person shall remain the responsibility of the
licensee.
(f) For purposes of this section, the following definitions apply:
(1) "Abuse" has the same meaning as defined in Section 14043.1.
(2) "Administered by the department" means administered by the
department or its agents or contractors.
(3) "Excessive services or billings" means an amount that is above
normal within the provider or health care community based on the
data available to the department from any source, including the
department.
(4) "Licensee" means a person licensed under Division 2
(commencing with Section 500) of the Business and Professions Code.
(5) "Other prescriber" means that person who is not the primary or
attending physician for a patient who is a beneficiary of the
Medi-Cal program or other health care program administered by the
department, and that person causes the department, or its agents or
contractors, to provide reimbursement for a drug, device, medical
service, or supply to the beneficiary.
(6) "Provider" has the same meaning as defined in Section 14043.1.
SEC. 60. Section 14087.101 is added to the Welfare and
Institutions Code, to read:
14087.101. For administrative costs incurred after January 1,
2004, the director may recover any administrative costs incurred by a
health plan authorized by this article deemed excessive pursuant to
Section 1300.78 of Title 28 of the California Code of Regulations.
Health plans that compensate their subcontractors on a capitated
basis shall comply with Section 1300.78 of Title 28 of the California
Code of Regulations, regarding administrative costs, considering the
combined administrative cost for the Medi-Cal business of the health
plan and its capitated subcontractors, that are Knox-Keene licensed
health care service plans. The recovery of excess administrative
cost shall be made in accordance with Sections 14087.103 and
14087.105.
SEC. 61. Section 14087.103 is added to the Welfare and
Institutions Code, to read:
14087.103. The department shall notify the health plan of the
director's decision to seek recovery of excess administrative costs
pursuant to Section 14087.101 at least 30 days prior to initiating
the recovery process. The department may recover excess
administrative costs immediately after the 30-day notification
period, if the health plan does not file an appeal. A health plan
may dispute or appeal the director's decision in accordance with the
disputes section of the health plan's contract with the department
for services under this article. If a health plan elects to dispute
or appeal the director's decision, the director may recover any
administrative costs deemed excessive, but only after the health plan
has had the opportunity to exhaust all appeal procedures provided
for in the disputes section of the health plan's contract with the
department.
SEC. 62. Section 14087.105 is added to the Welfare and
Institutions Code, to read:
14087.105. When it has been determined that the director may
recover any administrative costs deemed excessive pursuant to Section
14087.103, the director may recover any excess administrative costs
through an offset against any amount currently due to the health plan
under this chapter. The director may also recover any
administrative costs deemed excessive by means of a repayment
agreement executed between that health plan and the director, and by
any other means available at law.
SEC. 62.4. Section 14105.06 is added to the Welfare and
Institutions Code, to read:
14105.06. (a) Notwithstanding Section 14105 and any other
provision of law, the Medi-Cal reimbursement rates in effect on
August 1, 2003, shall remain in effect through July 31, 2005, for the
following providers:
(1) Freestanding nursing facilities licensed as any of the
following:
(A) A skilled nursing facility pursuant to subdivision (c) of
Section 1250 of the Health and Safety Code.
(B) An intermediate care facility pursuant to subdivision (d) of
Section 1250 of the Health and Safety Code.
(C) An intermediate care facility for the developmentally disabled
pursuant to subdivision (e), (g), or (h) of Section 1250 of the
Health and Safety Code.
(2) A skilled nursing facility that is a distinct part of a
general acute care hospital. For purposes of this paragraph,
"distinct part" shall have the same meaning as defined in Section
72041 of Title 22 of the California Code of Regulations.
(3) A subacute care program, as described in Section 14132.25 or
subacute care unit, as described in Sections 51215.5 and 51215.8 of
Title 22 of the California Code of Regulations.
(4) An adult day health care center.
(b) (1) The director may adopt regulations as are necessary to
implement subdivision (a). These regulations shall be adopted as
emergency regulations 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. For purposes of this section, the adoption of regulations
shall be deemed an emergency and necessary for the immediate
preservation of the public peace, health, and safety or general
welfare.
(2) As an alternative to paragraph (1), and Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code, the director may implement this article by
means of a provider bulletin, or similar instructions, without taking
regulatory action.
(c) The director shall implement subdivision (a) in a manner that
is consistent with federal medicaid law and regulations. The
director shall seek any necessary federal approvals for the
implementation of this section. This section shall be implemented
only to the extent that federal approval is obtained.
SEC. 62.5. Section 14105.19 is added to the Welfare and
Institutions Code, to read:
14105.19. (a) Due to the significant state budget deficit
projected for the 2003-04 fiscal year, and in order to implement
changes in the level of funding for health care services, the
Director of Health Services shall reduce provider payments as
specified in this section.
(b) (1) Payments shall be reduced by 5 percent for Medi-Cal
program services for dates of service on and after January 1, 2004.
(2) Payments shall be reduced by 5 percent for non-Medi-Cal
programs described in Section 14105.18, for dates of service on and
after January 1, 2004.
(3) The payments made to managed health care plans shall be
reduced by the actuarial equivalent amount of 5 percent at the time
of the plan's next rate determination.
(4) Reductions to payments for durable medical equipment shall be
made at the discretion of the director. If any reduction is made
pursuant to this paragraph, the reduction may not exceed 5 percent.
(c) The services listed below shall be exempt from the payment
reductions specified in subdivision (b):
(1) Acute hospital inpatient services.
(2) Federally qualified health clinic services.
(3) Rural health clinic services.
(4) Outpatient services billed by a hospital.
(5) Payments to state hospitals or developmental centers.
(6) Payments to long-term care facilities as defined by the
department, including, but not limited to, freestanding nursing
facilities, distinct-part nursing facilities, intermediate care
facilities for developmentally disabled individuals, subacute care
units of skilled nursing facilities, rural swing beds, ventilator
weaning services, special treatment program services, adult day
health care centers, and hospice room and board services.
