Amended in Senate June 13, 2013

Amended in Senate June 12, 2013

California Legislature—2013–14 Regular Session

Assembly BillNo. 82


Introduced by Committee on Budget (Blumenfield (Chair), Bloom, Bonilla, Campos, Chesbro, Daly, Dickinson, Gordon, Jones-Sawyer, Mitchell, Mullin, Muratsuchi, Nazarian, Skinner, Stone, and Ting)

January 10, 2013


An act to amend Section 680 of the Business and Professions Code, to amend Sections 6254, 26605.6, 26605.7, and 26605.8 of the Government Code, to amend Sections 1180.6, 1250.2, 1254, 1254.1, 1266.1, 1275.1, 1275.5, 1324.9, 1373, 111792, 123870, 123929, 123940, and 123955 of, and to add Section 104151 to, the Health and Safety Code, to amend Sections 10125, 10127, 12693.70, 12698, 12737, and 12739.61 of the Insurance Code, and to amend Sections 359, 708, 4005.7, 4080, 5150, 5151, 5157, 5202, 5326.9, 5358, 5366.1, 5404, 5405, 5585.21, 5585.50, 5585.55, 5675, 5675.1, 5675.2, 5751.7, 5768, 5840, 5845, 5846, 5909, 6007, 6551, 7100, 14105.22, 14105.3, 14131.10, 14134, 14707.5, and 15911 of, to add Sections 14100.3, 14100.51, 14100.52, 14132.86, and 14132.89 to, to add Part 3.3 (commencing with Section 15800) to Division 9 of, to add and repeal Section 14005.281 of, and to repeal Section 14131.07 of, the Welfare and Institutions Code, relating to health, and making an appropriation therefor, to take effect immediately, bill related to the budget.

LEGISLATIVE COUNSEL’S DIGEST

AB 82, as amended, Committee on Budget. Health.

(1) Existing law authorizes a sheriff to release a prisoner from a county correctional facility for transfer to a medical care facility or residential care facility upon the advice of a physician, as specified, or if the sheriff determines that the prisoner would not reasonably pose a threat to public safety and the prisoner, upon diagnosis by the examining physician, is deemed to have a life expectancy of 6 months or less, provided the sheriff gives specified notice to the superior court. Existing law also authorizes the sheriff to request the court to grant medical probation or to resentence a prisoner to medical probation in lieu of jail time if the prisoner is physically incapacitated with a medical condition that renders the prisoner permanently unable to perform activities of basic daily living, which has resulted in the prisoner requiring 24-hour care, and if that incapacitation did not exist at the time of sentencing or if the prisoner would require acute long-term inpatient rehabilitation services. Existing law requires a county that chooses to implement these provisions to pay the nonfederal share of a prisoner’s or probationer’s Medi-Cal costs for the period that the individual would have otherwise been incarcerated or been on medical probation. Existing law requires a county board of supervisors to adopt a process to fund the nonfederal share of Medi-Cal costs, as specified, before implementing the above-referenced provisions and to notify the State Department of Health Care Services of the process.

This bill would revise the conditions under which a county may implement these release or medical probation provisions by requiring the county to notify the department when a released prisoner has applied for Medi-Cal or is returned to custody and to also pay the nonfederal share of certain nonreimbursable medical costs paid by the state, and state administrative costs, as specified. The bill would specify the Legislature’s intent that implementation of these provisions would not result in increased costs to the General Fund and should not jeopardize federal financial participation for the Medi-Cal program.

(2) Existing law establishes the Long-Term Care Quality Assurance Fund in the State Treasury and requires, beginning August 1, 2013, all revenues received by the State Department of Health Care Services categorized by the department as long-term quality assurance fees, including specified fees on certain intermediate care facilities and skilled nursing facilities, as specified, to be deposited into the fund. Existing law requires the moneys in the fund to be available, upon appropriation by the Legislature, for expenditure by the department to provide supplemental Medi-Cal reimbursement for intermediate care facility services, and to enhance federal financial participation in the Medi-Cal program or to provide additional reimbursement to, and to support facility quality improvement efforts in, licensed skilled nursing facilities.

This bill would authorize the Controller to use the funds in the Long-Term Quality Assurance Fund for cashflow loans to the General Fund, as specified.

(3) Existing law requires the State Department of Health Care Services to provide, no later than January 10 and May 14 of each year, the fiscal committees of the Legislature with an estimate package for the Every Woman Counts Program, as specified.

This bill would instead require that the reporting occur each year no later than January 10 and concurrently with the May Revision of the annual budget. The bill would additionally require that the estimate package include a breakout of costs for specified clinical service activities, policy changes, and fund information.

(4) Existing law, the Mental Health Services Act, an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, funds a system of county mental health plans for the provision of mental health services, as specified. Among other things, the act establishes the Mental Health Services Oversight and Accountability Commission to oversee the administration of various parts of the Mental Health Services Act, and requires that the commission administer its operations separate and apart from the State Department of Health Care Services. The act provides that the Legislature may clarify procedures and terms of the act by majority vote.

This bill would require that the commission administer its operations separate and apart from the California Health and Human Services Agency. The bill would also make technical changes.

(5) Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services, including specialty mental health services and drug treatment services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.

This bill would require the department, by January 10 and concurrently with the May Revision of the annual budget, to provide to the fiscal committees of the Legislature specified fiscal information with respect to the Medi-Cal Specialty Mental Health Services Program and the Drug Medi-Cal Program. The bill also would require the department to post this information on its Internet Web site.

(6) Existing federal law requires the State Department of Health Care Services to describe the Medi-Cal program in a state plan. Under existing state law, the Director of Health Care Services has those powers and duties necessary to conform to requirements for securing approval of the state plan. Existing federal law authorizes the Secretary of Health and Human Services to waive provisions of federal Medicaid law under specified circumstances, including, among others, when the secretary finds that the waiver would be cost effective and efficient. Existing state law requires the department to seek a variety of waivers of federal law, including, among others, to implement objectives that may include better care coordination for seniors, persons with disabilities, and children with special health care needs.

This bill would require the department to post on its Internet Web site all submitted state plan amendments and all federal waiver applications and requests for new waivers, waiver amendments, and waiver renewals and extensions, within 10 business days from the date the department submits these documents for approval to the federal Centers for Medicare and Medicaid Services (CMS). The bill would require the department to also post on its Internet Web site approval or denial letters, or, if applicable, withdrawal notifications, and accompanying documents for all submitted state plan amendments and federal waiver applications and requests within 10 business days from the date the department receives notification of final approval or denial from CMS, or, if applicable, within 10 business days from when the department notifies CMS of the withdrawal. The bill would require the department to post on its Internet Web site all pending submitted state plan amendments and federal waiver requests, as specified, that were submitted in 2009 and every year thereafter unless already posted pursuant to these provisions.

(7) Existing law states the intent of the Legislature that the State Department of Health Care Services develop Medi-Cal reimbursement rates for clinical laboratory or laboratory services in accordance with specified criteria. Existing law exempts from compliance with a specified regulation laboratory providers reimbursed pursuant to any payment reductions implemented pursuant to these provisions for 12 months following the date of implementation of this reduction.

This bill would extend the length of this exemption from 12 months to 21 months. The bill also would extend the date by which laboratory providers are required to submit certain data reports, for the purposes of establishing reimbursement rates, by an additional 5 months. The bill would also make technical changes to those provisions.

(8) Existing law authorizes the State Department of Health Care Services to enter into contracts with providers licensed to dispense dangerous drugs or devices, as specified, to provide specialized care in the distribution of specialized drugs for Medi-Cal beneficiaries. Existing law requires the department, when implementing those provisions, to, among other things, consult current standards of practice when executing a provider contract, contract with a nonexclusive number of providers that meet the needs of the affected population, and generate an annual report, as prescribed. Under existing law, those provisions pertaining to specialized drugs become inoperative 3 years after the date of implementation or July 1, 2013, whichever is earlier.

This bill would delete the provision making those provisions inoperative and would delete the reporting requirement. This bill would also make technical changes to those provisions.

(9) Existing law limits the total number of Medi-Cal physician office and clinic visits to 7 visits per beneficiary per fiscal year, except as specified.

This bill would delete these provisions.

(10) Existing law requires Medi-Cal beneficiaries to make copayments for specified services and, upon federal approval, existing law revises the copayment rates and makes other related changes, as specified.

This bill would provide that these copayment requirements shall not apply to certain preventive services or any approved adult vaccines and their administration, as specified and that these services shall be provided without any cost sharing by the beneficiary.

(11) Existing law requires the State Department of Health Care Services, in collaboration with specified entities, to create a plan for a performance outcomes system for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) mental health services provided to eligible Medi-Cal beneficiaries under 21 years of age.

This bill would require the department, by February 1, 2014, to convene a stakeholder advisory committee for purposes, among other things, of developing measures for screening and referring Medi-Cal beneficiaries to mental health services and supports, and to make recommendations regarding performance and outcome measures. The bill would require the department to incorporate into the performance outcomes system these screenings and referrals, and to provide an updated performance outcomes system plan to the fiscal and appropriate policy committees of the Legislature by October 1, 2014. The bill would require the department to propose how to implement the updated performance systems outcome plan by January 10, 2015.

(12) Existing law requires the State Department of Health Care Services, to the extent federal participation is available pursuant to an approved state plan amendment, to extend Medi-Cal benefits to independent foster care adolescents, as defined.

This bill would require, until January 1, 2014, the department, using general fund moneys to the extent federal funds are not available, to maintain Medi-Cal eligibility for all former independent foster care adolescents who, on or after July 1, 2013, but no later than December 31, 2013, lose Medi-Cal coverage as a result of attaining 21 years of age.

(13) Existing law provides for a schedule of benefits under the Medi-Cal program, which includes all of the following: emergency and essential diagnostic and restorative dental services, subject to utilization controls, as specified, certain optional adult dental benefits, and enteral nutrition products subject to the Medi-Cal list of enteral nutrition products and utilization controls. Existing law, except as specified, requires that the purchase of enteral nutrition products be limited to those products administered through a feeding tube.

This bill would, on May 1, 2014, or the effective date of any necessary federal financial participation approvals, whichever is later, provide specified dental services be included as a covered medical benefit for persons 21 years of age or older, subject to utilization controls. The bill, effective May 1, 2014, would also provide that the purchase of prescribed enteral nutrition products is a covered benefit, subject to the Medi-Cal list of enteral nutrition products and utilization controls.

(14) Existing law requires the State Department of Health Care Services, subject to federal approval, to authorize a local Low Income Health Program (LIHP) to provide health care services to eligible low-income individuals under certain circumstances. Existing law requires the department, in consultation with participating entities, as defined, to determine actuarially sound per enrollee capitation rates for LIHPs, as specified, and to pay those rates to the participating entity. Existing law requires that, if the participating entity and the department reach an agreement regarding reimbursement rates, the rate be applied no earlier than the first day of the LIHP year in which the parties agree to the rate. Existing law provides an exception to that provision with respect to the LIHP year ending June 30, 2012.

This bill would delete the above-described exception.

(15) Under existing law, the State Department of Social Services is responsible for the licensing of psychiatric health facilities, as defined, and mental health rehabilitation centers, as described, and the approval of certain 72-hour treatment and evaluation facilities. Existing law requires the State Department of Social Services to adopt regulations necessary to implement those provisions.

This bill would transfer, from the State Department of Social Services, those responsibilities related to licensing and approval of those facilities to the State Department of Health Care Services. The bill would authorize the State Department of Health Care Services to adopt regulations necessary to implement those responsibilities. The bill would make various related, technical, and conforming changes to reflect the transfer of those responsibilities.

(16) Existing law provides the Director of Health Care Services with the authority and responsibility to monitor and approve special treatment programs in skilled nursing facilities.

This bill would require the State Department of Health Care Services to conduct annual certification inspections of special treatment programs for the mentally disordered, as specified.

(17) Existing law requires the manufacturer of any cosmetic product subject to regulation by the federal Food and Drug Administration that is sold in this state to, on a schedule and in electronic or other format, determined as specified, provide a complete and accurate list of specified cosmetic products that, as of the date of submission, are sold in the state and that contain any ingredient that is a chemical identified as causing cancer or reproductive toxicity. Existing law includes, among those chemicals identified, any chemical contained in the product for purposes of fragrance or flavoring, and any chemical identified by the phrase “and other ingredients” and determined to be a trade secret, as specified.

This bill would require the State Department of Public Health, on or before December 31, 2013, to develop and make operational a consumer-friendly, public Internet Web site that creates a database of cosmetic product information collected pursuant to those provisions. The bill would require that the database be searchable to accommodate a wide range of users, including users with limited technical and scientific literacy. The bill would require the Internet Web site to include hypertext links to other educational and informational Internet Web sites to enhance consumer understanding.

(18) Existing law establishes the Access for Infants and Mothers (AIM) Program, administered by the Managed Risk Medical Insurance Board. The board contracts with a variety of health plans and health care delivery systems to provide health insurance coverage to eligible persons who pay a subscriber contribution. An “AIM-linked infant” is defined as any infant born to a woman enrolled in AIM after June 30, 2004, and is eligible for health care coverage under the Healthy Families Program. Existing law establishes the Healthy Families Program administered by the board, and provides that eligible subscribers, except certain AIM-linked infants, be transitioned to the Medi-Cal program, no sooner than January 1, 2013.

This bill would terminate eligibility for coverage under the Healthy Families Program for AIM-linked infants, and the board would be required to cease providing health care coverage for those infants on October 1, 2013, or when the State Department of Health Care Services has implemented specified provisions, whichever occurs later. The bill would require the board to coordinate with the State Department of Health Care Services to implement the AIM-Linked Infants Program, which would be created by the bill, including transition of AIM-linked infants to the program. The bill would require the State Department of Health Care Services to administer the AIM-Linked Infants Program, as provided, to address the health care needs of children formerly covered under the Healthy Families Program. The bill would condition the implementation of these provisions on the receipt of federal approvals and the availability of federal financial participation. The bill would also make related and conforming changes.

This bill would also revise the eligibility criteria for the AIM Program by requiring that income be determined, counted, and valued as required under a specified provision of federal law.

(19) Existing law establishes the California Major Risk Medical Insurance Program, which is administered by the Managed Risk Medical Insurance Board, to provide major risk medical coverage to persons who, among other things, have been rejected for coverage by at least one private health plan. Existing law requires the board to establish program contribution amounts for each category of risk for each participating health plan and requires that these amounts be based on the average amount of subsidy funds required for the program as a whole, to be determined in a specified manner. Existing law, for the period commencing January 1, 2013, to December 31, 2013, inclusive, additionally authorizes the program to further subsidize subscriber contributions based on a specified percentage of the standard average individual risk rate for comparable coverage, as specified. Existing law requires the program to pay program contribution amounts to participating health plans from the Major Risk Medical Insurance Fund, a continuously appropriated fund.

This bill would delete the termination date for further subsidization of subscriber contributions. By extending the duration of these subsidies made from a continuously appropriated fund, the bill would make an appropriation.

(20) Existing law requires the Managed Risk Medical Insurance Board to manage a temporary high risk pool to provide health coverage, until January 1, 2014, to specified individuals who have preexisting conditions, consistent with the federal Patient Protection and Affordable Care Act.

This bill would change the termination date to July 1, 2013, except as required by the contract between the board and the United States Department of Health and Human Services, and would no longer require the board to conduct transition activities, as prescribed.

(21) Existing law establishes the California Health Benefit Exchange (Exchange) within state government, specifies the powers and duties of the executive board governing the Exchange, and requires the board to facilitate the purchase of qualified health plans through the Exchange by qualified individuals and small employers by January 1, 2014. Existing law requires the board to undertake outreach and enrollment activities that seek to assist enrollees and potential enrollees with enrolling in the Exchange, and requires the board to inform individuals of eligibility requirements for the Medi-Cal program, the Healthy Families Program, or any applicable state or local public program and, if, through screening of the application by the Exchange, the Exchange determines that an individual is eligible for of those programs, to enroll that individual in the program.

This bill would require the State Department of Health Care Services to accept contributions by private foundations in the amount of at least $14,000,000 for purposes of making payments to entities and persons for Medi-Cal in-person enrollment assistance, as specified, and in the amount of at least $12,500,000 to provide allocations for the management and funding of Medi-Cal outreach and enrollment plans, as specified. The bill would require the State Department of Health Care Services to immediately seek an equal amount of federal matching funds. The bill would also provide for the payment of those enrollment assistance payments, as specified.

(22) Existing law requires the State Department of Health Care Services to seek a demonstration project or federal waiver of Medicaid law to implement specified objectives, which may include better care coordination for seniors, persons with disabilities, and children with special health care needs.

This bill would require the department, commencing no later than August 1, 2013, to convene a series of stakeholder meetings to receive input from clients, family members, providers, counties, and representatives of the Legislature concerning the development of the Behavioral Health Services Plan as required by the Special Terms and Conditions of California’s Bridge to Reform Section 1115(a) Medicaid Demonstration.

(23) Existing law provides specified health care coverage to individuals under the AIDS Drug Assistance Program (ADAP) and under federal Ryan White Act funded programs, which are administered by the State Department of Public Health.

This bill would require the State Department of Public Health to report to the Joint Legislative Budget Committee by October 1, 2013, on whether any of the projections or assumptions used to develop the ADAP estimated budget in the Budget Act of 2013 may result in an inability of ADAP to provide services to ADAP eligible clients. If the State Department of Public Health determines, before October 1, 2013, that ADAP is unable to provide services to ADAP eligible clients, the bill would require the department to notify the committee with 15 calendar days of making that determination.

(24) Existing law establishes the Infant Botulism Treatment and Prevention Program and requires the State Department of Public Health to administer this program.

This bill would require the State Department of Public Health, by October 1, 2013, to submit to the fiscal and appropriate policy committees of the Legislature a report describing how it plans to address the findings and recommendations described in a report relating to this program.

(25) This bill would reappropriate the balance of specified funds appropriated in the Budget Act of 2012 to the Department of Managed Health Care until June 30, 2014, to be used as specified, thereby making an appropriation.

(26) This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.

Vote: majority. Appropriation: yes. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P11   1

SECTION 1.  

Section 680 of the Business and Professions Code
2 is amended to read:

3

680.  

(a) Except as otherwise provided in this section, a health
4care practitioner shall disclose, while working, his or her name
5and practitioner’s license status, as granted by this state, on a name
6tag in at least 18-point type. A health care practitioner in a practice
7or an office, whose license is prominently displayed, may opt to
8not wear a name tag. If a health care practitioner or a licensed
9clinical social worker is working in a psychiatric setting or in a
10setting that is not licensed by the state, the employing entity or
11agency shall have the discretion to make an exception from the
12name tag requirement for individual safety or therapeutic concerns.
13In the interest of public safety and consumer awareness, it shall
14be unlawful for any person to use the title “nurse” in reference to
15himself or herself and in any capacity, except for an individual
16who is a registered nurse or a licensed vocational nurse, or as
17otherwise provided in Section 2800. Nothing in this section shall
18prohibit a certified nurse assistant from using his or her title.

19(b) Facilities licensed by the State Department of Social
20Services, the State Department of Public Health, or the State
21Department of Health Care Services shall develop and implement
22policies to ensure that health care practitioners providing care in
23those facilities are in compliance with subdivision (a). The State
24Department of Social Services, the State Department of Public
25Health, and the State Department of Health Care Services shall
26verify through periodic inspections that the policies required
27pursuant to subdivision (a) have been developed and implemented
28by the respective licensed facilities.

29(c) For purposes of this article, “health care practitioner” means
30any person who engages in acts that are the subject of licensure
31or regulation under this division or under any initiative act referred
32to in this division.

P12   1

SEC. 2.  

Section 6254 of the Government Code is amended to
2read:

3

6254.  

Except as provided in Sections 6254.7 and 6254.13,
4nothing in this chapter shall be construed to require disclosure of
5records that are any of the following:

6(a) Preliminary drafts, notes, or interagency or intra-agency
7memoranda that are not retained by the public agency in the
8ordinary course of business, if the public interest in withholding
9those records clearly outweighs the public interest in disclosure.

10(b) Records pertaining to pending litigation to which the public
11agency is a party, or to claims made pursuant to Division 3.6
12(commencing with Section 810), until the pending litigation or
13claim has been finally adjudicated or otherwise settled.

14(c) Personnel, medical, or similar files, the disclosure of which
15would constitute an unwarranted invasion of personal privacy.

16(d) Contained in or related to any of the following:

17(1) Applications filed with any state agency responsible for the
18regulation or supervision of the issuance of securities or of financial
19institutions, including, but not limited to, banks, savings and loan
20associations, industrial loan companies, credit unions, and
21insurance companies.

22(2) Examination, operating, or condition reports prepared by,
23on behalf of, or for the use of, any state agency referred to in
24paragraph (1).

25(3) Preliminary drafts, notes, or interagency or intra-agency
26communications prepared by, on behalf of, or for the use of, any
27state agency referred to in paragraph (1).

28(4) Information received in confidence by any state agency
29referred to in paragraph (1).

30(e) Geological and geophysical data, plant production data, and
31similar information relating to utility systems development, or
32market or crop reports, that are obtained in confidence from any
33person.

34(f) Records of complaints to, or investigations conducted by,
35or records of intelligence information or security procedures of,
36the office of the Attorney General and the Department of Justice,
37the California Emergency Management Agency, and any state or
38local police agency, or any investigatory or security files compiled
39by any other state or local police agency, or any investigatory or
40security files compiled by any other state or local agency for
P13   1correctional, law enforcement, or licensing purposes. However,
2state and local law enforcement agencies shall disclose the names
3and addresses of persons involved in, or witnesses other than
4confidential informants to, the incident, the description of any
5property involved, the date, time, and location of the incident, all
6diagrams, statements of the parties involved in the incident, the
7statements of all witnesses, other than confidential informants, to
8the victims of an incident, or an authorized representative thereof,
9an insurance carrier against which a claim has been or might be
10made, and any person suffering bodily injury or property damage
11or loss, as the result of the incident caused by arson, burglary, fire,
12 explosion, larceny, robbery, carjacking, vandalism, vehicle theft,
13or a crime as defined by subdivision (b) of Section 13951, unless
14the disclosure would endanger the safety of a witness or other
15person involved in the investigation, or unless disclosure would
16endanger the successful completion of the investigation or a related
17investigation. However, nothing in this division shall require the
18disclosure of that portion of those investigative files that reflects
19the analysis or conclusions of the investigating officer.

20Customer lists provided to a state or local police agency by an
21alarm or security company at the request of the agency shall be
22construed to be records subject to this subdivision.

23Notwithstanding any other provision of this subdivision, state
24and local law enforcement agencies shall make public the following
25information, except to the extent that disclosure of a particular
26item of information would endanger the safety of a person involved
27in an investigation or would endanger the successful completion
28of the investigation or a related investigation:

29(1) The full name and occupation of every individual arrested
30by the agency, the individual’s physical description including date
31of birth, color of eyes and hair, sex, height and weight, the time
32and date of arrest, the time and date of booking, the location of
33the arrest, the factual circumstances surrounding the arrest, the
34amount of bail set, the time and manner of release or the location
35where the individual is currently being held, and all charges the
36individual is being held upon, including any outstanding warrants
37from other jurisdictions and parole or probation holds.

38(2) Subject to the restrictions imposed by Section 841.5 of the
39Penal Code, the time, substance, and location of all complaints or
40requests for assistance received by the agency and the time and
P14   1nature of the response thereto, including, to the extent the
2information regarding crimes alleged or committed or any other
3incident investigated is recorded, the time, date, and location of
4occurrence, the time and date of the report, the name and age of
5the victim, the factual circumstances surrounding the crime or
6incident, and a general description of any injuries, property, or
7weapons involved. The name of a victim of any crime defined by
8Section 220, 236.1, 261, 261.5, 262, 264, 264.1, 265, 266, 266a,
9266b, 266c, 266e, 266f, 266j, 267, 269, 273a, 273d, 273.5, 285,
10286, 288, 288a, 288.2, 288.3 (as added by Chapter 337 of the
11Statutes of 2006), 288.3 (as added by Section 6 of Proposition 83
12of the November 7, 2006, statewide general election), 288.5, 288.7,
13289, 422.6, 422.7, 422.75, 646.9, or 647.6 of the Penal Code may
14be withheld at the victim’s request, or at the request of the victim’s
15parent or guardian if the victim is a minor. When a person is the
16victim of more than one crime, information disclosing that the
17person is a victim of a crime defined in any of the sections of the
18Penal Code set forth in this subdivision may be deleted at the
19request of the victim, or the victim’s parent or guardian if the
20victim is a minor, in making the report of the crime, or of any
21crime or incident accompanying the crime, available to the public
22in compliance with the requirements of this paragraph.

23(3) Subject to the restrictions of Section 841.5 of the Penal Code
24and this subdivision, the current address of every individual
25arrested by the agency and the current address of the victim of a
26crime, where the requester declares under penalty of perjury that
27the request is made for a scholarly, journalistic, political, or
28governmental purpose, or that the request is made for investigation
29purposes by a licensed private investigator as described in Chapter
3011.3 (commencing with Section 7512) of Division 3 of the Business
31and Professions Code. However, the address of the victim of any
32crime defined by Section 220, 236.1, 261, 261.5, 262, 264, 264.1,
33265, 266, 266a, 266b, 266c, 266e, 266f, 266j, 267, 269, 273a,
34273d, 273.5, 285, 286, 288, 288a, 288.2, 288.3 (as added by
35Chapter 337 of the Statutes of 2006), 288.3 (as added by Section
366 of Proposition 83 of the November 7, 2006, statewide general
37election), 288.5, 288.7, 289, 422.6, 422.7, 422.75, 646.9, or 647.6
38of the Penal Code shall remain confidential. Address information
39obtained pursuant to this paragraph may not be used directly or
40indirectly, or furnished to another, to sell a product or service to
P15   1any individual or group of individuals, and the requester shall
2execute a declaration to that effect under penalty of perjury.
3Nothing in this paragraph shall be construed to prohibit or limit a
4scholarly, journalistic, political, or government use of address
5information obtained pursuant to this paragraph.

6(g) Test questions, scoring keys, and other examination data
7used to administer a licensing examination, examination for
8employment, or academic examination, except as provided for in
9Chapter 3 (commencing with Section 99150) of Part 65 of Division
1014 of Title 3 of the Education Code.

11(h) The contents of real estate appraisals or engineering or
12feasibility estimates and evaluations made for or by the state or
13local agency relative to the acquisition of property, or to
14prospective public supply and construction contracts, until all of
15the property has been acquired or all of the contract agreement
16obtained. However, the law of eminent domain shall not be affected
17by this provision.

18(i) Information required from any taxpayer in connection with
19the collection of local taxes that is received in confidence and the
20disclosure of the information to other persons would result in unfair
21competitive disadvantage to the person supplying the information.

22(j) Library circulation records kept for the purpose of identifying
23the borrower of items available in libraries, and library and museum
24materials made or acquired and presented solely for reference or
25 exhibition purposes. The exemption in this subdivision shall not
26apply to records of fines imposed on the borrowers.

27(k) Records, the disclosure of which is exempted or prohibited
28pursuant to federal or state law, including, but not limited to,
29provisions of the Evidence Code relating to privilege.

30(l) Correspondence of and to the Governor or employees of the
31Governor’s office or in the custody of or maintained by the
32Governor’s Legal Affairs Secretary. However, public records shall
33not be transferred to the custody of the Governor’s Legal Affairs
34Secretary to evade the disclosure provisions of this chapter.

35(m) In the custody of or maintained by the Legislative Counsel,
36except those records in the public database maintained by the
37Legislative Counsel that are described in Section 10248.

38(n) Statements of personal worth or personal financial data
39required by a licensing agency and filed by an applicant with the
P16   1licensing agency to establish his or her personal qualification for
2the license, certificate, or permit applied for.

3(o) Financial data contained in applications for financing under
4Division 27 (commencing with Section 44500) of the Health and
5Safety Code, where an authorized officer of the California Pollution
6Control Financing Authority determines that disclosure of the
7financial data would be competitively injurious to the applicant
8and the data is required in order to obtain guarantees from the
9United States Small Business Administration. The California
10Pollution Control Financing Authority shall adopt rules for review
11of individual requests for confidentiality under this section and for
12making available to the public those portions of an application that
13 are subject to disclosure under this chapter.

14(p) Records of state agencies related to activities governed by
15Chapter 10.3 (commencing with Section 3512), Chapter 10.5
16(commencing with Section 3525), and Chapter 12 (commencing
17with Section 3560) of Division 4, that reveal a state agency’s
18deliberative processes, impressions, evaluations, opinions,
19recommendations, meeting minutes, research, work products,
20theories, or strategy, or that provide instruction, advice, or training
21to employees who do not have full collective bargaining and
22representation rights under these chapters. Nothing in this
23subdivision shall be construed to limit the disclosure duties of a
24state agency with respect to any other records relating to the
25activities governed by the employee relations acts referred to in
26this subdivision.

27(q) (1) Records of state agencies related to activities governed
28by Article 2.6 (commencing with Section 14081), Article 2.8
29(commencing with Section 14087.5), and Article 2.91
30(commencing with Section 14089) of Chapter 7 of Part 3 of
31Division 9 of the Welfare and Institutions Code, that reveal the
32special negotiator’s deliberative processes, discussions,
33communications, or any other portion of the negotiations with
34providers of health care services, impressions, opinions,
35recommendations, meeting minutes, research, work product,
36theories, or strategy, or that provide instruction, advice, or training
37to employees.

38(2) Except for the portion of a contract containing the rates of
39payment, contracts for inpatient services entered into pursuant to
40these articles, on or after April 1, 1984, shall be open to inspection
P17   1one year after they are fully executed. If a contract for inpatient
2services that is entered into prior to April 1, 1984, is amended on
3or after April 1, 1984, the amendment, except for any portion
4containing the rates of payment, shall be open to inspection one
5year after it is fully executed. If the California Medical Assistance
6Commission enters into contracts with health care providers for
7other than inpatient hospital services, those contracts shall be open
8to inspection one year after they are fully executed.

9(3) Three years after a contract or amendment is open to
10inspection under this subdivision, the portion of the contract or
11amendment containing the rates of payment shall be open to
12inspection.

13(4) Notwithstanding any other provision of law, the entire
14contract or amendment shall be open to inspection by the Joint
15Legislative Audit Committee and the Legislative Analyst’s Office.
16The committee and that office shall maintain the confidentiality
17of the contracts and amendments until the time a contract or
18amendment is fully open to inspection by the public.

19(r) Records of Native American graves, cemeteries, and sacred
20places and records of Native American places, features, and objects
21described in Sections 5097.9 and 5097.993 of the Public Resources
22Code maintained by, or in the possession of, the Native American
23Heritage Commission, another state agency, or a local agency.

24(s) A final accreditation report of the Joint Commission on
25Accreditation of Hospitals that has been transmitted to the State
26Department of Health Care Services pursuant to subdivision (b)
27of Section 1282 of the Health and Safety Code.

28(t) Records of a local hospital district, formed pursuant to
29Division 23 (commencing with Section 32000) of the Health and
30Safety Code, or the records of a municipal hospital, formed
31pursuant to Article 7 (commencing with Section 37600) or Article
328 (commencing with Section 37650) of Chapter 5 of Part 2 of
33Division 3 of Title 4 of this code, that relate to any contract with
34an insurer or nonprofit hospital service plan for inpatient or
35outpatient services for alternative rates pursuant to Section 10133
36of the Insurance Code. However, the record shall be open to
37inspection within one year after the contract is fully executed.

38(u) (1) Information contained in applications for licenses to
39carry firearms issued pursuant to Section 26150, 26155, 26170,
40or 26215 of the Penal Code by the sheriff of a county or the chief
P18   1or other head of a municipal police department that indicates when
2or where the applicant is vulnerable to attack or that concerns the
3applicant’s medical or psychological history or that of members
4of his or her family.