(7) Clinical laboratory or laboratory services as defined in
Section 51137.2 of Title 22 of the California Code of Regulations.
(8) Contract services as designated by the Director of Health
Services pursuant to subdivision (e).
(9) Supplemental reimbursement provided pursuant to Sections
14105.27, 14105.95, and 14105.96.
(d) Subject to the exception for services listed in subdivision
(c), the payment reductions required by subdivision (b) shall apply
to the services rendered by any provider who may be authorized to
bill for the service, including, but not limited to, physicians,
podiatrists, nurse practitioners, certified nurse midwives, nurse
anesthetists, and organized outpatient clinics.
(e) 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 this section by means of provider bulletin,
or similar instruction, without taking regulatory action.
(f) The department shall promptly seek all necessary federal
approvals in order to implement this section, including necessary
amendments to the state plan.
(g) This section shall remain in effect only until January 1,
2007, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2007, deletes or extends
that date.
SEC. 63. Section 14105.21 is added to the Welfare and Institutions
Code, to read:
14105.21. (a) An assistive device and sickroom supply dealer may
not bill the Medi-Cal program for prosthetic and orthotic appliances.
(b) A pharmacy may not bill the Medi-Cal program for prosthetic or
orthotic appliances, unless the pharmacy is certified by the
National Community Pharmacists Association and only for prosthetic
and orthotic appliances that have been identified pursuant to
subdivision (c) or otherwise approved by the department.
(c) The department shall establish a list of covered services and
maximum allowable reimbursement rates, subject to Section 14107.7,
for prosthetic and orthotic appliances, and the list shall be
published in provider manuals.
(d) Reimbursement for prosthetic and orthotic appliances, as
defined in Section 51160 of Title 22 of the California Code of
Regulations, may not exceed 80 percent of the lowest maximum
allowance for California established by the federal Medicare program
for the same or similar services.
(e) The department shall repeal Section 51515 of Title 22 of the
California Code of Regulations, as it read on the effective date of
the act adding this section.
(f) The department may implement this section by provider manual
or bulletin. Notwithstanding the provisions of the Administrative
Procedure Act, 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 rulemaking provisions of the
Administrative Procedure Act or to the review and approval of the
Office of Administrative Law.
SEC. 64. Section 14105.22 is added to the Welfare and Institutions
Code, to read:
14105.22. Reimbursement for clinical laboratory or laboratory
services, as defined in Section 51137.2 of Title 22 of the California
Code of Regulations, may not exceed 80
percent of the lowest maximum allowance established
by the federal Medicare program for the same or similar services.
SEC. 65. 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 30 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 120 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 120 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 120 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 120 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. 66. Section 14105.395 is added to the Welfare and
Institutions Code, to read:
14105.395. (a) The department may implement utilization controls
through the establishment of guidelines, protocols, algorithms, or
criteria for drugs, medical supplies, durable medical equipment, and
enteral formulae. The department shall publish the guidelines,
protocols, algorithms, or criteria in the pharmacy and medical
provider manuals.
(b) The department shall issue providers written notice of changes
pursuant to subdivision (a) at least 30 days prior to
implementation.
(c) Changes made pursuant to this 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. The department shall consult with interested parties and
appropriate stakeholders in implementing this section with respect to
all of the following:
(1) Notifying the provider representatives of the proposed change.
(2) Scheduling at least one meeting to discuss the change.
(3) Allowing for written input regarding the change.
(4) Providing advance notice on the implementation and effective
date of the change.
SEC. 67. Section 14105.48 is added to the Welfare and Institutions
Code, to read:
14105.48. (a) The department shall establish a list of covered
services and maximum allowable reimbursement rates for durable
medical equipment as defined in Section 51160 of Title 22 of the
California Code of Regulations and the list shall be published in
provider manuals. The list shall specify utilization controls to be
applied to each type of durable medical equipment.
(b) Reimbursement for durable medical equipment, except
wheelchairs and wheelchair accessories, shall be the lesser of (1)
the amount billed pursuant to Section 51008.1 of Title 22 of the
California Code of Regulations, or (2) an amount that does not exceed
80 percent of the lowest maximum allowance for California
established by the federal Medicare program for the same or similar
item or service, or (3) the guaranteed acquisition cost negotiated by
means of the contracting process provided for pursuant to Section
14105.3 plus a percentage markup to be established by the department.
(c) Reimbursement for wheelchairs and wheelchair accessories shall
be the lesser of (1) the amount billed pursuant to Section 51008.1
of Title 22 of the California Code of Regulations, or (2) an amount
that does not exceed 100 percent of the lowest maximum allowance for
California established by the federal Medicare program for the same
or similar item or service, or (3) the guaranteed acquisition cost
negotiated by means of the contracting process provided for pursuant
to Section 14105.3 plus a percentage markup to be established by the
department.
(d) Reimbursement for all durable medical equipment billed to the
Medi-Cal program utilizing codes with no specified maximum allowable
rate shall be the lesser of (1) the amount billed pursuant to Section
51008.1 of Title 22 of the California Code of Regulations, or (2)
the guaranteed acquisition cost negotiated by means of the
contracting process provided for pursuant to Section 14105.3 plus a
percentage markup to be established by the department, or (3) the
actual acquisition cost plus a markup to be established by the
department, or (4) 80 percent of the manufacturer's suggested retail
purchase price, or (5) a price established through targeted
product-specific cost containment provisions developed with
providers.
(e) Reimbursement for all durable medical equipment supplies and
accessories billed to the Medi-Cal program shall be the lesser of (1)
the amount billed pursuant to Section 51008.1 of Title 22 of the
California Code of Regulations, or (2) the acquisition cost plus a 23
percent markup.
(f) Any regulation in Division 3 of Title 22 of the California
Code of Regulations that contains provisions for reimbursement rates
for durable medical equipment shall be amended or repealed effective
for dates of service on or after the date of the act adding this
section.
(g) Notwithstanding 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.
(h) The department shall consult with interested parties and
appropriate stakeholders in implementing this section with respect to
all of the following:
(1) Notifying the provider representatives of the proposed change.
(2) Scheduling at least one meeting to discuss the change.
(3) Allowing for written input regarding the change.
(4) Providing advance notice on the implementation and effective
date of the change.
SEC. 67.4. Section 14105.49 is added to the Welfare and
Institutions Code, to read:
14105.49. (a) (1) The department shall establish a list of
hearing aids and hearing aid accessories and determine the maximum
allowable product cost for each hearing aid product provided as a
benefit under the Medi-Cal program.
(2) The list established pursuant to paragraph (1) shall be
published in provider manuals. Notwithstanding the rulemaking
provisions of the Administrative Procedure Act (Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of the
Government Code), actions of the department under this section shall
not be subject to the Administrative Procedure Act or to the review
and approval of the Office of Administrative Law.
(b) The maximum reimbursement rate for hearing aids and hearing
aid accessories may not exceed the lesser of the following:
(1) The billed amount.
(2) The cost of the item, plus a percentage markup as determined
by the department.
(3) The rate established by the department's contracting program.
SEC. 67.5. Section 14105.51 is added to the Welfare and
Institutions Code, to read:
14105.51. (a) The department shall establish "capped rental"
reimbursement for specific items of durable medical equipment. Items
in this category shall be reimbursed on a monthly rental basis not
to exceed a period of continuous use of 10 months. After 10 months
of rental have been paid, the provider shall continue to provide the
item without charge, except for maintenance and servicing fees, until
the medical necessity ends or Medi-Cal coverage ceases. Monthly
reimbursement for the rental of these specific items of durable
medical equipment may not exceed 80 percent of the lowest maximum
allowance for California established by the federal Medicare program
for the same or similar item or service.
(b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of the Government Code, actions under
subdivision (a) shall not be subject to the rulemaking provisions of
the Administrative Procedure Act or to the review and approval of the
Office of Administrative Law.
(c) The department shall consult with interested parties and
appropriate stakeholders in determining which items will be subject
to capped rental, including doing all of the following:
(1) Notifying provider representatives of the items that will be
subject to capped rental.
(2) Scheduling at least one meeting to discuss the items.
(3) Allowing for written input regarding the items.
(4) Providing advance notice of the effective date on and after
which the items will be subject to capped rental.
SEC. 68. Section 14105.86 is added to the Welfare and Institutions
Code, to read:
14105.86. (a) For the purposes of this section, the following
definitions apply:
(1) (A) "Average selling price" means the average unit price
charged by the manufacturer to wholesalers for drugs distributed to
the retail pharmacy class of trade, including sales to wholesalers,
pharmacies, physician offices, home health care providers, nursing
homes, pharmacy benefit managers, and distributors.
(B) "Average selling price" excludes direct sales to hospitals,
health maintenance organizations, and wholesalers or distributors
when the drug is relabeled under the wholesaler's or distributor's
national drug code number. It also excludes prices charged to the
Indian Health Service, the Department of Veterans Affairs, a state
veteran's home receiving funds under Subchapter V (commencing with
Section 1741) of Title 38 of the United States Code, the Department
of Defense, the Public Health Service, or a covered entity described
in Section 340B(a)(4) of the United States Public Health Service Act,
any price charged under the federal Supply Schedule of the General
Services Administration, any prices used under a state pharmaceutical
assistance program, or any depot prices and single award contract
prices, as defined by the secretary of any agency of the state or
federal government.
(2) "Blood factors" means plasma protein therapies and their
recombinant analogs. Blood factors include, but are not limited to,
all of the following:
(A) Coagulation factors, including:
(i) Factor VIII, nonrecombinant.
(ii) Factor VIII, porcine.
(iii) Factor VIII, recombinant.
(iv) Factor IX, nonrecombinant.
(v) Factor IX, complex.
(vi) Factor IX, recombinant.
(vii) Antithrombin III.
(viii) Anti-inhibitor factor.
(ix) Von Willebrand factor.
(B) Immune Globulin Intravenous.
(C) Alpha-1 Proteinase Inhibitor.
(b) The reimbursement for blood factors shall be by national drug
code number and shall not exceed 120 percent of the average selling
price of the preceding quarter.
(c) The average selling price for blood factors of manufacturers
or distributors that do not report an average selling price pursuant
to subdivision (a) shall be identical to the average manufacturer's
price that the manufacturer or distributor reports to the federal
United States Centers for Medicare and Medicaid Services. The
reporting of an average selling price that does not meet the
requirement of this subdivision shall result in that blood factor no
longer being considered a covered benefit. This reporting shall be
done on the national drug code level.
(d) The average selling price shall be based on the criteria in
subdivision (a) and reported to the department on a quarterly basis.