5(2) The home address and telephone number of prosecutors,
6public defenders, peace officers, judges, court commissioners, and
7magistrates that are set forth in applications for licenses to carry
8firearms issued pursuant to Section 26150, 26155, 26170, or 26215
9of the Penal Code by the sheriff of a county or the chief or other
10head of a municipal police department.

11(3) The home address and telephone number of prosecutors,
12public defenders, peace officers, judges, court commissioners, and
13magistrates that are set forth in licenses to carry firearms issued
14pursuant to Section 26150, 26155, 26170, or 26215 of the Penal
15Code by the sheriff of a county or the chief or other head of a
16municipal police department.

17(v) (1) Records of the Managed Risk Medical Insurance Board
18and the State Department of Health Care Services related to
19activities governed by Part 6.3 (commencing with Section 12695),
20Part 6.5 (commencing with Section 12700), Part 6.6 (commencing
21with Section 12739.5), and Part 6.7 (commencing with Section
2212739.70) of Division 2 of the Insurance Code, and Chapter 2
23(commencing with Section 15850) of Part 3.3 of Division 9 of the
24Welfare and Institutions Code, and that reveal any of the following:

25(A) The deliberative processes, discussions, communications,
26or any other portion of the negotiations with entities contracting
27or seeking to contract with the board or the department, entities
28with which the board or the department is considering a contract,
29 or entities with which the board is considering or enters into any
30other arrangement under which the board or the department
31provides, receives, or arranges services or reimbursement.

32(B) The impressions, opinions, recommendations, meeting
33minutes, research, work product, theories, or strategy of the board
34or its staff or the department or its staff, or records that provide
35instructions, advice, or training to their employees.

36(2) (A) Except for the portion of a contract that contains the
37rates of payment, contracts entered into pursuant to Part 6.3
38(commencing with Section 12695), Part 6.5 (commencing with
39Section 12700), Part 6.6 (commencing with Section 12739.5), or
40Part 6.7 (commencing with Section 12739.70) of Division 2 of the
P19   1Insurance Code, or Chapter 2.2 (commencing with Section 15850)
2of Part 3.3 of Division 9 of the Welfare and Institutions Code, on
3or after July 1, 1991, shall be open to inspection one year after
4their effective dates.

5(B) If a contract that is entered into prior to July 1, 1991, is
6amended on or after July 1, 1991, the amendment, except for any
7portion containing the rates of payment, shall be open to inspection
8one year after the effective date of the amendment.

9(3) Three years after a contract or amendment is open to
10inspection pursuant to this subdivision, the portion of the contract
11or amendment containing the rates of payment shall be open to
12inspection.

13(4) Notwithstanding any other law, the entire contract or
14amendments to a contract shall be open to inspection by the Joint
15Legislative Audit Committee. The committee shall maintain the
16confidentiality of the contracts and amendments thereto, until the
17contracts or amendments to the contracts are open to inspection
18pursuant to paragraph (3).

19(w) (1) Records of the Managed Risk Medical Insurance Board
20related to activities governed by Chapter 8 (commencing with
21Section 10700) of Part 2 of Division 2 of the Insurance Code, and
22that reveal the deliberative processes, discussions, communications,
23or any other portion of the negotiations with health plans, or the
24impressions, opinions, recommendations, meeting minutes,
25research, work product, theories, or strategy of the board or its
26staff, or records that provide instructions, advice, or training to
27employees.

28(2) Except for the portion of a contract that contains the rates
29of payment, contracts for health coverage entered into pursuant to
30Chapter 8 (commencing with Section 10700) of Part 2 of Division
312 of the Insurance Code, on or after January 1, 1993, shall be open
32to inspection one year after they have been fully executed.

33(3) Notwithstanding any other law, the entire contract or
34amendments to a contract shall be open to inspection by the Joint
35Legislative Audit Committee. The committee shall maintain the
36confidentiality of the contracts and amendments thereto, until the
37contracts or amendments to the contracts are open to inspection
38pursuant to paragraph (2).

39(x) Financial data contained in applications for registration, or
40 registration renewal, as a service contractor filed with the Director
P20   1of Consumer Affairs pursuant to Chapter 20 (commencing with
2Section 9800) of Division 3 of the Business and Professions Code,
3for the purpose of establishing the service contractor’s net worth,
4or financial data regarding the funded accounts held in escrow for
5service contracts held in force in this state by a service contractor.

6(y) (1) Records of the Managed Risk Medical Insurance Board
7related to activities governed by Part 6.2 (commencing with Section
812693) or Part 6.4 (commencing with Section 12699.50) of
9Division 2 of the Insurance Code, and that reveal any of the
10following:

11(A) The deliberative processes, discussions, communications,
12or any other portion of the negotiations with entities contracting
13or seeking to contract with the board, entities with which the board
14is considering a contract, or entities with which the board is
15considering or enters into any other arrangement under which the
16board provides, receives, or arranges services or reimbursement.

17(B) The impressions, opinions, recommendations, meeting
18minutes, research, work product, theories, or strategy of the board
19or its staff, or records that provide instructions, advice, or training
20to employees.

21(2) (A) Except for the portion of a contract that contains the
22rates of payment, contracts entered into pursuant to Part 6.2
23(commencing with Section 12693) or Part 6.4 (commencing with
24Section 12699.50) of Division 2 of the Insurance Code, on or after
25January 1, 1998, shall be open to inspection one year after their
26effective dates.

27(B) If a contract entered into pursuant to Part 6.2 (commencing
28with Section 12693) or Part 6.4 (commencing with Section
2912699.50) of Division 2 of the Insurance Code is amended, the
30amendment shall be open to inspection one year after the effective
31date of the amendment.

32(3) Three years after a contract or amendment is open to
33inspection pursuant to this subdivision, the portion of the contract
34or amendment containing the rates of payment shall be open to
35inspection.

36(4) Notwithstanding any other law, the entire contract or
37amendments to a contract shall be open to inspection by the Joint
38Legislative Audit Committee. The committee shall maintain the
39confidentiality of the contracts and amendments thereto until the
P21   1contract or amendments to a contract are open to inspection
2pursuant to paragraph (2) or (3).

3(5) The exemption from disclosure provided pursuant to this
4subdivision for the contracts, deliberative processes, discussions,
5communications, negotiations, impressions, opinions,
6recommendations, meeting minutes, research, work product,
7theories, or strategy of the board or its staff shall also apply to the
8contracts, deliberative processes, discussions, communications,
9negotiations, impressions, opinions, recommendations, meeting
10minutes, research, work product, theories, or strategy of applicants
11pursuant to Part 6.4 (commencing with Section 12699.50) of
12Division 2 of the Insurance Code.

13(z) Records obtained pursuant to paragraph (2) of subdivision
14(f) of Section 2891.1 of the Public Utilities Code.

15(aa) A document prepared by or for a state or local agency that
16assesses its vulnerability to terrorist attack or other criminal acts
17intended to disrupt the public agency’s operations and that is for
18distribution or consideration in a closed session.

19(ab) Critical infrastructure information, as defined in Section
20131(3) of Title 6 of the United States Code, that is voluntarily
21submitted to the California Emergency Management Agency for
22use by that office, including the identity of the person who or entity
23that voluntarily submitted the information. As used in this
24subdivision, “voluntarily submitted” means submitted in the
25absence of the office exercising any legal authority to compel
26access to or submission of critical infrastructure information. This
27subdivision shall not affect the status of information in the
28possession of any other state or local governmental agency.

29(ac) All information provided to the Secretary of State by a
30person for the purpose of registration in the Advance Health Care
31Directive Registry, except that those records shall be released at
32the request of a health care provider, a public guardian, or the
33 registrant’s legal representative.

34(ad) The following records of the State Compensation Insurance
35Fund:

36(1) Records related to claims pursuant to Chapter 1
37(commencing with Section 3200) of Division 4 of the Labor Code,
38to the extent that confidential medical information or other
39individually identifiable information would be disclosed.

P22   1(2) Records related to the discussions, communications, or any
2other portion of the negotiations with entities contracting or seeking
3to contract with the fund, and any related deliberations.

4(3) Records related to the impressions, opinions,
5recommendations, meeting minutes of meetings or sessions that
6are lawfully closed to the public, research, work product, theories,
7or strategy of the fund or its staff, on the development of rates,
8contracting strategy, underwriting, or competitive strategy pursuant
9to the powers granted to the fund in Chapter 4 (commencing with
10Section 11770) of Part 3 of Division 2 of the Insurance Code.

11(4) Records obtained to provide workers’ compensation
12insurance under Chapter 4 (commencing with Section 11770) of
13Part 3 of Division 2 of the Insurance Code, including, but not
14limited to, any medical claims information, policyholder
15information provided that nothing in this paragraph shall be
16interpreted to prevent an insurance agent or broker from obtaining
17proprietary information or other information authorized by law to
18be obtained by the agent or broker, and information on rates,
19pricing, and claims handling received from brokers.

20(5) (A) Records that are trade secrets pursuant to Section
216276.44, or Article 11 (commencing with Section 1060) of Chapter
224 of Division 8 of the Evidence Code, including without limitation,
23instructions, advice, or training provided by the State Compensation
24Insurance Fund to its board members, officers, and employees
25regarding the fund’s special investigation unit, internal audit unit,
26and informational security, marketing, rating, pricing, underwriting,
27claims handling, audits, and collections.

28(B) Notwithstanding subparagraph (A), the portions of records
29containing trade secrets shall be available for review by the Joint
30Legislative Audit Committee, the Bureau of State Audits, Division
31of Workers’ Compensation, and the Department of Insurance to
32ensure compliance with applicable law.

33(6) (A) Internal audits containing proprietary information and
34the following records that are related to an internal audit:

35(i) Personal papers and correspondence of any person providing
36assistance to the fund when that person has requested in writing
37that his or her papers and correspondence be kept private and
38confidential. Those papers and correspondence shall become public
39records if the written request is withdrawn, or upon order of the
40fund.

P23   1(ii) Papers, correspondence, memoranda, or any substantive
2information pertaining to any audit not completed or an internal
3audit that contains proprietary information.

4(B) Notwithstanding subparagraph (A), the portions of records
5containing proprietary information, or any information specified
6in subparagraph (A) shall be available for review by the Joint
7Legislative Audit Committee, the Bureau of State Audits, Division
8of Workers’ Compensation, and the Department of Insurance to
9ensure compliance with applicable law.

10(7) (A) Except as provided in subparagraph (C), contracts
11entered into pursuant to Chapter 4 (commencing with Section
1211770) of Part 3 of Division 2 of the Insurance Code shall be open
13to inspection one year after the contract has been fully executed.

14(B) If a contract entered into pursuant to Chapter 4 (commencing
15with Section 11770) of Part 3 of Division 2 of the Insurance Code
16is amended, the amendment shall be open to inspection one year
17after the amendment has been fully executed.

18(C) Three years after a contract or amendment is open to
19inspection pursuant to this subdivision, the portion of the contract
20or amendment containing the rates of payment shall be open to
21inspection.

22(D) Notwithstanding any other law, the entire contract or
23amendments to a contract shall be open to inspection by the Joint
24Legislative Audit Committee. The committee shall maintain the
25confidentiality of the contracts and amendments thereto until the
26contract or amendments to a contract are open to inspection
27pursuant to this paragraph.

28(E) This paragraph is not intended to apply to documents related
29to contracts with public entities that are not otherwise expressly
30confidential as to that public entity.

31(F) For purposes of this paragraph, “fully executed” means the
32point in time when all of the necessary parties to the contract have
33signed the contract.

34This section shall not prevent any agency from opening its
35records concerning the administration of the agency to public
36inspection, unless disclosure is otherwise prohibited by law.

37This section shall not prevent any health facility from disclosing
38to a certified bargaining agent relevant financing information
39pursuant to Section 8 of the National Labor Relations Act (29
40U.S.C. Sec. 158).

P24   1

SEC. 3.  

Section 26605.6 of the Government Code is amended
2to read:

3

26605.6.  

(a) The sheriff, or his or her designee, has the
4authority, after conferring with a physician who has oversight for
5providing medical care at a county jail, or that physician’s designee,
6to release from a county correctional facility, a prisoner sentenced
7to a county jail if the sheriff determines that the prisoner would
8not reasonably pose a threat to public safety and the prisoner, upon
9diagnosis by the examining physician, is deemed to have a life
10expectancy of six months or less.

11(b) Before the release of any prisoner pursuant to this section,
12the sheriff shall notify the presiding judge of the superior court of
13his or her intention to release the prisoner. This notification shall
14include:

15(1) The prisoner’s name.

16(2) The offense or offenses for which the prisoner was
17incarcerated, if applicable, and the pending charges, if applicable.

18(3) The date of sentence, if applicable.

19(4) The physician’s diagnosis of the prisoner’s condition.

20(5) The physician’s prognosis for the prisoner’s recovery.

21(6) The prisoner’s address after release.

22(c) (1) This section shall be implemented only to the extent that
23a county that releases a prisoner pursuant to this section does both
24of the following:

25(A) Sends a letter to the State Department of Health Care
26Services agreeing to do both of the following:

27(i) Notify the State Department of Health Care Services, in
28writing, when a prisoner released pursuant to this section has
29applied for Medi-Cal.

30(ii) Notify the State Department of Health Care Services, in
31writing, if a prisoner released pursuant to this section, who is
32Medi-Cal eligible, is returned to the custody of the sheriff.

33(B) For the period of time that the offender would otherwise
34have been incarcerated:

35(i) Reimburses the State Department of Health Care Services
36for the nonfederal share of the Medi-Cal costs and any medical
37costs paid by the State Department of Health Care Services that
38are not reimbursable pursuant to Title XIX or XXI of the federal
39Social Security Act, for an offender released pursuant to this
40section.

P25   1(ii) Provides to the State Department of Health Care Services
2the nonfederal share of the state’s administrative costs associated
3with this section.

4(2) It is the intent of the Legislature that the implementation of
5this section shall not result in increased costs to the General Fund.

6(3) Participation in the program under this section is voluntary
7for purposes of all applicable federal law. This section shall be
8implemented only to the extent that federal financial participation
9for the Medi-Cal program is not jeopardized.

10(d) Before a prisoner’s compassionate release from a county
11jail pursuant to this section, the sheriff, or his or her designee, shall
12secure a placement option for the prisoner in the community and,
13in consultation with the county welfare department or another
14applicable county agency, examine the prisoner’s eligibility for
15federal Medicaid benefits or other medical coverage that might
16assist in funding the prisoner’s medical treatment while in the
17community.

18(e) (1) For any prisoner released pursuant to this section who
19is eligible for Medi-Cal, the county shall continue to pay the
20nonfederal share of the prisoner’s Medi-Cal costs for the period
21of time that the offender would have otherwise been incarcerated.

22(2) For any prisoner granted compassionate release pursuant to
23this section who is ineligible for Medi-Cal, the county shall
24consider whether the prisoner has private medical insurance or
25sufficient income or assets to provide for his or her own medical
26care. If the county determines that the prisoner can provide for his
27or her own medical care, the county shall not be required to provide
28the prisoner with medical care.

29(f) This section shall not be construed as authorizing the sheriff
30to refuse to receive and incarcerate a defendant or sentenced
31individual who is not in need of immediate medical care or who
32has a terminal medical condition.

33(g) Notwithstanding any other law, the State Department of
34Health Care Services may exempt individuals released pursuant
35to this section from mandatory enrollment in managed health care,
36including county-organized health plans and, as deemed necessary
37by the State Department of Health Care Services, may determine
38the proper prior authorization process for individuals who have
39been released pursuant to this section.