(e) Changes made to the list of covered blood factors under this
or any other section shall be 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. 68.5. Section 14110.65 of the Welfare and Institutions Code
is amended to read:
14110.65. (a) (1) The department shall, upon federal approval of
a federal Medicaid State Plan amendment authorizing federal financial
participation, provide a supplemental rate adjustment to the
Medi-Cal reimbursement rate for specific nursing facilities,
intermediate care facilities/developmentally disabled, intermediate
care facilities/developmentally disabled-habilitative, intermediate
care facilities/developmentally disabled-nursing, and pediatric
subacute units that have a collectively bargained contract or a
comparable, legally binding, written commitment to increase salaries,
wages, or benefits for nonmanagerial, nonadministrative, noncontract
staff. It is the intent of this section to make this supplemental
rate adjustment available to both facilities with collective
bargaining agreements and facilities without collective bargaining
agreements that meet the requirements of this section. The
supplemental rate adjustment shall be sufficient to fund the Medi-Cal
portion of each facility's commitment that exceeds the labor cost
adjustment for the covered employees that is already included in the
Medi-Cal base reimbursement rate. Starting on the date of federal
approval of the Medicaid State Plan amendment and at the start of
each rate year thereafter, the supplemental rate adjustments made
pursuant to this section shall occur for the commitments that
increase salaries, wages, or benefits during the rate year as
compared to the salaries, wages, or benefits paid in the preceding
year. These supplemental rate adjustments shall be subject to
certification of the availability of funds by the Department of
Finance on May 15 of each year for the following fiscal year, and
subject to the extent funds are appropriated for this purpose in the
annual Budget Act. Authorization for the supplemental rate
adjustments shall terminate on the date of implementation by the
department of a Medi-Cal reimbursement system that uses
facility-specific rates for nonhospital-based nursing facilities
covered by this section.
(2) For a specific facility to be eligible for the supplemental
rate adjustment, the facility shall submit the following to the
department:
(A) Proof of a legally binding, written commitment to increase the
salaries, wages, or benefits of existing and newly hired employees,
excluding managers, administrators, and contract employees, during
the rate year.
(B) Proof of the existence of a method of enforcement of the
commitment, such as arbitration, that is available to the employees
or their representative, and all of the following apply.
(i) It is expeditious.
(ii) It uses a neutral decisionmaker.
(iii) It is economical for the employees.
(C) Proof that the specific facility has provided written notice
of the terms of the commitment and the availability of the
enforcement mechanism to the relevant employees or their recognized
representatives.
(3) For purposes of this section, a supplemental rate adjustment
shall equal the Medi-Cal portion of the total amount of any increase
in salaries, wages, and benefits provided in the enforceable written
agreement minus any increase provided to that facility during that
rate year provided in the standardized rate methodology (Medi-Cal
base reimbursement rate) for labor related costs attributable to the
employees covered by the commitment. Any supplemental rate
adjustment made pursuant to this section shall only cover the period
of the nonexpired, enforceable, written agreement. The department
shall adjust the methodology for determining costs in the future rate
determinations.
(4) Any supplemental rate adjustment for any facility under this
section shall be no more than the greater of either of the following:
(A) Eight percent of that portion of the facility's per diem labor
costs, prior to the rate year, attributable to employees covered by
the commitment.
(B) Eight percent of the facility's peer group's per diem labor
costs multiplied by the percentage of the facility's per diem labor
costs attributable to employees covered by the commitment.
(5) The department shall terminate the adjustment for the specific
facility if it finds the binding written commitment has expired and
does not otherwise remain enforceable.
(6) The department may inspect relevant payroll and personnel
records of facilities receiving funds pursuant to this section in
order to ensure that the salary, wage, and benefit increases provided
for in this section have been implemented. In addition to the
remedies provided in subdivision (b), the department may
retroactively recover funds provided to a facility for labor costs
incurred after expiration of the commitment or due to the failure of
the facility to comply with the commitment.
(7) An employees enforcement or attempted enforcement of the
written commitment pursuant to paragraph (2) of subdivision (a) shall
not constitute a basis for adverse action against that employee.
(b) The department shall provide instructions on facility
requirements by November 1, 2001, or at least 60 days before
implementation of this section, whichever is earlier. In developing
these instructions, the department shall consult with provider and
employee representatives. Audit, exit conference, and other review
protocol for determining facility compliance with this section shall
be developed by the department after consulting with provider and
employee representatives. Any facility that is paid under the
supplemental rate adjustment provided for in this section that the
director finds has not provided the salary, wage, and benefit
increases provided for shall be liable for the amount of funds paid
to the facility by this section but not distributed to employees for
salary, wage, and benefit increases, plus a penalty equal to 10
percent of the funds not so distributed. Recoupment of funds from
any facility that disagrees with the findings of the director
specific to this section and has filed a request for hearing pursuant
to Section 14171, shall be deferred until the request for hearing is
either rejected or the director's final administrative decision is
rendered. Interest shall be applied to any recoupment amount at the
interest rate and timeframes specified in subdivision (h) of Section
14171. The facility shall be subject to Section 14107.
(c) This section shall be operative on the effective date of the
act that added subdivision (d).
(d) (1) Solely for the period commencing February 1, 2002, to July
31, 2004, inclusive, the department shall pay any supplemental rate
adjustment pursuant to subdivision (a) to the extent that a facility
submits a rate adjustment request to the department within the period
of time specified in this subdivision, and where the department
approves the supplemental rate adjustment for the particular
facility. Rate adjustment requests shall be postmarked no later than
90 days after the department mails the instructions described in
subdivision (b) to the facilities.
(2) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the director
may promulgate the instructions described in subdivision (b) by
means of a letter, notice, provider bulletin, or other similar
communication, without taking regulatory action.
(3) Notwithstanding any other provision of law, amounts
appropriated for purposes of this section in the Budget Act of 2003,
may be expended for supplemental rate adjustments relating to periods
in the 2002-03 fiscal year.
(e) This section shall become inoperative on August 1, 2004, and,
as of January 1, 2007, is repealed, unless a later enacted statute
that is enacted before January 1, 2007, deletes or extends the dates
on which it becomes inoperative and is repealed.
SEC. 69. Section 14124.79 of the Welfare and Institutions Code is
amended to read:
14124.79. In the event that the beneficiary, his guardian,
conservator, personal representative, estate or survivors or any of
them brings an action against the third person who may be liable for
the injury, notice of institution of legal proceedings, notice of
settlement and all other notices required by this code shall be given
to the director in Sacramento except in cases where the director
specifies that notice shall be given to the Attorney General. All
such notices shall be given by insurance carriers, as described in
Section 14124.70, having liability for the beneficiary's claim, and
by the attorney retained to assert the beneficiary's claim, or by the
injured party beneficiary, his guardian, conservator, personal
representative, estate or survivors, if no attorney is retained.
SEC. 70. Section 14124.795 is added to the Welfare and
Institutions Code, to read:
14124.795. It is the intent of the Legislature to comply with
federal law requiring that when a beneficiary has other available
health coverage or insurance, the Medi-Cal program shall be the payer
of last resort. Notwithstanding any other provision of law, any
carrier described in Section 14124.70, including automobile,
casualty, property, and malpractice insurers, shall enter into an
agreement with the department to permit and assist the matching of
the department's Medi-Cal eligibility file against the carrier's
claim files, utilizing, if necessary, social security numbers as
common identifiers for the purpose of determining whether Medi-Cal
benefits were provided to a beneficiary because of an injury for
which another person is liable, or for which a carrier is liable in
accordance with the provisions of any policy of insurance. The
carrier shall maintain a centralized file of claimants' names,
mailing addresses, and social security numbers or dates of birth.
This information shall be made available to the department upon the
department's reasonable request. The agreement described in this
section shall include financial arrangements for reimbursing carriers
for necessary costs incurred in furnishing requested information.
SEC. 70.5. Section 14126.02 of the Welfare and Institutions Code
is amended to read:
14126.02. (a) It is the intent of the Legislature to devise a
Medi-Cal long-term care reimbursement methodology that more
effectively ensures individual access to appropriate long-term care
services, promotes quality resident care, advances decent wages and
benefits for nursing home workers, supports provider compliance with
all applicable state and federal requirements, and encourages
administrative efficiency.
(b) (1) The department shall implement a facility-specific
rate-setting system by August 1, 2005, subject to federal approval,
that reflects the costs and staffing levels associated with quality
of care for residents in nursing facilities, as defined in
subdivision (k) of Section 1250 of the Health and Safety Code, which
shall include hospital-based nursing facilities.
(2) The department shall examine several alternative rate
methodology models for a new Medi-Cal reimbursement system for
skilled nursing facilities to include, but not be limited to,
consideration of the following:
(A) Classification of residents based on the resource utilization
group system or other appropriate acuity classification system.
(B) Facility specific case mix factors.
(C) Direct care labor based factors.
(D) Geographic or regional differences in the cost of operating
facilities and providing resident care.
(E) Facility-specific cost based rate models used in other states.
(c) The department shall submit to the Legislature a status report
on the implementation of this section on April 1, 2002, April 1,
2003, and April 1, 2004.
(d) The alternatives for a new system described in paragraph (2)
of subdivision (b) shall be developed in consultation with recognized
experts with experience in long-term care reimbursement, economists,
the Attorney General, the federal Centers for Medicare and Medicaid
Services, and other interested parties.
(e) In implementing this section, the department may contract as
necessary, on a bid or nonbid basis, for professional consulting
services from nationally recognized higher education and research
institutions, or other qualified individuals and entities not
associated with a skilled nursing facility, with demonstrated
expertise in long-term care reimbursement systems. The rate-setting
system specified in subdivision (b) shall be developed with all
possible expedience. This subdivision establishes an accelerated
process for issuing contracts pursuant to this section and contracts
entered into pursuant to this subdivision shall be exempt from the
requirements of Chapter 1 (commencing with Section 10100) and Chapter
2 (commencing with Section 10290) of Part 2 of Division 2 of the
Public Contract Code.
SEC. 71. Section 14132.27 is added to the Welfare and Institutions
Code, to read:
14132.27. (a) (1) The department shall apply for a waiver of
federal law pursuant to Section 1396n of Title 42 of the United
States Code to test the efficacy of providing a disease management
benefit to beneficiaries under the Medi-Cal program. A disease
management benefit shall include, but not be limited to, the use of
evidence-based practice guidelines, supporting adherence to care
plans, and providing patient education, monitoring, and healthy
lifestyle changes.
(2) The waiver developed pursuant to this section shall be known
as the Disease Management Waiver. The department shall submit any
necessary waiver applications
or modifications to the Medicaid State Plan to the federal
Centers for Medicare and Medicaid Services to implement the Disease
Management Waiver, and shall implement the waiver only to the extent
federal financial participation is available.
(b) The Disease Management Waiver 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 care necessary to protect their health and
well-being. Services 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, medication management,
coordination with a primary care provider, use of evidence-based
practice guidelines, supporting adherence to a plan of care, patient
education, communication and collaboration among providers, and
process and outcome measures. Coverage for those services shall be
limited by the terms, conditions, and duration of the federal waiver.
(c) Eligibility for the Disease Management Waiver shall be limited
to those persons who are eligible for the Medi-Cal program as aged,
blind, and disabled persons or those persons over 21 years of age who
are not enrolled in a Medi-Cal managed care plan, or eligible for
the federal Medicare program, and who are determined by the
department to be at risk of, or diagnosed with, select chronic
diseases, including, but not limited to, advanced atherosclerotic
disease syndromes, congestive heart failure, and diabetes.
Eligibility shall be based on the individual's medical diagnosis and
prognosis, and other criteria, as specified in the waiver.
(d) The Disease Management Waiver shall test the effectiveness of
providing a Medi-Cal disease management benefit. The department
shall evaluate the effectiveness of the Disease Management Waiver.
(1) The evaluation shall include, but not be limited to,
participant satisfaction, health and safety, the quality of life of
the participant receiving the disease management benefit, and
demonstration of the cost neutrality of the Disease Management Waiver
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 Disease
Management Waiver was expanded statewide.
(3) The evaluation shall be submitted to the appropriate policy
and fiscal committees of the Legislature on or before January 1,
2008.