P26   1(h) Notwithstanding Chapter 3.5 (commencing with Section
211340) of Part 1 of Division 3 of Title 2, the State Department of
3Health Care Services, without taking any further regulatory action,
4shall implement, interpret, and make specific this section by means
5of provider bulletins, all-county letters, manuals, or similar
6instructions until the time that regulations are adopted. Thereafter,
7the department shall adopt regulations in accordance with Chapter
83.5 (commencing with Section 11340) of Part 1 of Division 3 of
9Title 2. Six months after the effective date of the act that added
10this subdivision, the department shall provide a status update to
11the Legislature on its efforts to adopt the regulations. Thereafter,
12notwithstanding Section 10231.5, the department shall report on
13the status of this effort to the Legislature on an annual basis, until
14the regulations have been adopted.

15

SEC. 4.  

Section 26605.7 of the Government Code is amended
16to read:

17

26605.7.  

(a) The sheriff, or his or her designee, after conferring
18with the physician who has oversight for providing medical care,
19or the physician’s designee, may request the court to grant medical
20probation or to resentence a prisoner to medical probation in lieu
21of jail time for any prisoner sentenced to a county jail under either
22of the following circumstances:

23(1) The prisoner is physically incapacitated with a medical
24condition that renders the prisoner permanently unable to perform
25activities of basic daily living, which has resulted in the prisoner
26requiring 24-hour care, if that incapacitation did not exist at the
27time of sentencing.

28(2) The prisoner would require acute long-term inpatient
29 rehabilitation services.

30(b) Before a prisoner’s release to medical probation, the sheriff,
31or his or her designee, shall secure a placement option for the
32prisoner in the community and, in consultation with the county
33welfare department or another applicable county agency, examine
34the prisoner’s eligibility for federal Medicaid benefits or other
35medical coverage that might assist in funding the prisoner’s
36medical treatment while in the community.

37(c) During the time on probation pursuant to this section, the
38probation officer or court may, at any time, request a medical
39reexamination of the probationer by a physician who has oversight
40for providing medical care to prisoners in a county jail, or the
P27   1physician’s designee. If the court determines, based on that medical
2examination, that the probationer’s medical condition has improved
3to the extent that the probationer no longer qualifies for medical
4probation, the court may return the probationer to the custody of
5the sheriff.

6(d) (1) For any probationer granted medical probation pursuant
7to this section who is eligible for Medi-Cal, the county shall
8continue to pay the nonfederal share of the probationer’s Medi-Cal
9costs. After a probationer is released from medical probation, the
10county shall no longer be required to pay the nonfederal share of
11the Medi-Cal costs.

12(2) For any probationer granted medical probation pursuant to
13this section who is ineligible for Medi-Cal, the county shall
14consider whether the probationer has private medical insurance or
15sufficient income or assets to provide for his or her own medical
16care. If the county determines that the probationer can provide for
17his or her own medical care, the county shall not be required to
18provide the probationer with medical care.

19(e) (1) This section shall be implemented only to the extent that
20a court sentences a person to medical probation pursuant to this
21section and the sheriff does both of the following:

22(A) Sends a letter to the State Department of Health Care
23Services agreeing to do both of the following:

24(i) Notify the State Department of Health Care Services, in
25writing, when a probationer released pursuant to this section has
26applied for Medi-Cal.

27(ii) Notify the State Department of Health Care Services, in
28writing, if a probationer released pursuant to this section, who is
29Medi-Cal eligible, is returned to the custody of the sheriff. The
30chief probation officer shall notify the State Department of Health
31Care Services, in writing, when a Medi-Cal eligible probationer’s
32term of medical probation ends.

33(B) For the period of time the offender is on medical probation:

34(i) Reimburses the State Department of Health Care Services
35for the nonfederal share of the Medi-Cal costs and any medical
36costs paid by the State Department of Health Care Services that
37are not reimbursable pursuant to Title XIX or XXI of the federal
38Social Security Act, for an offender released pursuant to this
39section.

P28   1(ii) Provides to the State Department of Health Care Services
2the nonfederal share of the state’s administrative costs associated
3with this section.

4(2) It is the intent of the Legislature that the implementation of
5this section shall not result in increased costs to the General Fund.

6(3) Participation in the program under this section is voluntary
7for purposes of all applicable federal law. This section shall be
8implemented only to the extent that federal financial participation
9for the Medi-Cal program is not jeopardized.

10(f) Notwithstanding any other law, the State Department of
11Health Care Services may exempt individuals released pursuant
12to this section from mandatory enrollment in managed health care,
13including county-organized health plans and, as deemed necessary
14by the State Department of Health Care Services, may determine
15the proper prior authorization process for individuals who have
16been released pursuant to this section.

17(g) Notwithstanding Chapter 3.5 (commencing with Section
1811340) of Part 1 of Division 3 of Title 2, the State Department of
19Health Care Services, without taking any further regulatory action,
20may implement, interpret, and make specific this section by means
21of provider bulletins, all-county letters, manuals, or similar
22instructions until the time that regulations are adopted. Thereafter,
23the department shall adopt regulations in accordance with Chapter
243.5 (commencing with Section 11340) of Part 1 of Division 3 of
25Title 2. Six months after the effective date of the act that added
26this subdivision, the department shall provide a status update to
27the Legislature on its efforts to adopt the regulations. Thereafter,
28notwithstanding Section 10231.5, the department shall report on
29the status of this effort to the Legislature on an annual basis, until
30the regulations have been adopted.

31

SEC. 5.  

Section 26605.8 of the Government Code is amended
32to read:

33

26605.8.  

Before implementing Sections 26605.6 and 26605.7,
34the county board of supervisors shall adopt a process to fund the
35nonfederal share of Medi-Cal costs for the period of time that a
36prisoner would have otherwise been incarcerated or for the period
37of time that a probationer is on medical probation. The county
38board of supervisors shall provide the State Department of Health
39Care Services with written notification of the process.

P29   1

SEC. 6.  

Section 1180.6 of the Health and Safety Code is
2amended to read:

3

1180.6.  

The State Department of Public Health, the State
4Department of State Hospitals, the State Department of Social
5Services, the State Department of Developmental Services, and
6the State Department of Health Care Services shall annually
7provide information to the Legislature, during Senate and Assembly
8budget committee hearings, about the progress made in
9implementing this division. This information shall include the
10progress of implementation and barriers to achieving full
11implementation.

12

SEC. 7.  

Section 1250.2 of the Health and Safety Code is
13amended to read:

14

1250.2.  

(a) (1) As defined in Section 1250, “health facility”
15includes a “psychiatric health facility,” defined to mean a health
16facility, licensed by the State Department of Health Care Services,
17that provides 24-hour inpatient care for mentally disordered,
18incompetent, or other persons described in Division 5 (commencing
19with Section 5000) or Division 6 (commencing with Section 6000)
20of the Welfare and Institutions Code. This care shall include, but
21not be limited to, the following basic services: psychiatry, clinical
22psychology, psychiatric nursing, social work, rehabilitation, drug
23administration, and appropriate food services for those persons
24whose physical health needs can be met in an affiliated hospital
25or in outpatient settings.

26(2) It is the intent of the Legislature that the psychiatric health
27facility shall provide a distinct type of service to psychiatric
28patients in a 24-hour acute inpatient setting. The State Department
29of Health Care Services shall require regular utilization reviews
30of admission and discharge criteria and lengths of stay in order to
31assure that these patients are moved to less restrictive levels of
32care as soon as appropriate.

33(b) (1) The State Department of Health Care Services may issue
34a special permit to a psychiatric health facility for it to provide
35structured outpatient services (commonly referred to as SOPS)
36consisting of morning, afternoon, or full daytime organized
37programs, not exceeding 10 hours, for acute daytime care for
38patients admitted to the facility. This subdivision shall not be
39construed as requiring a psychiatric health facility to apply for a
40special permit to provide these alternative levels of care.

P30   1(2) The Legislature recognizes that, with access to structured
2outpatient services, as an alternative to 24-hour inpatient care,
3certain patients would be provided with effective intervention and
4less restrictive levels of care. The Legislature further recognizes
5that, for certain patients, the less restrictive levels of care eliminate
6the need for inpatient care, enable earlier discharge from inpatient
7care by providing a continuum of care with effective aftercare
8services, or reduce or prevent the need for a subsequent readmission
9to inpatient care.

10(c) Any reference in any statute to Section 1250 of the Health
11and Safety Code shall be deemed and construed to also be a
12reference to this section.

13(d) Notwithstanding any other provision of law, and to the extent
14consistent with federal law, a psychiatric health facility shall be
15eligible to participate in the medicare program under Title XVIII
16of the federal Social Security Act (42 U.S.C. Sec. 1395 et seq.),
17and the medicaid program under Title XIX of the federal Social
18Security Act (42 U.S.C. Sec. 1396 et seq.), if all of the following
19conditions are met:

20(1) The facility is a licensed facility.

21(2) The facility is in compliance with all related statutes and
22regulations enforced by the State Department of Health Care
23Services, including regulations contained in Chapter 9
24(commencing with Section 77001) of Division 5 of Title 22 of the
25California Code of Regulations.

26(3) The facility meets the definitions and requirements contained
27in subdivisions (e) and (f) of Section 1861 of the federal Social
28 Security Act (42 U.S.C. Sec. 1395x(e) and (f)), including the
29approval process specified in Section 1861(e)(7)(B) of the federal
30Social Security Act (42 U.S.C. Sec. 1395x(e)(7)(B)), which
31requires that the state agency responsible for licensing hospitals
32has assured that the facility meets licensing requirements.

33(4) The facility meets the conditions of participation for hospitals
34pursuant to Part 482 of Title 42 of the Code of Federal Regulations.

35

SEC. 8.  

Section 1254 of the Health and Safety Code is amended
36to read:

37

1254.  

(a) Except as provided in subdivision (e), the state
38department shall inspect and license health facilities. The state
39department shall license health facilities to provide their respective
40basic services specified in Section 1250. Except as provided in
P31   1Section 1253, the state department shall inspect and approve a
2general acute care hospital to provide special services as specified
3in Section 1255. The state department shall develop and adopt
4regulations to implement the provisions contained in this section.

5(b) Upon approval, the state department shall issue a separate
6license for the provision of the basic services enumerated in
7subdivision (c) or (d) of Section 1250 whenever these basic services
8are to be provided by an acute care hospital, as defined in
9 subdivision (a), (b), or (f) of that section, where the services
10enumerated in subdivision (c) or (d) of Section 1250 are to be
11provided in any separate freestanding facility, whether or not the
12location of the separate freestanding facility is contiguous to the
13acute care hospital. The same requirement shall apply to any new
14freestanding facility constructed for the purpose of providing basic
15services, as defined in subdivision (c) or (d) of Section 1250, by
16any acute care hospital on or after January 1, 1984.

17(c) (1) Those beds licensed to an acute care hospital which,
18prior to January 1, 1984, were separate freestanding beds and were
19not part of the physical structure licensed to provide acute care,
20and which beds were licensed to provide those services enumerated
21in subdivision (c) or (d) of Section 1250, are exempt from the
22requirements of subdivision (b).

23(2) All beds licensed to an acute care hospital and located within
24the physical structure in which acute care is provided are exempt
25from the requirements of subdivision (b) irrespective of the date
26of original licensure of the beds, or the licensed category of the
27beds.

28(3) All beds licensed to an acute care hospital owned and
29operated by the State of California or any other public agency are
30exempt from the requirements of subdivision (b).

31(4) All beds licensed to an acute care hospital in a rural area as
32defined by Chapter 1010, of the Statutes of 1982, are exempt from
33the requirements of subdivision (b), except where there is a
34freestanding skilled nursing facility or intermediate care facility
35which has experienced an occupancy rate of 95 percent or less
36during the past 12 months within a 25-mile radius or which may
37be reached within 30 minutes using a motor vehicle.

38(5) All beds licensed to an acute care hospital which meet the
39criteria for designation within peer group six or eight, as defined
40in the report entitled Hospital Peer Grouping for Efficiency
P32   1Comparison, dated December 20, 1982, and published by the
2California Health Facilities Commission, and all beds in hospitals
3which have fewer than 76 licensed acute care beds and which are
4located in a census designation place of 15,000 or less population,
5are exempt from the requirements of subdivision (b), except where
6there is a free-standing skilled nursing facility or intermediate care
7facility which has experienced an occupancy rate of 95 percent or
8less during the past 12 months within a 25-mile radius or which
9may be reached within 30 minutes using a motor vehicle.

10(6) All beds licensed to an acute care hospital which has had a
11certificate of need approved by a health systems agency on or
12before July 1, 1983, are exempt from the requirements of
13subdivision (b).

14(7) All beds licensed to an acute care hospital are exempt from
15the requirements of subdivision (b), if reimbursement from the
16Medi-Cal program for beds licensed for the provision of services
17enumerated in subdivision (c) or (d) of Section 1250 and not
18otherwise exempt does not exceed the reimbursement which would
19be received if the beds were in a separately licensed facility.

20(d) Except as provided in Section 1253, the state department
21shall inspect and approve a general acute care hospital to provide
22special services as specified in Section 1255. The state department
23shall develop and adopt regulations to implement subdivisions (a)
24to (d), inclusive, of this section.

25(e) The State Department of Health Care Services shall inspect
26and license psychiatric health facilities. The State Department of
27Health Care Services shall license psychiatric health facilities to
28provide their basic services specified in Section 1250.2. The State
29Department of Health Care Services shall develop, adopt, or amend
30regulations to implement this subdivision.

31

SEC. 9.  

Section 1254.1 of the Health and Safety Code is
32amended to read:

33

1254.1.  

(a) The State Department of Health Care Services
34shall license psychiatric health facilities to provide their basic
35services specified in Section 1250.

36(b) Any reference in any statute to Section 1254 shall be deemed
37and construed to also be a reference to this section.

38

SEC. 10.  

Section 1266.1 of the Health and Safety Code is
39amended to read:

P33   1

1266.1.  

(a) Each new or renewal application for a license for
2a psychiatric health facility shall be accompanied by a fee credited
3to the State Department of Health Care Services for its costs
4incurred in the review of psychiatric health facility programs, in
5connection with the licensing of these facilities. The amount of
6the fees shall be determined and collected by the State Department
7of Health Care Services, but the total amount of the fees collected
8shall not exceed the actual costs of licensure and review of
9psychiatric health facility programs, including, but not limited to,
10the costs of processing the application, inspection costs, and other
11related costs.

12(b) New or renewal licensure application fees for psychiatric
13health facilities shall be collected by the State Department of Health
14Care Services.

15(c) The annual fees shall be waived for any psychiatric health
16facility conducted, maintained, or operated by this state or any
17state department, authority, bureau, commission, or officer, or by
18the Regents of the University of California, or by a local hospital
19district, city, county, or city and county.

20(d) If additional private psychiatric health facilities seek new
21licensure on or after January 1, 1991, the State Department of
22Health Care Services may increase the fees for all private
23psychiatric health facilities with more than nine beds sufficient to
24accommodate the increased level of workload and costs.

25(e) (1) Any licensee desiring to obtain a special permit to offer
26and provide structured outpatient services shall file an application
27with the State Department of Health Care Services.

28(2) The application for a special permit, if any, shall be
29submitted with each new or renewal application for a license for
30a psychiatric health facility, and shall be accompanied by a
31reasonable fee, as determined by the State Department of Health
32Care Services, not to exceed the actual costs of administration
33related to the special permit. An application for a special permit
34submitted by a psychiatric health facility operated by a public
35entity shall be exempt from the fee required pursuant to this section
36for the issuance of the special permit.

37(3) The State Department of Health Care Services shall not issue
38a special permit unless the applicant furnishes all of the following:

39(A) Its annual licensing fee required pursuant to subdivision
40(a).

P34   1(B) A completed application submitted on forms furnished by
2the department.

3(C) A written agreement ensuring that the facility will have
4additional staffing for the services to be provided under the special
5permit, that the additional staffing will meet the same professional
6standards as required by regulation for inpatient services, and that
7a coordinator of these services will be appointed.

8(D) Any other information or documentation as may be required
9by the department for its proper and efficient administration and
10enforcement of special permit services.

11(4) The provision of structured outpatient services pursuant to
12a special permit may be as an alternative to admission to inpatient
13services, as aftercare services following discharge from inpatient
14care, or as both.

15

SEC. 11.  

Section 1275.1 of the Health and Safety Code is
16amended to read:

17

1275.1.  

(a) Notwithstanding any rules or regulations governing
18other health facilities, the regulations developed by the State
19Department of Health Care Services, or a predecessor, for
20psychiatric health facilities shall prevail. The regulations applying
21to psychiatric health facilities shall prescribe standards of adequacy,
22safety, and sanitation of the physical plant, of staffing with duly
23qualified licensed personnel, and of services based on the needs
24of the persons served thereby.

25(b) The regulations shall include standards appropriate for two
26levels of disorder:

27(1) Involuntary ambulatory psychiatric patients.

28(2) Voluntary ambulatory psychiatric patients.

29For purposes of this subdivision, “ambulatory patients” shall
30include, but not be limited to, deaf, blind, and physically
31handicapped persons. Disoriented persons who are not bedridden
32or confined to a wheelchair shall also be considered as ambulatory
33patients.

34(c) The regulations shall not require, but may permit building
35and services requirements for hospitals which are only applicable
36to physical health care needs of patients that can be met in an
37affiliated hospital or in outpatient settings including, but not limited
38to, such requirements as surgical, dietary, laboratory, laundry,
39central supply, radiologic, and pharmacy.

P35   1(d) The regulations shall include provisions for an “open
2planning” architectural concept.

3(e) The regulations shall exempt from seismic requirements all
4structures of Type V and of one-story construction.

5(f) Standards for involuntary patients shall include provisions
6to allow for restraint and seclusion of patients. These standards
7shall provide for adequate safeguards for patient safety and
8protection of patient rights.

9(g) The regulations shall provide for the retention by the
10psychiatric health facility of a consultant pharmacist, who shall
11supervise and review pharmaceutical services within the facility
12and perform any other services, including prevention of the
13unlawful diversion of controlled substances subject to abuse, as
14the State Department of Health Care Services may by regulation
15require. Regulations adopted pursuant to this subdivision shall
16take into consideration the varying bed sizes of psychiatric health
17facilities.

18

SEC. 12.  

Section 1275.5 of the Health and Safety Code is
19amended to read:

20

1275.5.  

(a) The regulations relating to the licensing of
21hospitals, heretofore adopted by the State Department of Public
22Health pursuant to former Chapter 2 (commencing with Section
231400) of Division 2, and in effect immediately prior to July 1,
241973, shall remain in effect and shall be fully enforceable with
25respect to any hospital required to be licensed by this chapter,
26unless and until the regulations are readopted, amended, or repealed
27by the director.

28(b) The regulations relating to private institutions receiving or
29caring for any mentally disordered persons, intellectually disabled
30persons, and other incompetent persons, heretofore adopted by the
31Department of Mental Hygiene pursuant to Chapter 1 (commencing
32with Section 7000) of Division 7 of the Welfare and Institutions
33Code, and in effect immediately prior to July 1, 1973, shall remain
34in effect and shall be fully enforceable with respect to any facility,
35establishment, or institution for the reception and care of mentally
36disordered persons, intellectually disabled persons and other
37incompetent persons, required to be licensed by the provisions of
38this chapter unless and until said regulations are readopted,
39amended, or repealed by the director.

P36   1(c) (1) All regulations relating to the licensing of psychiatric
2health facilities heretofore adopted by the State Department of
3Health Services, pursuant to authority now vested in the State
4Department of Health Care Services by Section 4080 of the Welfare
5and Institutions Code, and in effect immediately preceding
6September 20, 1988, shall remain in effect and shall be fully
7enforceable by the State Department of Health Care Services with
8respect to any facility or program required to be licensed as a
9psychiatric health facility, unless and until readopted, amended,
10or repealed by the Director of Health Care Services.

11(2) The State Department of Health Care Services shall succeed
12to and be vested with all duties, powers, purposes, functions,
13responsibilities, and jurisdiction as they relate to licensing
14psychiatric health facilities.

15

SEC. 13.  

Section 1324.9 of the Health and Safety Code is
16amended to read:

17

1324.9.  

(a) The Long-Term Care Quality Assurance Fund is
18hereby created in the State Treasury. Moneys in the fund shall be
19available, upon appropriation by the Legislature, for expenditure
20by the State Department of Health Care Services for the purposes
21of this article and Article 7.6 (commencing with Section 1324.20).
22Notwithstanding Section 16305.7 of the Government Code, the
23fund shall contain all interest and dividends earned on moneys in
24the fund.

25(b) Notwithstanding any other law, beginning August 1, 2013,
26all revenues received by the State Department of Health Care
27Services categorized by the State Department of Health Care
28Services as long-term care quality assurance fees shall be deposited
29into the Long-Term Care Quality Assurance Fund. Revenue that
30shall be deposited into this fund shall include quality assurance
31fees imposed pursuant to this article and quality assurance fees
32imposed pursuant to Article 7.6 (commencing with Section
331324.20).

34(c) Notwithstanding any other law, the Controller may use the
35funds in the Long-Term Care Quality Assurance Fund for cashflow
36loans to the General Fund as provided in Sections 16310 and 16381
37of the Government Code.

38

SEC. 14.  

Section 1373 of the Health and Safety Code is
39amended to read:

P37   1

1373.  

(a) (1) A plan contract may not provide an exception
2for other coverage if the other coverage is entitlement to Medi-Cal
3benefits under Chapter 7 (commencing with Section 14000) or
4Chapter 8 (commencing with Section 14200) of Part 3 of Division
59 of the Welfare and Institutions Code, or Medicaid benefits under
6Subchapter 19 (commencing with Section 1396) of Chapter 7 of
7Title 42 of the United States Code.

8(2) Each plan contract shall be interpreted not to provide an
9exception for the Medi-Cal or Medicaid benefits.

10(3) A plan contract shall not provide an exemption for
11enrollment because of an applicant’s entitlement to Medi-Cal
12benefits under Chapter 7 (commencing with Section 14000) or
13Chapter 8 (commencing with Section 14200) of Part 3 of Division
149 of the Welfare and Institutions Code, or Medicaid benefits under
15Subchapter 19 (commencing with Section 1396) of Chapter 7 of
16Title 42 of the United States Code.

17(4) A plan contract may not provide that the benefits payable
18thereunder are subject to reduction if the individual insured has
19entitlement to the Medi-Cal or Medicaid benefits.

20(b) (1) A plan contract that provides coverage, whether by
21specific benefit or by the effect of general wording, for sterilization
22operations or procedures shall not impose any disclaimer,
23restriction on, or limitation of, coverage relative to the covered
24individual’s reason for sterilization.

25(2) As used in this section, “sterilization operations or
26procedures” shall have the same meaning as that specified in
27Section 10120 of the Insurance Code.

28(c) Every plan contract that provides coverage to the spouse or
29dependents of the subscriber or spouse shall grant immediate
30accident and sickness coverage, from and after the moment of
31birth, to each newborn infant of any subscriber or spouse covered
32and to each minor child placed for adoption from and after the date
33on which the adoptive child’s birth parent or other appropriate
34legal authority signs a written document, including, but not limited
35to, a health facility minor release report, a medical authorization
36form, or a relinquishment form, granting the subscriber or spouse
37the right to control health care for the adoptive child or, absent
38this written document, on the date there exists evidence of the
39subscriber’s or spouse’s right to control the health care of the child
40placed for adoption. No plan may be entered into or amended if it
P38   1contains any disclaimer, waiver, or other limitation of coverage
2relative to the coverage or insurability of newborn infants of, or
3children placed for adoption with, a subscriber or spouse covered
4as required by this subdivision.

5(d) (1) Every plan contract that provides that coverage of a
6dependent child of a subscriber shall terminate upon attainment
7of the limiting age for dependent children specified in the plan,
8shall also provide that attainment of the limiting age shall not
9operate to terminate the coverage of the child while the child is
10and continues to meet both of the following criteria:

11(A) Incapable of self-sustaining employment by reason of a
12physically or mentally disabling injury, illness, or condition.

13(B) Chiefly dependent upon the subscriber for support and
14maintenance.

15(2) The plan shall notify the subscriber that the dependent child’s
16coverage will terminate upon attainment of the limiting age unless
17the subscriber submits proof of the criteria described in
18subparagraphs (A) and (B) of paragraph (1) to the plan within 60
19days of the date of receipt of the notification. The plan shall send
20this notification to the subscriber at least 90 days prior to the date
21the child attains the limiting age. Upon receipt of a request by the
22subscriber for continued coverage of the child and proof of the
23criteria described in subparagraphs (A) and (B) of paragraph (1),
24the plan shall determine whether the child meets that criteria before
25the child attains the limiting age. If the plan fails to make the
26determination by that date, it shall continue coverage of the child
27pending its determination.

28(3) The plan may subsequently request information about a
29dependent child whose coverage is continued beyond the limiting
30age under this subdivision but not more frequently than annually
31after the two-year period following the child’s attainment of the
32 limiting age.

33(4) If the subscriber changes carriers to another plan or to a
34health insurer, the new plan or insurer shall continue to provide
35coverage for the dependent child. The new plan or insurer may
36request information about the dependent child initially and not
37more frequently than annually thereafter to determine if the child
38continues to satisfy the criteria in subparagraphs (A) and (B) of
39paragraph (1). The subscriber shall submit the information
P39   1requested by the new plan or insurer within 60 days of receiving
2the request.

3(5) (A) Except as set forth in subparagraph (B), under no
4circumstances shall the limiting age be less than 26 years of age
5with respect to plan years beginning on or after September 23,
62010.

7(B) For plan years beginning before January 1, 2014, a group
8health care service plan contract that qualifies as a grandfathered
9health plan under Section 1251 of the federal Patient Protection
10and Affordable Care Act (Public Law 111-148) and that makes
11available dependent coverage of children may exclude from
12coverage an adult child who has not attained 26 years of age only
13if the adult child is eligible to enroll in an eligible
14employer-sponsored health plan, as defined in Section 5000A(f)(2)
15of the Internal Revenue Code, other than a group health plan of a
16parent.

17(C) (i) With respect to a child (I) whose coverage under a group
18or individual plan contract ended, or who was denied or not eligible
19for coverage under a group or individual plan contract, because
20under the terms of the contract the availability of dependent
21coverage of children ended before the attainment of 26 years of
22age, and (II) who becomes eligible for that coverage by reason of
23the application of this paragraph, the health care service plan shall
24give the child an opportunity to enroll that shall continue for at
25least 30 days. This opportunity and the notice described in clause
26(ii) shall be provided not later than the first day of the first plan
27year beginning on or after September 23, 2010, consistent with
28the federal Patient Protection and Affordable Care Act (Public
29Law 111-148), as amended by the federal Health Care and
30Education Reconciliation Act of 2010 (Public Law 111-152), and
31any additional federal guidance or regulations issued by the United
32States Secretary of Health and Human Services.

33(ii)  The health care service plan shall provide written notice
34stating that a dependent described in clause (i) who has not attained
3526 years of age is eligible to enroll in the plan for coverage. This
36notice may be provided to the dependent’s parent on behalf of the
37dependent. If the notice is included with other enrollment materials
38for a group plan, the notice shall be prominent.

P40   1(iii) In the case of an individual who enrolls under this
2subparagraph, coverage shall take effect no later than the first day
3of the first plan year beginning on or after September 23, 2010.

4(iv) A dependent enrolling in a group health plan for coverage
5pursuant to this subparagraph shall be treated as a special enrollee
6as provided under the rules of Section 146.117(d) of Title 45 of
7the Code of Federal Regulations. The health care service plan shall
8offer the recipient of the notice all of the benefit packages available
9to similarly situated individuals who did not lose coverage by
10reason of cessation of dependent status. Any difference in benefits
11or cost-sharing requirements shall constitute a different benefit
12package. A dependent enrolling in a group health plan for coverage
13pursuant to this subparagraph shall not be required to pay more
14for coverage than similarly situated individuals who did not lose
15coverage by reason of cessation of dependent status.

16(D) Nothing in this section shall require a health care service
17plan to make coverage available for a child of a child receiving
18dependent coverage. Nothing in this section shall be construed to
19modify the definition of “dependent” as used in the Revenue and
20Taxation Code with respect to the tax treatment of the cost of
21coverage.

22(e) A plan contract that provides coverage, whether by specific
23benefit or by the effect of general wording, for both an employee
24and one or more covered persons dependent upon the employee
25and provides for an extension of the coverage for any period
26following a termination of employment of the employee shall also
27provide that this extension of coverage shall apply to dependents
28upon the same terms and conditions precedent as applied to the
29covered employee, for the same period of time, subject to payment
30of premiums, if any, as required by the terms of the policy and
31subject to any applicable collective bargaining agreement.

32(f) A group contract shall not discriminate against handicapped
33persons or against groups containing handicapped persons. Nothing
34in this subdivision shall preclude reasonable provisions in a plan
35contract against liability for services or reimbursement of the
36handicap condition or conditions relating thereto, as may be
37allowed by rules of the director.

38(g) Every group contract shall set forth the terms and conditions
39under which subscribers and enrollees may remain in the plan in
40the event the group ceases to exist, the group contract is terminated,
P41   1or an individual subscriber leaves the group, or the enrollees’
2eligibility status changes.

3(h) (1) A health care service plan or specialized health care
4service plan may provide for coverage of, or for payment for,
5professional mental health services, or vision care services, or for
6the exclusion of these services. If the terms and conditions include
7coverage for services provided in a general acute care hospital or
8an acute psychiatric hospital as defined in Section 1250 and do
9not restrict or modify the choice of providers, the coverage shall
10extend to care provided by a psychiatric health facility as defined
11in Section 1250.2 operating pursuant to licensure by the State
12Department of Health Care Services. A health care service plan
13that offers outpatient mental health services but does not cover
14these services in all of its group contracts shall communicate to
15 prospective group contractholders as to the availability of outpatient
16coverage for the treatment of mental or nervous disorders.

17(2) No plan shall prohibit the member from selecting any
18psychologist who is licensed pursuant to the Psychology Licensing
19Law (Chapter 6.6 (commencing with Section 2900) of Division 2
20of the Business and Professions Code), any optometrist who is the
21holder of a certificate issued pursuant to Chapter 7 (commencing
22with Section 3000) of Division 2 of the Business and Professions
23Code or, upon referral by a physician and surgeon licensed pursuant
24to the Medical Practice Act (Chapter 5 (commencing with Section
252000) of Division 2 of the Business and Professions Code), (A)
26any marriage and family therapist who is the holder of a license
27under Section 4980.50 of the Business and Professions Code, (B)
28any licensed clinical social worker who is the holder of a license
29under Section 4996 of the Business and Professions Code, (C) any
30registered nurse licensed pursuant to Chapter 6 (commencing with
31Section 2700) of Division 2 of the Business and Professions Code,
32who possesses a master’s degree in psychiatric-mental health
33nursing and is listed as a psychiatric-mental health nurse by the
34Board of Registered Nursing, (D) any advanced practice registered
35nurse certified as a clinical nurse specialist pursuant to Article 9
36(commencing with Section 2838) of Chapter 6 of Division 2 of
37the Business and Professions Code who participates in expert
38clinical practice in the specialty of psychiatric-mental health
39nursing, to perform the particular services covered under the terms
40of the plan, and the certificate holder is expressly authorized by
P42   1law to perform these services, or (E) any professional clinical
2counselor who is the holder of a license under Chapter 16
3(commencing with Section 4999.10) of Division 2 of the Business
4and Professions Code.

5(3) Nothing in this section shall be construed to allow any
6certificate holder or licensee enumerated in this section to perform
7professional mental health services beyond his or her field or fields
8of competence as established by his or her education, training, and
9experience.

10(4) For the purposes of this section:

11(A) “Marriage and family therapist” means a licensed marriage
12and family therapist who has received specific instruction in
13assessment, diagnosis, prognosis, and counseling, and
14psychotherapeutic treatment of premarital, marriage, family, and
15child relationship dysfunctions, which is equivalent to the
16instruction required for licensure on January 1, 1981.