(e) The department shall limit the number of participants in the
Disease Management Waiver during the initial three years of its
operation to a number that will be statistically significant for
purposes of the waiver evaluation and that meets any requirements of
the federal government, including a request to waive statewide
implementation requirements for the waiver during the initial years
of evaluation.
(f) In undertaking this Disease Management Waiver, the director
may enter into contracts for the purpose of directly providing
Disease Management Waiver services.
(g) The department shall seek all federal waivers necessary to
allow for federal financial participation under this section.
(h) The Disease Management Waiver shall be developed and
implemented only to the extent that funds are appropriated or
otherwise available for that purpose.
(i) The department shall not implement this section if any of the
following apply:
(1) The department's application for federal funds under the
Disease Management Waiver is not accepted.
(2) Federal funding for the waiver ceases to be available.
SEC. 71.3. 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.
(c) For persons 21 years of age or older, laboratory-processed
crowns on posterior teeth are not a covered benefit except when a
posterior tooth is necessary as an abutment for any fixed or
removable prosthesis.
(d) Any prefabricated crown made from ADA-approved materials may
be used on posterior teeth and may be reimbursed as a stainless steel
crown.
(e) The department shall reduce the rate of subgingival curettage
and root planing by 41 percent for all beneficiaries except those
residing in a skilled nursing facility or an intermediate care
facility for the developmentally disabled. Notwithstanding Section
14105 and Chapter 3.5 (commencing with Section 11340) of Part 1 of
Division 3 of Title 2 of the Government Code, the department may
implement this subdivision by means of a provider bulletin or similar
instruction, without taking regulatory action.
(f) (1) The department shall require pretreatment radiograph
documentation on posttreatment claims to establish the medical
necessity for dental restorations. The pretreatment documentation
required under this subdivision is intended to reduce fraudulent
claims for unnecessary dental fillings. In order to avoid any undue
barriers to accessing dental care, the department shall stipulate
that the pretreatment radiograph documentation for posttreatment
claims will be required only when there are four or more dental
fillings being completed in any 12-month period.
(2) 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 this subdivision by means of a provider
bulletin or similar instruction, without taking regulatory action.
SEC. 71.5. Section 14154 of the Welfare and Institutions Code is
amended to read:
14154. (a) The department shall establish and maintain a plan
whereby costs for county administration of the determination of
eligibility for benefits under this chapter will be effectively
controlled within the amounts annually appropriated for that
administration. The plan, to be known as the County Administrative
Cost Control Plan, shall establish standards and performance
criteria, including workload, productivity, and support services
standards, to which counties shall adhere. The plan shall include
standards for controlling eligibility determination costs that are
incurred by performing eligibility determinations at county
hospitals, or that are incurred due to the outstationing of any other
eligibility function. Except as provided in Section 14154.15,
reimbursement to a county for outstationed eligibility functions
shall be based solely on productivity standards applied to that
county's welfare department office. The plan shall be part of a
single state plan, jointly developed by the department and the State
Department of Social Services, in conjunction with the counties, for
administrative cost control for the California Work Opportunity and
Responsibility to Kids (CalWORKs), Food Stamp, and Medical Assistance
(Medi-Cal) programs. Allocations shall be made to each county and
shall be limited by and determined based upon the County
Administrative Cost Control Plan. In administering the plan to
control county administrative costs, the department shall not
allocate state funds to cover county cost overruns that result from
county failure to meet requirements of the plan. The department and
the State Department of Social Services shall budget, administer, and
allocate state funds for county administration in a uniform and
consistent manner.
(b) Nothing in this section, Section 15204.5, or Section 18906
shall be construed so as to limit the administrative or budgetary
responsibilities of the department in a manner that would violate
Section 14100.1, and thereby jeopardize federal financial
participation under the Medi-Cal program.
(c) The department is responsible for the Medi-Cal program in
accordance with state and federal law. A county shall determine
Medi-Cal eligibility in accordance with state and federal law. If in
the course of its duties the department becomes aware of accuracy
problems in any county, the department shall, within available
resources, provide training and technical assistance as appropriate.
Nothing in this section shall be interpreted to eliminate any remedy
otherwise available to the department to enforce accurate county
administration of the program. In administering the Medi-Cal
eligibility process, each county shall meet the following performance
standards each fiscal year:
(1) Complete eligibility determinations as follows:
(A) Ninety percent of the general applications without applicant
errors and are complete shall be completed within 45 days.
(B) Ninety percent of the applications for Medi-Cal based on
disability shall be completed within 90 days, excluding delays by the
state.
(2) (A) The department shall establish best-practice guidelines
for expedited enrollment of newborns into the Medi-Cal program,
preferably with the goal of enrolling newborns within 10 days after
the county is informed of the birth. The department, in consultation
with counties and other stakeholders, shall work to develop a
process for expediting enrollment for all newborns, including those
born to mothers receiving CalWORKs assistance.
(B) Upon the development and implementation of the best-practice
guidelines and expedited processes, the department and the counties
may develop an expedited enrollment timeframe for newborns that is
separate from the standards for all other applications, to the extent
that the timeframe is consistent with these guidelines and
processes.
(C) Notwithstanding the rulemaking procedures of Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code, the department may implement this section by
means of all-county letters or similar instructions, without further
regulatory action.
(3) Perform timely annual redeterminations, as follows:
(A) Ninety percent of the annual redetermination forms shall be
mailed to the recipient by the anniversary date.
(B) Ninety percent of the annual redeterminations shall be
completed within 60 days of the recipient's annual redetermination
date for those redeterminations based on forms that are complete and
have been returned to the county by the recipient in a timely manner.
(C) Ninety percent of those annual redeterminations where the
redetermination form has not been returned to the county by the
recipient shall be completed by sending a notice of action to the
recipient within 45 days after the date the form was due to the
county.
(d) The department shall develop procedures in collaboration with
the counties and stakeholder groups for determining county review
cycles, sampling methodology and procedures, and data reporting.