17(B) “Professional clinical counselor” means a licensed
18professional clinical counselor who has received specific
19instruction in assessment, diagnosis, prognosis, counseling, and
20 psychotherapeutic treatment of mental and emotional disorders,
21which is equivalent to the instruction required for licensure on
22January 1, 2012.

23(5) Nothing in this section shall be construed to allow a member
24to select and obtain mental health or psychological or vision care
25services from a certificate holder or licenseholder who is not
26directly affiliated with or under contract to the health care service
27plan or specialized health care service plan to which the member
28belongs. All health care service plans and individual practice
29associations that offer mental health benefits shall make reasonable
30efforts to make available to their members the services of licensed
31psychologists. However, a failure of a plan or association to comply
32with the requirements of the preceding sentence shall not constitute
33a misdemeanor.

34(6) As used in this subdivision, “individual practice association”
35means an entity as defined in subsection (5) of Section 1307 of
36the federal Public Health Service Act (42 U.S.C. Sec. 300e-1(5)).

37(7) Health care service plan coverage for professional mental
38health services may include community residential treatment
39services that are alternatives to inpatient care and that are directly
P43   1affiliated with the plan or to which enrollees are referred by
2providers affiliated with the plan.

3(i) If the plan utilizes arbitration to settle disputes, the plan
4contracts shall set forth the type of disputes subject to arbitration,
5the process to be utilized, and how it is to be initiated.

6(j) A plan contract that provides benefits that accrue after a
7certain time of confinement in a health care facility shall specify
8what constitutes a day of confinement or the number of consecutive
9 hours of confinement that are requisite to the commencement of
10benefits.

11(k) If a plan provides coverage for a dependent child who is
12over 26 years of age and enrolled as a full-time student at a
13secondary or postsecondary educational institution, the following
14shall apply:

15(1) Any break in the school calendar shall not disqualify the
16dependent child from coverage.

17(2) If the dependent child takes a medical leave of absence, and
18the nature of the dependent child’s injury, illness, or condition
19would render the dependent child incapable of self-sustaining
20employment, the provisions of subdivision (d) shall apply if the
21dependent child is chiefly dependent on the subscriber for support
22and maintenance.

23(3) (A) If the dependent child takes a medical leave of absence
24from school, but the nature of the dependent child’s injury, illness,
25or condition does not meet the requirements of paragraph (2), the
26dependent child’s coverage shall not terminate for a period not to
27exceed 12 months or until the date on which the coverage is
28scheduled to terminate pursuant to the terms and conditions of the
29plan, whichever comes first. The period of coverage under this
30paragraph shall commence on the first day of the medical leave of
31absence from the school or on the date the physician and surgeon
32determines the illness prevented the dependent child from attending
33school, whichever comes first. Any break in the school calendar
34shall not disqualify the dependent child from coverage under this
35paragraph.

36(B) Documentation or certification of the medical necessity for
37a leave of absence from school shall be submitted to the plan at
38least 30 days prior to the medical leave of absence from the school,
39if the medical reason for the absence and the absence are
40foreseeable, or 30 days after the start date of the medical leave of
P44   1absence from school and shall be considered prima facie evidence
2of entitlement to coverage under this paragraph.

3(4) This subdivision shall not apply to a specialized health care
4service plan or to a Medicare supplement plan.

5

SEC. 15.  

Section 104151 is added to the Health and Safety
6Code
, to read:

7

104151.  

Notwithstanding Section 10231.5 of the Government
8Code, each year, by no later than January 10 and concurrently with
9the release of the May Revision, the State Department of Health
10Care Services shall provide the fiscal committees of the Legislature
11with an estimate package for the Every Woman Counts Program.
12This estimate package shall include all significant assumptions
13underlying the estimate for the Every Woman Counts Program’s
14current-year and budget-year proposals, and shall contain concise
15information identifying applicable estimate components, such as
16caseload; a breakout of costs, including, but not limited to, clinical
17service activities, including office visits and consults, screening
18mammograms, diagnostic mammograms, diagnostic breast
19procedures, case management, and other clinical services; policy
20changes; contractor information; General Fund, special fund, and
21federal fund information; and other assumptions necessary to
22support the estimate.

23

SEC. 16.  

Section 111792 of the Health and Safety Code is
24amended to read:

25

111792.  

(a) The manufacturer of any cosmetic product subject
26to regulation by the federal Food and Drug Administration that is
27sold in this state shall, on a schedule and in electronic or other
28format, as determined by the division, provide the division with a
29complete and accurate list of its cosmetic products that, as of the
30date of submission, are sold in the state and that contain any
31ingredient that is a chemical identified as causing cancer or
32reproductive toxicity, including any chemical that meets either of
33the following conditions:

34(1) A chemical contained in the product for purposes of
35fragrance or flavoring.

36(2) A chemical identified by the phrase “and other ingredients”
37and determined to be a trade secret pursuant to the procedure
38established in Part 20 and Section 720.8 of Part 720 of Title 21 of
39the Code of Federal Regulations. Any ingredient identified pursuant
40to this paragraph shall be considered to be a trade secret and shall
P45   1be treated by the division in a manner consistent with the
2requirements of Part 20 and Part 720 of Title 21 of the Code of
3Federal Regulations. Any ingredients considered to be a trade
4secret shall not be subject to the California Public Records Act
5(Chapter 3.5 (commencing with Section 6250) of Division 7 of
6Title 1 of the Government Code) for the purposes of this section.

7(b) Any information submitted pursuant to subdivision (a) shall
8identify each chemical both by name and Chemical Abstract
9Service number and shall specify the product or products in which
10the chemical is contained.

11(c) If an ingredient identified pursuant to this section
12subsequently is removed from the product in which it was
13contained, is removed from the list of chemicals known to cause
14cancer or reproductive toxicity published under Section 25249.8,
15or is no longer a chemical identified as causing cancer or
16reproductive toxicity by an authoritative body, the manufacturer
17of the product containing the ingredient shall submit the new
18information to the division. Upon receipt of new information, the
19division, after verifying the accuracy of that information, shall
20revise the manufacturer’s information on record with the division
21to reflect the new information. The manufacturer shall not be under
22obligation to submit subsequent information on the presence of
23the ingredient in the product unless subsequent changes require
24submittal of the information.

25(d) This section shall not apply to any manufacturer of cosmetic
26products with annual aggregate sales of cosmetic products, both
27within and outside of California, of less than one million dollars
28($1,000,000), based on the manufacturer’s most recent tax year
29filing.

30(e) On or before December 31, 2013, the State Department of
31Public Health shall develop and make operational a
32consumer-friendly, public Internet Web site that creates a database
33of the information collected pursuant to this section. The database
34shall be searchable to accommodate a wide range of users,
35including users with limited technical and scientific literacy. Data
36shall be presented in an educational manner with, among other
37things, hypertext links that explain the meanings of technical terms,
38including, but not limited to, “carcinogenic” and “reproductive
39toxicity.” The Internet Web site shall be designed to be easily
40navigable and to enable users to compare and contrast products
P46   1and reportable ingredients. The Internet Web site shall include
2hypertext links to other educational and informational Internet
3Web sites to enhance consumer understanding.

4

SEC. 17.  

Section 123870 of the Health and Safety Code is
5amended to read:

6

123870.  

(a) The department shall establish standards of
7financial eligibility for treatment services under the California
8Children’s Services Program (CCS program).

9(1) Financial eligibility for treatment services under this program
10shall be limited to persons in families with an adjusted gross
11income of forty thousand dollars ($40,000) or less in the most
12recent tax year, as calculated for California state income tax
13purposes. If a person is enrolled in the Healthy Families Program
14(Part 6.2 (commencing with Section 12693) of Division 2 of the
15Insurance Code), the financial documentation required for that
16program in Section 2699.6600 of Title 10 of the California Code
17of Regulations may be used instead of the person’s California state
18income tax return. If a person is enrolled in the Medi-Cal program
19pursuant to Section 14005.26 of the Welfare and Institutions Code,
20or enrolled in the AIM-Linked Infants Program pursuant to Chapter
212 (commencing with Section 15850) of Part 3.3 of Division 9 of
22the Welfare and Institutions Code, the financial documentation
23required to establish eligibility for the respective programs may
24be used instead of the person’s California state income tax return.
25However, the director may authorize treatment services for persons
26in families with higher incomes if the estimated cost of care to the
27family in one year is expected to exceed 20 percent of the family’s
28adjusted gross income.

29(2) Children enrolled in the Healthy Families Program, the
30Medi-Cal program pursuant to Section 14005.26 of the Welfare
31and Institutions Code, or the AIM-Linked Infants Program pursuant
32to Chapter 2 (commencing with Section 15850) of Part 3.3 of
33Division 9 of the Welfare and Institutions Code, who have a CCS
34program eligible medical condition under Section 123830, and
35whose families do not meet the financial eligibility requirements
36of paragraph (1), shall be deemed financially eligible for CCS
37program benefits.

38(b) Necessary medical therapy treatment services under the
39California Children’s Services Program rendered in the public
40schools shall be exempt from financial eligibility standards and
P47   1enrollment fee requirements for the services when rendered to any
2handicapped child whose educational or physical development
3would be impeded without the services.

4(c) All counties shall use the uniform standards for financial
5eligibility and enrollment fees established by the department. All
6enrollment fees shall be used in support of the California Children’s
7Services Program.

8(d) Annually, every family with a child eligible to receive
9services under this article shall pay a fee of twenty dollars ($20),
10that shall be in addition to any other program fees for which the
11family is liable. This assessment shall not apply to any child who
12is eligible for full scope Medi-Cal benefits without a share of cost,
13for children receiving therapy through the California Children’s
14Services Program as a related service in their individualized
15education plans, for children from families having incomes of less
16than 100 percent of the federal poverty level, or for children
17covered under the Healthy Families Program or the AIM-Linked
18Infants Program.

19

SEC. 18.  

Section 123929 of the Health and Safety Code is
20amended to read:

21

123929.  

(a) Except as otherwise provided in this section and
22Section 14133.05 of the Welfare and Institutions Code, California
23Children’s Services Program services provided pursuant to this
24article require prior authorization by the department or its designee.
25Prior authorization is contingent on determination by the
26department or its designee of all of the following:

27(1) The child receiving the services is confirmed to be medically
28eligible for the CCS program.

29(2) The provider of the services is approved in accordance with
30the standards of the CCS program.

31(3) The services authorized are medically necessary to treat the
32child’s CCS-eligible medical condition.

33(b) The department or its designee may approve a request for a
34treatment authorization that is otherwise in conformance with
35subdivision (a) for services for a child participating in the Healthy
36Families Program or the AIM-Linked Infants Program pursuant
37to clause (ii) of subparagraph (A) of paragraph (6) of subdivision
38(a) of Section 12693.70 of the Insurance Code or Chapter 2
39(commencing with Section 15850) of Part 3.3 of Division 9 of the
40Welfare and Institutions Code, received by the department or its
P48   1designee after the requested treatment has been provided to the
2child.

3(c) If a provider of services who meets the requirements of
4paragraph (2) of subdivision (a) incurs costs for services described
5in paragraph (3) of subdivision (a) to treat a child described in
6subdivision (b) who is subsequently determined to be medically
7eligible for the CCS program as determined by the department or
8its designee, the department may reimburse the provider for those
9costs. Reimbursement under this section shall conform to the
10requirements of Section 14105.18 of the Welfare and Institutions
11Code.

12

SEC. 19.  

Section 123940 of the Health and Safety Code is
13amended to read:

14

123940.  

(a) (1) Annually, the board of supervisors shall
15appropriate a sum of money for services for handicapped children
16of the county, including diagnosis, treatment, and therapy services
17for physically handicapped children in public schools, equal to 25
18percent of the actual expenditures for the county program under
19this article for the 1990-91 fiscal year, except as specified in
20paragraph (2).

21(2) If the state certifies that a smaller amount is needed in order
22for the county to pay 25 percent of costs of the county’s program
23from this source. The smaller amount certified by the state shall
24be the amount that the county shall appropriate.

25(b) In addition to the amount required by subdivision (a), the
26county shall allocate an amount equal to the amount determined
27pursuant to subdivision (a) for purposes of this article from
28revenues allocated to the county pursuant to Chapter 6
29(commencing with Section 17600) of Division 9 of the Welfare
30and Institutions Code.

31(c) (1) The state shall match county expenditures for this article
32from funding provided pursuant to subdivisions (a) and (b).

33(2) County expenditures shall be waived for payment of services
34for children who are eligible pursuant to paragraph (2) of
35subdivision (a) of Section 123870.

36(d) The county may appropriate and expend moneys in addition
37to those set forth in subdivision (a) and (b) and the state shall match
38the expenditures, on a dollar-for-dollar basis, to the extent that
39state funds are available for this article.

P49   1(e) County appropriations under subdivisions (a) and (b) shall
2include county financial participation in the nonfederal share of
3expenditures for services for children who are enrolled in the
4Medi-Cal program pursuant to Section 14005.26 of the Welfare
5and Institutions Code, or the AIM-Linked Infants Program pursuant
6to Chapter 2 (commencing with Section 15850) of Part 3.3 of
7Division 9 of the Welfare and Institutions Code, and who are
8eligible for services under this article pursuant to paragraph (1) of
9subdivision (a) of Section 123870, to the extent that federal
10financial participation is available at the enhanced federal
11reimbursement rate under Title XXI of the federal Social Security
12Act (42 U.S.C. Sec. 1397aa et seq.) and funds are appropriated for
13the California Children’s Services Program in the State Budget.

14(f) Nothing in this section shall require the county to expend
15more than the amount set forth in subdivision (a) plus the amount
16set forth in subdivision (b) nor shall it require the state to expend
17more than the amount of the match set forth in subdivision (c).

18(g) Notwithstanding Chapter 3.5 (commencing with Section
1911340) of Part 1 of Division 3 of Title 2 of the Government Code,
20the department, without taking further regulatory action, shall
21implement this section by means of California Children’s Services
22numbered letters.

23

SEC. 20.  

Section 123955 of the Health and Safety Code is
24amended to read:

25

123955.  

(a) The state and the counties shall share in the cost
26of administration of the California Children’s Services Program
27at the local level.

28(b) (1) The director shall adopt regulations establishing
29minimum standards for the administration, staffing, and local
30implementation of this article subject to reimbursement by the
31state.

32(2) The standards shall allow necessary flexibility in the
33administration of county programs, taking into account the
34variability of county needs and resources, and shall be developed
35and revised jointly with state and county representatives.

36(c) The director shall establish minimum standards for
37administration, staffing and local operation of the program subject
38to reimbursement by the state.

39(d) Until July 1, 1992, reimbursable administrative costs, to be
40paid by the state to counties, shall not exceed 4.1 percent of the
P50   1gross total expenditures for diagnosis, treatment and therapy by
2counties as specified in Section 123940.

3(e) Beginning July 1, 1992, this subdivision shall apply with
4respect to all of the following:

5(1) Counties shall be reimbursed by the state for 50 percent of
6the amount required to meet state administrative standards for that
7portion of the county caseload under this article that is ineligible
8for Medi-Cal to the extent funds are available in the State Budget
9for the California Children’s Services Program.

10(2) Counties shall be reimbursed by the state for 50 percent of
11the nonfederal share of the amount required to meet state
12administrative standards for that portion of the county caseload
13under this article that is enrolled in the Medi-Cal program pursuant
14to Section 14005.26 of the Welfare and Institutions Code or the
15AIM-Linked Infants Program pursuant to Chapter 2 (commencing
16with Section 15850) of Part 3.3 of Division 9 of the Welfare and
17Institutions Code, and who are eligible for services under this
18article pursuant to subdivision (a) of Section 123870, to the extent
19that federal financial participation is available at the enhanced
20federal reimbursement rate under Title XXI of the federal Social
21Security Act (42 U.S.C. Sec. 1397aa et seq.) and funds are
22appropriated for the California Children’s Services Program in the
23State Budget.

24(3) On or before September 15 of each year, each county
25program implementing this article shall submit an application for
26the subsequent fiscal year that provides information as required
27by the state to determine if the county administrative staff and
28budget meet state standards.

29(4) The state shall determine the maximum amount of state
30funds available for each county from state funds appropriated for
31CCS county administration. If the amount appropriated for any
32fiscal year in the Budget Act for county administration under this
33article differs from the amounts approved by the department, each
34county shall submit a revised application in a form and at the time
35specified by the department.

36(f) The department and counties shall maximize the use of
37federal funds for administration of the programs implemented
38pursuant to this article, including using state and county funds to
39match funds claimable under Title XIX or Title XXI of the federal
P51   1Social Security Act (42 U.S.C. Sec. 1396 et seq.; 42 U.S.C. Sec.
21397aa et seq.).

3

SEC. 21.  

Section 10125 of the Insurance Code is amended to
4read:

5

10125.  

(a) On and after January 1, 1974, every insurer issuing
6group disability insurance which covers hospital, medical, or
7surgical expenses shall offer coverage for expenses incurred as a
8result of mental or nervous disorders, under the terms and
9conditions which may be agreed upon between the group
10policyholder and the insurer. If the terms and conditions include
11coverage for inpatient care for nervous or mental disorders, the
12coverage shall extend to treatment provided at all of the following
13facilities:

14(1) A general acute care hospital as defined in subdivision (a)
15of Section 1250 of the Health and Safety Code.

16(2) An acute psychiatric hospital as defined in subdivision (b)
17of Section 1250 of the Health and Safety Code.

18(3) A psychiatric health facility as defined by Section 1250.2
19of the Health and Safety Code operating pursuant to licensure by
20the State Department of Health Care Services.

21Nothing in this subdivision prohibits an insurer that negotiates
22and enters into a contract with a professional or institutional
23provider for alternative rates of payment pursuant to Section 10133
24from restricting or modifying the choice of providers.

25(b) Every insurer shall communicate to prospective group
26policyholders as to the availability of outpatient coverage for the
27treatment of mental or nervous disorders. Every insurer shall
28communicate the availability of that coverage to all group
29policyholders and to all prospective group policyholders with
30whom they are negotiating. This coverage may include community
31residential treatment services, as described in former Section 5458
32of the Welfare and Institutions Code, that are alternatives to
33institutional care.

34

SEC. 22.  

Section 10127 of the Insurance Code is amended to
35read:

36

10127.  

On and after January 1, 1974, every self-insured
37employee welfare benefit plan that provides coverage for hospital,
38medical, or surgical expenses shall offer coverage for expenses
39incurred as a result of mental or nervous disorders, under the terms
40and conditions which may be agreed upon between the self-insured
P52   1welfare benefit plan and the member. If the terms and conditions
2include coverage for services provided in a general acute care
3hospital, or an acute psychiatric hospital as defined in Section 1250
4of the Health and Safety Code, and do not restrict or modify the
5choice of providers, the coverage shall extend to care provided by
6a psychiatric health facility, as defined by Section 1250.2 of the
7Health and Safety Code, operating pursuant to licensure by the
8State Department of Health Care Services. Every plan shall
9communicate to prospective members as to the availability of
10outpatient coverage for the treatment of mental or nervous
11disorders. Every self-insured welfare benefit plan shall
12communicate the availability of this coverage to all members and
13prospective members. This coverage may include community
14residential treatment services, as described in former Section 5458
15of the Welfare and Institutions Code, that are alternatives to
16institutional care.

17

SEC. 23.  

Section 12693.70 of the Insurance Code is amended
18to read:

19

12693.70.  

To be eligible to participate in the program, an
20applicant shall meet all of the following requirements:

21(a) Be an applicant applying on behalf of an eligible child, which
22means a child who is all of the following:

23(1) Less than 19 years of age. An application may be made on
24behalf of a child not yet born up to three months prior to the
25expected date of delivery. Coverage shall begin as soon as
26administratively feasible, as determined by the board, after the
27board receives notification of the birth. However, no child less
28than 12 months of age shall be eligible for coverage until 90 days
29after the enactment of the Budget Act of 1999.

30(2) Not eligible for no-cost full-scope Medi-Cal or Medicare
31coverage at the time of application.

32(3) In compliance with Sections 12693.71 and 12693.72.

33(4) A child who meets citizenship and immigration status
34requirements that are applicable to persons participating in the
35program established by Title XXI of the Social Security Act, except
36as specified in Section 12693.76.

37(5) A resident of the State of California pursuant to Section 244
38of the Government Code; or, if not a resident pursuant to Section
39244 of the Government Code, is physically present in California
40and entered the state with a job commitment or to seek
P53   1employment, whether or not employed at the time of application
2to or after acceptance in, the program.

3(6) (A) In either of the following:

4(i) In a family with an annual or monthly household income
5equal to or less than 200 percent of the federal poverty level.

6(ii) (I) When implemented by the board, subject to subdivision
7(b) of Section 12693.765 and pursuant to this section, a child under
8the age of two years who was delivered by a mother enrolled in
9the Access for Infants and Mothers Program as described in Part
106.3 (commencing with Section 12695). Commencing July 1, 2007,
11eligibility under this subparagraph shall not include infants during
12any time they are enrolled in employer-sponsored health insurance
13or are subject to an exclusion pursuant to Section 12693.71 or
1412693.72, or are enrolled in the full scope of benefits under the
15Medi-Cal program at no share of cost. For purposes of this clause,
16any infant born to a woman whose enrollment in the Access for
17Infants and Mothers Program begins after June 30, 2004, shall be
18automatically enrolled in the Healthy Families Program, except
19during any time on or after July 1, 2007, that the infant is enrolled
20in employer-sponsored health insurance or is subject to an
21exclusion pursuant to Section 12693.71 or 12693.72, or is enrolled
22in the full scope of benefits under the Medi-Cal program at no
23share of cost. Except as otherwise specified in this section, this
24enrollment shall cover the first 12 months of the infant’s life. At
25the end of the 12 months, as a condition of continued eligibility,
26the applicant shall provide income information. The infant shall
27be disenrolled if the gross annual household income exceeds the
28 income eligibility standard that was in effect in the Access for
29Infants and Mothers Program at the time the infant’s mother
30became eligible, or following the two-month period established
31in Section 12693.981 if the infant is eligible for Medi-Cal with no
32share of cost. At the end of the second year, infants shall again be
33screened for program eligibility pursuant to this section, with
34income eligibility evaluated pursuant to clause (i), subparagraphs
35(B) and (C), and paragraph (2) of subdivision (a).

36(II) Effective on October 1, 2013, or when the State Department
37of Health Care Services has implemented Chapter 2 (commencing
38with Section 15850) of Part 3.3 of Division 9 of the Welfare and
39Institutions Code, whichever is later, eligibility for coverage in
40the program pursuant to this clause shall terminate. The board shall
P54   1 coordinate with the State Department of Health Care Services to
2implement Chapter 2 (commencing with Section 15850) of Part
33.3 of Division 9 of the Welfare and Institutions Code, including
4transition of subscribers to the AIM-Linked Infants Program. The
5State Department of Health Care Services shall administer the
6AIM-Linked Infants Program, pursuant to Chapter 2 (commencing
7with Section 15850) of Part 3.3 of Division 9 of the Welfare and
8Institutions Code, to address the health care needs of children
9formerly covered pursuant to this clause.

10(B) All income over 200 percent of the federal poverty level
11but less than or equal to 250 percent of the federal poverty level
12shall be disregarded in calculating annual or monthly household
13income.

14(C) In a family with an annual or monthly household income
15greater than 250 percent of the federal poverty level, any income
16deduction that is applicable to a child under Medi-Cal shall be
17applied in determining the annual or monthly household income.
18If the income deductions reduce the annual or monthly household
19income to 250 percent or less of the federal poverty level,
20subparagraph (B) shall be applied.

21(b) The applicant shall agree to remain in the program for six
22months, unless other coverage is obtained and proof of the coverage
23is provided to the program.

24(c) An applicant shall enroll all of the applicant’s eligible
25children in the program.

26(d) In filing documentation to meet program eligibility
27requirements, if the applicant’s income documentation cannot be
28provided, as defined in regulations promulgated by the board, the
29applicant’s signed statement as to the value or amount of income
30shall be deemed to constitute verification.

31(e) An applicant shall pay in full any family contributions owed
32in arrears for any health, dental, or vision coverage provided by
33the program within the prior 12 months.

34(f) By January 2008, the board, in consultation with
35stakeholders, shall implement processes by which applicants for
36subscribers may certify income at the time of annual eligibility
37review, including rules concerning which applicants shall be
38permitted to certify income and the circumstances in which
39supplemental information or documentation may be required. The
40board may terminate using these processes not sooner than 90 days
P55   1after providing notification to the Chair of the Joint Legislative
2Budget Committee. This notification shall articulate the specific
3reasons for the termination and shall include all relevant data
4elements that are applicable to document the reasons for the
5termination. Upon the request of the Chair of the Joint Legislative
6Budget Committee, the board shall promptly provide any additional
7clarifying information regarding implementation of the processes
8required by this subdivision.

9

SEC. 24.  

Section 12698 of the Insurance Code is amended to
10read:

11

12698.  

To be eligible to participate in the program, a person
12shall meet all of the following requirements:

13(a) Be a resident of the state. A person who is a member of a
14federally recognized California Indian tribe is a resident of the
15state for these purposes.

16(b) (1) Until the first day of the second month following the
17effective date of the amendment made to this subdivision in 1994,
18have a household income that does not exceed 250 percent of the
19official federal poverty level unless the board determines that the
20program funds are adequate to serve households above that level.

21(2) Upon the first day of the second month following the
22effective date of the amendment made to this subdivision in 1994,
23have a household income that is above 200 percent of the official
24federal poverty level but does not exceed 250 percent of the official
25federal poverty level unless the board determines that the program
26funds are adequate to serve households above the 250 percent of
27the official federal poverty level.

28(c) Pay an initial subscriber contribution of not more than fifty
29dollars ($50), and agree to the payment of the complete subscriber
30contribution. A federally recognized California Indian tribal
31government may make the initial and complete subscriber
32contributions on behalf of a member of the tribe only if a
33contribution on behalf of members of federally recognized
34California Indian tribes does not limit or preclude federal financial
35participation under Title XXI of the Social Security Act. If a
36federally recognized California Indian tribal government makes a
37contribution on behalf of a member of the tribe, the tribal
38government shall ensure that the subscriber is made aware of all
39 the health plan options available in the county where the member
40resides.

P56   1(d) Effective January 1, 2014, when determining eligibility for
2benefits under the program, income shall be determined, counted,
3and valued in accordance with the requirements of Section
41397bb(b)(1)(B) of Title 42 of the United States Code as added
5by the federal Patient Protection and Affordable Care Act (Public
6Law 111-148) and as amended by the federal Health Care and
7Education Reconciliation Act of 2010 (Public Law 111-152) and
8any subsequent amendments.

9

SEC. 25.  

Section 12737 of the Insurance Code is amended to
10read:

11

12737.  

(a) The board shall establish program contribution
12amounts for each category of risk for each participating health
13plan. The program contribution amounts shall be based on the
14average amount of subsidy funds required for the program as a
15whole. To determine the average amount of subsidy funds required,
16the board shall calculate a loss ratio, including all medical costs,
17administration fees, and risk payments, for the program in the prior
18calendar year. The loss ratio shall be calculated using 125 percent
19of the standard average individual rates for comparable coverage
20as the denominator, and all medical costs, administration fees, and
21risk payments as the numerator. The average amount of subsidy
22funds required is calculated by subtracting 100 percent from the
23program loss ratio. For purposes of calculating the program loss
24ratio, no participating health plan’s loss ratio shall be less than 100
25percent and participating health plans with fewer than 1,000
26program members shall be excluded from the calculation.

27Subscriber contributions shall be established to encourage
28members to select those health plans requiring subsidy funds at or
29below the program average subsidy. Subscriber contribution
30amounts shall be established so that no subscriber receives a
31subsidy greater than the program average subsidy, except that:

32(1) In all areas of the state, at least one plan shall be available
33to program participants at an average subscriber contribution of
34125 percent of the standard average individual rates for comparable
35coverage.

36(2) No subscriber contribution shall be increased by more than
3710 percent above 125 percent of the standard average individual
38rates for comparable coverage.

39(3) Subscriber contributions for participating health plans joining
40the program after January 1, 1997, shall be established at 125
P57   1percent of the standard average individual rates for comparable
2coverage for the first two benefit years the plan participates in the
3program.

4(b) The program shall pay program contribution amounts to
5participating health plans from the Major Risk Medical Insurance
6Fund.

7(c) Commencing January 1, 2013, in addition to the amount of
8subsidy funds required pursuant to subdivision (a), the program
9may further subsidize subscriber contributions so that the amount
10paid by each subscriber is below 125 percent of the standard
11average individual risk rate for comparable coverage but no less
12than 100 percent of the standard average individual risk rate for
13comparable coverage. For purposes of calculating premiums for
14the following products, any reference to, or use of, subscriber
15contributions, premiums, average premiums, or amounts paid by
16subscribers in the program shall be construed to mean subscriber
17contributions as described in subdivision (a) without application
18of the additional subsidies permitted by this subdivision:

19(1) Standard benefit plans pursuant to Section 10127.16 and
20Section 1373.622 of the Health and Safety Code.

21(2) Health benefit plans and health care service plan contracts
22for federally eligible defined individuals pursuant to Sections
2310901.3 and 10901.9 and Sections 1399.805 and 1399.811 of the
24Health and Safety Code.

25(3) Conversion coverage pursuant to Section 12682.1 and
26Section 1373.6 of the Health and Safety Code.

27

SEC. 26.  

Section 12739.61 of the Insurance Code is amended
28to read:

29

12739.61.  

The board shall cease to provide coverage through
30the program on July 1, 2013, except as required by the contract
31between the board and the United States Department of Health
32and Human Services, and at that time shall cease to operate the
33program except as required to complete payments to, or payment
34reconciliations with, participating health plans or other contractors,
35process appeals, or conduct other necessary termination activities.

36

SEC. 27.  

Section 359 of the Welfare and Institutions Code is
37amended to read:

38

359.  

(a) Whenever a minor who appears to be a danger to
39himself or others as a result of the use of narcotics, as defined in
40Section 11019 of the Health and Safety Code, or a restricted
P58   1dangerous drug (as defined in former Section 11901 of the Health
2and Safety Code), is brought before any judge of the juvenile court,
3the judge may continue the hearing and proceed pursuant to this
4section. The court may order the minor taken to a facility
5designated by the county and approved by the State Department
6of Health Care Services as a facility for 72-hour treatment and
7evaluation. Thereupon the provisions of Section 11922 of the
8Health and Safety Code shall apply, except that the professional
9person in charge of the facility shall make a written report to the
10court concerning the results of the evaluation of the minor.

11(b) If the professional person in charge of the facility for 72-hour
12evaluation and treatment reports to the juvenile court that the minor
13is not a danger to himself or others as a result of the use of narcotics
14or restricted dangerous drugs or that the minor does not require
1514-day intensive treatment, or if the minor has been certified for
16not more than 14 days of intensive treatment and the certification
17is terminated, the minor shall be released if the juvenile court
18proceedings have been dismissed; referred for further care and
19treatment on a voluntary basis, subject to the disposition of the
20juvenile court proceedings; or returned to the juvenile court, in
21which event the court shall proceed with the case pursuant to this
22chapter.

23(c) Any expenditure for the evaluation or intensive treatment
24of a minor under this section shall be considered an expenditure
25made under Part 2 (commencing with Section 5600) of Division
265, and shall be reimbursed by the state as are other local
27expenditures pursuant to that part.

28

SEC. 28.  

Section 708 of the Welfare and Institutions Code is
29amended to read:

30

708.  