(e) On January 1 of each year, each applicable county, as
determined by the department, shall report to the department on the
county's results in meeting the performance standards specified in
this section. The report shall be subject to verification by the
department. County reports shall be provided to the public upon
written request.
(f) If the department finds that a county is not in compliance
with one or more of the standards set forth in this section, the
county shall, within 60 days, submit a corrective action plan to the
department for approval. The corrective action plan shall, at a
minimum, include steps that the county shall take to improve its
performance on the standard of standards with which the county is out
of compliance. The plan shall establish interim benchmarks for
improvement that shall be expected to be met by the county in order
to avoid a sanction.
(g) If a county does not meet the performance standards for
completing eligibility determinations and redeterminations as
specified in this section, the department may, at its sole
discretion, reduce the allocation of funds to that county in the
following year by 2 percent. Any funds so reduced may be restored by
the department if, in the determination of the department,
sufficient improvement has been made by the county in meeting the
performance standards during the year for which the funds were
reduced. If the county continues not to meet the performance
standards, the department may reduce the allocation by an additional
2 percent for each year thereafter in which sufficient improvement
has not been made to meet the performance standards.
SEC. 72. Section 14159 is added to the Welfare and Institutions
Code, to read:
14159. Commencing with the 2004-05 fiscal year, expenditures for
Medi-Cal services and fiscal intermediary and county administration
costs included in the department's budget shall be charged against
the appropriation for the fiscal year in which the billing is paid.
Commencing July 1, 2004, all 2002-03 fiscal year and prior accrued
obligations of the Health Care Deposit Fund shall become obligations
of the 2004-05 fiscal year and all moneys available from the 2002-03
fiscal year and prior appropriations shall be reappropriated to the
2004-05 fiscal year for that purpose.
SEC. 73. Article 5.5 (commencing with Section 14464.5) is added to
Chapter 8 of Part 3 of Division 9 of the Welfare and Institutions
Code, to read:
Article 5.5. Quality Improvement Fee for Medi-Cal Managed Care
Plans
14464.5. (a) For purposes of this article, the following
definitions apply:
(1) "Capitation payment" means the monthly amount paid by the
state to a designated Medi-Cal managed care plan in exchange for
contracted health care services procured by means of the Medi-Cal
managed care contracts set forth in paragraph (3).
(2) "Capitation rate" means the per member per month rate used to
calculate the capitation payments.
(3) "Medi-Cal managed care plan" means any Medi-Cal managed care
plan contracting with the department to provide services to enrolled
Medi-Cal beneficiaries pursuant to Chapter 7 (commencing with Section
14000), this chapter, or Chapter 8.75 (commencing with Section
14590), and that is also an organization that meets the criteria to
contract for services in Section 1396b(m) of Title 42 of the United
States Code.
(b) The department may impose, on an annual basis, a quality
improvement fee on the capitation payments paid to Medi-Cal managed
care plans for enrolled Medi-Cal beneficiaries. The quality
improvement fee shall be paid to the state monthly and shall be a
percentage as determined pursuant to paragraph (1) multiplied by each
Medi-Cal managed care plan's capitation payments. The quality
improvement fee shall be subject to all of the following provisions:
(1) The department shall determine the quality improvement
percentage, not to exceed 6 percent of the capitation payments and
shall notify the Medi-Cal managed care plans of that determination.
(2) The quality improvement fee shall be paid to the state within
15 calendar days following notification by the department of the
amount due.
(3) The quality improvement fee shall be deposited in the General
Fund.
(4) If the Medi-Cal managed care plan does not timely pay the
quality improvement fee, or any part thereof, the department may
offset the amount of the fee that is unpaid against any amounts due
from the state to the Medi-Cal managed care plan. Notwithstanding
any such offset, the methodology for determining the fee as set forth
in this subdivision shall be followed.
(5) The department shall make retrospective adjustments as
necessary to the amounts calculated pursuant to this subdivision in
order to assure that the Medi-Cal managed care plan's aggregate
quality improvement fee for any particular state fiscal year does not
exceed 6 percent of the aggregate annual capitation payments paid to
the Medi-Cal managed care plan for that year.
(c) (1) The department shall implement this section in a manner
that complies with federal requirements. If the department is unable
to comply with the federal requirements for federal matching funds
under this section or is unable to use the 2002-03 fiscal year level
of support for federal matching dollars other than for a change in
covered benefits or covered populations required under the state's
Medi-Cal contract with health care service plans, the quality
improvement fee shall no longer be assessed or collected.
(2) In all fiscal years governed by this section, Medi-Cal
capitation rates shall not be reduced as a direct result of the
quality improvement fee assessed under this section. This
subdivision does not apply to a change in Medi-Cal capitation rates
caused by a change in actuarial factors, including covered benefits,
covered populations, or Medi-Cal provider reimbursement, under the
state's Medi-Cal contract with health care service plans.
(d) The director, or his or her designee, shall administer this
section.
(e) The director may adopt regulations as are necessary to
implement this section. These regulations shall be adopted as
emergency regulations 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). For purposes of this section, the adoption of regulations
shall be deemed an emergency and necessary for the immediate
preservation of the public peace, health, and safety or general
welfare. The regulations shall include, but not be limited to, any
regulations necessary for either of the following purposes:
(1) The administration of this section, including the proper
imposition and collection of the quality improvement fees and
associated penalties.
(2) The development of any forms necessary to calculate, notify,
collect, and distribute the quality improvement fees.
(f) As an alternative to subdivision (e), and notwithstanding
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code, the director may implement this
section by means of a provider bulletin, contract amendment, policy
letter, or other similar instructions, without taking regulatory
action.
(g) This section shall not apply to either of the following:
(1) State supported services contracts separately entered into
with Medi-Cal managed care plans to cover only those services that
are expressly set forth in those contracts, are paid for solely with
state funds, and are unavailable for federal financial participation.
(2) Payments derived from intergovernmental transfers and
associated federal financial participation.
(h) Any limitation on rates or payments to the Medi-Cal managed
care plan based on Medi-Cal fee-for-service costs shall be increased
to include any capitation rate increase related to the quality
improvement fee in subdivision (b).
(i) To the extent necessary to comply with federal requirements
pursuant to paragraph (2) of subdivision (c), the director may
deviate from the provisions of this section with respect to either or
both of the following:
(1) The methodology for calculating or imposing the quality
improvement fee pursuant to subdivision (b).
(2) The exclusions specified in subdivision (g).
(j) Notwithstanding any other provision of this section, the
department may not impose a quality improvement fee on any payment to
be made to Medi-Cal managed care plans, other than the capitated
payments as defined in paragraph (1) of subdivision (a).
(k) The department shall commence collecting the quality
improvement fees pursuant to subdivision (b) no sooner than January
1, 2004.
SEC. 74. Section 14684.1 is added to the Welfare and Institutions
Code, to read:
14684.1. (a) The State Department of Mental Health shall
establish a process for second level treatment authorization request
appeals to review and resolve disputes between mental health plans
and hospitals.
(b) When the department establishes an appeals process, the
department shall comply with all of the following:
(1) The department shall review appeals initiated by hospitals and
render decisions on appeals based on findings that are the result of
a review of supporting documents submitted by mental health plans
and hospitals.
(2) If the department upholds a mental health plan denial of
payment of a hospital claim, a review fee shall be assessed on the
provider.
(3) If the State Department of Mental Health reverses a mental
health plan denial of payment of a hospital claim, a review fee shall
be assessed on the mental health plan.
(4) If the department decision regarding a mental health plan
denial of payment upholds the claim in part and reverses the claim in
part, the department shall prorate the review fee between the
parties accordingly.
(c) The amount of the review fees shall be calculated and adjusted
annually. The methodology and calculation used to determine the fee
amounts shall result in an aggregate fee amount that, in conjunction
with any other outside source of funding for this function, may not
exceed the aggregate annual costs of providing second level treatment
authorization request reviews.
(d) Fees collected by the department shall be retained by the
department and used to offset administrative and personnel services
costs associated with the appeals process.
(e) The department may use the fees collected, in conjunction with
other available appropriate funding for this function, to contract
for the performance of the appeals process function.
SEC. 75. Section 16809 of the Welfare and Institutions Code, as
amended by Section 90 of Chapter 1161 of the Statutes of 2002, 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, 2002-03, and
2003-04 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, 2002-03, and 2003-04 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, 2002-03, and 2003-04
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, 2002-03, and 2003-04 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. 75.5. Section 13 of Chapter 9 of the Statutes of the First
Extraordinary Session of 2003 is repealed.
SEC. 76. (a) Of the amount appropriated in Item 4260-111-0001 of
the Budget Act of 2003 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 2003-04 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. 77. (a) The State Department of Health Services may not
implement limits on laboratory services provided by more than one
laboratory, as provided for in the Budget Act of 2003 until, at a
minimum, an Internet and telephone process are available for
applicable providers to access the laboratory service reservation
system.
(b) The Legislature finds and declares both of the following:
(1) The laboratory service reservation system will allow
laboratories, prior to performing a lab procedure, the opportunity to
verify that service limits have not been reached for that procedure
and for that Medi-Cal beneficiary.
(2) It is the intent of the State Department of Health Services to
have the laboratory service reservation system accessible through a
point of service device process within 9 to 12 months after the
enactment of this act.
SEC. 78. The State Department of Health Services shall require
contractors and grantees under the Office of Family Planning, Male
Involvement Program, and Information and Education Program, to
establish and implement, commencing in the 2003-04 fiscal year, a
clinical services linkage to the Family PACT program. This linkage
shall include, but not be limited to, planning and development of a
referral process of participants in these programs to ensure access
of family planning and other reproductive health care services. This
clinical services linkage shall commence in the 2003-04 state fiscal
year and operate thereafter.
SEC. 79. 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. 80. The Managed Risk Medical Insurance Board may adopt
emergency regulations to implement provisions of this act repealing
Section 12698.10 of, adding Section 12693.765 to, and amending
Sections 12693.43, 12693.70, 12693.73, 12695.06, 12698.05, and
12698.30 of, the Insurance Code. The Office of Administrative Law
shall consider those regulations to be necessary for the immediate
preservation of the public peace, health and safety, and general
welfare for purposes of Section 11349.6 of the Government Code.
Notwithstanding the 120-day limitation in subdivision (e) of Section
11346.1 of the Government Code, the emergency regulations adopted or
amended pursuant to this subdivision shall be repealed 180 days after
the effective date of the regulations, unless the department
readopts those regulations, in whole or in part, in compliance with
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code.
SEC. 80.5. The Legislature finds and declares that the state faces
a fiscal crisis that requires unprecedented measures to be taken to
reduce General Fund expenditures. Notwithstanding any other
provision of law or regulation, the Medi-Cal reimbursement rates in
effect for the 2003-04 fiscal year for hospitals, not under contract
with the California Medical Assistance Commission, providing
inpatient services to Medi-Cal recipients shall remain the same for
the entire 2004-05 fiscal year. It is the intent of the Legislature
that the California Medical Assistance Commission freeze all Medi-Cal
reimbursement rates paid to hospitals for inpatient services at
their 2003-04 contract rate, or at a lower level, whichever is
applicable based on contract negotiations.
SEC. 81. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution for
certain costs that may be incurred by a local agency or school
district because in that regard this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.
However, notwithstanding Section 17610 of the Government Code, if
the Commission on State Mandates determines that this act contains
other 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. 82. 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 the necessary statutory changes to implement the
Budget Act of 2003 at the earliest possible time, it is necessary
that this act take effect immediately.