(a) Whenever a minor who appears to be a danger to
31himself or herself or others as a result of the use of controlled
32substances (as defined in Division 10 (commencing with Section
3311000) of the Health and Safety Code), is brought before any judge
34of the juvenile court, the judge may continue the hearing and
35proceed pursuant to this section. The court may order the minor
36taken to a facility designated by the county and approved by the
37State Department of Health Care Services as a facility for 72-hour
38treatment and evaluation. Thereupon the provisions of Section
395343 shall apply, except that the professional person in charge of
P59   1the facility shall make a written report to the court concerning the
2results of the evaluation of the minor.

3(b) If the professional person in charge of the facility for 72-hour
4evaluation and treatment reports to the juvenile court that the minor
5is not a danger to himself or herself or others as a result of the use
6of controlled substances or that the minor does not require 14-day
7intensive treatment, or if the minor has been certified for not more
8than 14 days of intensive treatment and the certification is
9terminated, the minor shall be released if the juvenile court
10proceedings have been dismissed; referred for further care and
11treatment on a voluntary basis, subject to the disposition of the
12juvenile court proceedings; or returned to the juvenile court, in
13which event the court shall proceed with the case pursuant to this
14chapter.

15(c) Any expenditure for the evaluation or intensive treatment
16of a minor under this section shall be considered an expenditure
17made under Part 2 (commencing with Section 5600) of Division
185, and shall be reimbursed by the state as are other local
19expenditures pursuant to that part.

20

SEC. 29.  

Section 4005.7 of the Welfare and Institutions Code
21 is amended to read:

22

4005.7.  

All regulations heretofore adopted by the State
23Department of Mental Health, and its successor, pursuant to
24authority vested in the State Department of Health Care Services
25by Section 4005.1 and in effect immediately preceding the
26operative date of the act that amended this section in the first year
27of the 2013-14 Regular Session shall remain in effect and shall
28be fully enforceable unless and until readopted, amended, or
29repealed by the Director of Health Care Services.

30

SEC. 30.  

Section 4080 of the Welfare and Institutions Code is
31amended to read:

32

4080.  

(a) Psychiatric health facilities, as defined in Section
331250.2 of the Health and Safety Code, shall only be licensed by
34the State Department of Health Care Services subsequent to
35application by counties, county contract providers, or other
36organizations pursuant to this part.

37(b) (1) For counties or county contract providers that choose
38to apply, the local mental health director shall first present to the
39local mental health advisory board for its review an explanation
40of the need for the facility and a description of the services to be
P60   1provided. The local mental health director shall then submit to the
2governing body the explanation and description. The governing
3body, upon its approval, may submit the application to the State
4Department of Health Care Services.

5(2) Other organizations that will be applying for licensure and
6do not intend to use any Bronzan-McCorquodale funds pursuant
7to Section 5707 shall submit to the local mental health director
8and the governing body in the county in which the facility is to be
9located a written and dated proposal of the services to be provided.
10The local mental health director and governing body shall have
1130 days during which to provide any advice and recommendations
12regarding licensure, as they deem appropriate. At any time after
13the 30-day period, the organizations may then submit their
14applications, along with the mental health director’s and governing
15body’s advice and recommendations, if any, to the State
16Department of Health Care Services.

17(c) The State Fire Marshal and other appropriate state agencies,
18to the extent required by law, shall cooperate fully with the State
19Department of Health Care Services to ensure that the State
20Department of Health Care Services approves or disapproves the
21licensure applications not later than 90 days after the application
22submission by a county, county contract provider, or other
23organization.

24(d) Every psychiatric health facility and program for which a
25license has been issued shall be periodically inspected by a
26multidisciplinary team appointed or designated by the State
27Department of Health Care Services. The inspection shall be
28conducted no less than once every two years and as often as
29necessary to ensure the quality of care provided. During the
30inspections the review team shall offer such advice and assistance
31to the psychiatric health facility as it deems appropriate.

32(e) (1) The program aspects of a psychiatric health facility that
33shall be reviewed and may be approved by the State Department
34of Health Care Services shall include, but not be limited to:

35(A) Activities programs.

36(B) Administrative policies and procedures.

37(C) Admissions, including provisions for a mental evaluation.

38(D) Discharge planning.

39(E) Health records content.

40(F) Health records services.

P61   1(G) Interdisciplinary treatment teams.

2(H) Nursing services.

3(I) Patient rights.

4(J) Pharmaceutical services.

5(K) Program space requirements.

6(L) Psychiatrist and clinical psychological services.

7(M) Rehabilitation services.

8(N) Restraint and seclusion.

9(O) Social work services.

10(P) Space, supplies, and equipment.

11(Q) Staffing standards.

12(R) Unusual occurrences.

13(S) Use of outside resources, including agreements with general
14acute care hospitals.

15(T) Linguistic access and cultural competence.

16(U) Structured outpatient services to be provided under special
17permit.

18(2) The State Department of Health Care Services has the sole
19authority to grant program flexibility.

20(f) Commencing July 1, 2013, the State Department of Health
21Care Services may adopt regulations regarding psychiatric health
22facilities that shall include, but not be limited to, all of the
23following:

24(1) Procedures by which the State Department of Health Care
25Services shall review and may approve the program and facility
26requesting licensure as a psychiatric health facility as being in
27compliance with program standards established by the department.

28(2) Procedures by which the Director of Health Care Services
29shall approve, or deny approval of, the program and facility
30licensed as a psychiatric health facility pursuant to this section.

31(3) Provisions for site visits by the State Department of Health
32Care Services for the purpose of reviewing a facility’s compliance
33with program and facility standards.

34(4) Provisions for the State Department of Health Care Services
35for any administrative proceeding regarding denial, suspension,
36or revocation of a psychiatric health facility license.

37(5) Procedures for the appeal of an administrative finding or
38action pursuant to paragraph (4) of this subdivision and subdivision
39(j).

P62   1(g) Regulations may be adopted by the State Department of
2Health Care Services that establish standards for pharmaceutical
3services in psychiatric health facilities. Licensed psychiatric health
4facilities shall be exempt from requirements to obtain a separate
5pharmacy license or permit.

6(h) (1) It is the intent of the Legislature that the State
7Department of Health Care Services shall license the facility in
8order to establish innovative and more competitive and specialized
9acute care services.

10(2) The State Department of Health Care Services shall review
11and may approve the program aspects of public or private facilities,
12with the exception of those facilities that are federally certified or
13accredited by a nationally recognized commission that accredits
14health care facilities, only if the average per diem charges or costs
15of service provided in the facility is approximately 60 percent of
16the average per diem charges or costs of similar psychiatric services
17provided in a general hospital.

18(3) (A) When a private facility is accredited by a nationally
19recognized commission that accredits health care facilities, the
20State Department of Health Care Services shall review and may
21approve the program aspects only if the average per diem charges
22or costs of service provided in the facility do not exceed
23approximately 75 percent of the average per diem charges or costs
24of similar psychiatric service provided in a psychiatric or general
25hospital.

26(B) When a private facility serves county patients, the State
27Department of Health Care Services shall review and may approve
28the program aspects only if the facility is federally certified by the
29federal Centers for Medicare and Medicaid Services and serves a
30population mix that includes a proportion of Medi-Cal patients
31sufficient to project an overall cost savings to the county, and the
32average per diem charges or costs of service provided in the facility
33do not exceed approximately 75 percent of the average per diem
34charges or costs of similar psychiatric service provided in a
35psychiatric or general hospital.

36(4) When a public facility is federally certified by the federal
37Centers for Medicare and Medicaid Services and serves a
38population mix that includes a proportion of Medi-Cal patients
39sufficient to project an overall program cost savings with
40certification, the State Department of Health Care Services shall
P63   1approve the program aspects only if the average per diem charges
2or costs of service provided in the facility do not exceed
3approximately 75 percent of the average per diem charges or costs
4of similar psychiatric service provided in a psychiatric or general
5hospital.

6(5) (A) The State Department of Health Care Services may set
7a lower rate for private or public facilities than that required by
8paragraph (3) or (4), if so required by the federal Centers for
9Medicare and Medicaid Services as a condition for the receipt of
10federal matching funds.

11(B) This section does not impose any obligation on any private
12facility to contract with a county for the provision of services to
13Medi-Cal beneficiaries, and any contract for that purpose is subject
14to the agreement of the participating facility.

15(6) (A) In using the guidelines specified in this subdivision,
16the State Department of Health Care Services shall take into
17account local conditions affecting the costs or charges.

18(B) In those psychiatric health facilities authorized by special
19permit to offer structured outpatient services not exceeding 10
20daytime hours, the following limits on per diem rates shall apply:

21(i) The per diem charge for patients in both a morning and an
22afternoon program on the same day shall not exceed 60 percent of
23the facility’s authorized per diem charge for inpatient services.

24(ii) The per diem charge for patients in either a morning or
25afternoon program shall not exceed 30 percent of the facility’s
26authorized per diem charge for inpatient services.

27(i) The licensing fees charged for these facilities shall be credited
28to the State Department of Health Care Services for its costs
29incurred in the review of psychiatric health facility programs, in
30connection with the licensing of these facilities.

31(j) (1) The State Department of Health Care Services shall
32establish a system for the imposition of prompt and effective civil
33sanctions against psychiatric health facilities in violation of the
34laws and regulations of this state pertaining to psychiatric health
35facilities. If the State Department of Health Care Services
36determines that there is or has been a failure, in a substantial
37manner, on the part of a psychiatric health facility to comply with
38the laws and regulations, the Director of Health Care Services may
39impose the following sanctions:

40(A) Cease and desist orders.

P64   1(B) Monetary sanctions, which may be imposed in addition to
2the penalties of suspension, revocation, or cease and desist orders.
3The amount of monetary sanctions permitted to be imposed
4pursuant to this subparagraph shall not be less than fifty dollars
5($50) nor more than one hundred dollars ($100) multiplied by the
6licensed bed capacity, per day, for each violation. However, the
7monetary sanction shall not exceed three thousand dollars ($3,000)
8per day. A facility that is assessed a monetary sanction under this
9subparagraph, and that repeats the deficiency, may, in accordance
10with the regulations adopted pursuant to this subdivision, be subject
11to immediate suspension of its license until the deficiency is
12corrected.

13(2) The State Department of Health Care Services may adopt
14regulations necessary to implement this subdivision and paragraph
15(5) of subdivision (f) in accordance with the Administrative
16Procedure Act (Chapter 3.5 (commencing with Section 11340) of
17Part 1 of Division 3 of Title 2 of the Government Code).

18(k) Proposed changes in the standards or regulations affecting
19health facilities that serve the mentally disordered shall be effected
20only with the review and coordination of the California Health and
21Human Services Agency.

22(l) In psychiatric health facilities where the clinical director is
23not a physician, a psychiatrist, or if one is temporarily not available,
24a physician shall be designated who shall direct those medical
25treatments and services that can only be provided by, or under the
26direction of, a physician.

27

SEC. 31.  

Section 5150 of the Welfare and Institutions Code is
28amended to read:

29

5150.  

(a) When any person, as a result of mental disorder, is
30a danger to others, or to himself or herself, or gravely disabled, a
31peace officer, member of the attending staff, as defined by
32regulation, of an evaluation facility designated by the county, or
33other professional person designated by the county may, upon
34probable cause, take, or cause to be taken, the person into custody
35and place him or her in a facility designated by the county and
36approved by the State Department of Health Care Services as a
37facility for 72-hour treatment and evaluation.

38(b) The facility shall require an application in writing stating
39the circumstances under which the person’s condition was called
40to the attention of the officer, member of the attending staff, or
P65   1professional person, and stating that the officer, member of the
2attending staff, or professional person has probable cause to believe
3that the person is, as a result of mental disorder, a danger to others,
4or to himself or herself, or gravely disabled. If the probable cause
5is based on the statement of a person other than the officer, member
6of the attending staff, or professional person, the person shall be
7liable in a civil action for intentionally giving a statement which
8he or she knows to be false.

9

SEC. 32.  

Section 5151 of the Welfare and Institutions Code is
10amended to read:

11

5151.  

(a) If the facility for 72-hour treatment and evaluation
12admits the person, it may detain him or her for evaluation and
13treatment for a period not to exceed 72 hours. Saturdays, Sundays,
14and holidays may be excluded from the 72-hour period if the State
15Department of Health Care Services certifies for each facility that
16evaluation and treatment services cannot reasonably be made
17available on those days. The certification by the department is
18subject to renewal every two years. The department may adopt
19regulations defining criteria for determining whether a facility can
20reasonably be expected to make evaluation and treatment services
21available on Saturdays, Sundays, and holidays.

22(b) Prior to admitting a person to the facility for 72-hour
23treatment and evaluation pursuant to Section 5150, the professional
24person in charge of the facility or his or her designee shall assess
25the individual in person to determine the appropriateness of the
26involuntary detention.

27(c) If in the judgment of the professional person in charge of
28the facility providing evaluation and treatment, or his or her
29designee, the person can be properly served without being detained,
30he or she shall be provided evaluation, crisis intervention, or other
31inpatient or outpatient services on a voluntary basis.

32(d) Nothing in this section shall be interpreted to prevent a peace
33officer from delivering individuals to a designated facility for
34assessment under Section 5150. Furthermore, the preadmission
35assessment requirement of this section shall not be interpreted to
36require peace officers to perform any additional duties other than
37those specified in Sections 5150.1 and 5150.2.

38

SEC. 33.  

Section 5157 of the Welfare and Institutions Code is
39amended to read:

P66   1

5157.  

(a) Each person, at the time he or she is first taken into
2custody under provisions of Section 5150, shall be provided, by
3the person who takes such other person into custody, the following
4information orally. The information shall be in substantially the
5following form:

 

My name is    .

I am a     .

(peace officer, mental health professional)

with     .

(name of agency)

You are not under criminal arrest, but I am taking you for examination by mental health professionals at     .

   

(name of facility)

You will be told your rights by the mental health staff.

 If taken into custody at his or her residence, the person shall also be told the following information in substantially the following form:

 You may bring a few personal items with you which I will have to approve. You can make a phone call and/or leave a note to tell your friends and/or family where you have been taken.

P66  22

 

23(b) The designated facility shall keep, for each patient evaluated,
24a record of the advisement given pursuant to subdivision (a) which
25shall include:

26(1) Name of person detained for evaluation.

27(2) Name and position of peace officer or mental health
28professional taking person into custody.

29(3) Date.

30(4) Whether advisement was completed.

31(5) If not given or completed, the mental health professional at
32the facility shall either provide the information specified in
33subdivision (a), or include a statement of good cause, as defined
34by regulations of the State Department of Health Care Services,
35which shall be kept with the patient’s medical record.

36(c) Each person admitted to a designated facility for 72-hour
37evaluation and treatment shall be given the following information
38by admission staff at the evaluation unit. The information shall be
39given orally and in writing and in a language or modality accessible
40to the person. The written information shall be available in the
P67   1person’s native language or the language which is the person’s
2principal means of communication. The information shall be in
3substantially the following form:

 

My name is    .

My position here is    .

 You are being placed into the psychiatric unit because it is our professional opinion that as a result of mental disorder, you are likely to:

 (check applicable)
  harm yourself ____
  harm someone else ____
  be unable to take care of your own
   food, clothing, and housing needs ____
We feel this is true because

   

(herewith a listing of the facts upon which the allegation of dangerous
or gravely disabled due to mental disorder is based, including pertinent
facts arising from the admission interview.)

 You will be held on the ward for a period up to 72 hours.
 This does not include weekends or holidays.

Your 72-hour period will begin    

(day and time.)

 During these 72 hours you will be evaluated by the hospital staff, and you may be given treatment, including medications. It is possible for you to be released before the end of the 72 hours. But if the staff decides that you need continued treatment you can be held for a longer period of time. If you are held longer than 72 hours you have the right to a lawyer and a qualified interpreter and a hearing before a judge. If you are unable to pay for the lawyer, then one will be provided free.

 

31(d) For each patient admitted for 72-hour evaluation and
32treatment, the facility shall keep with the patient’s medical record
33a record of the advisement given pursuant to subdivision (c) which
34shall include:

35(1) Name of person performing advisement.

36(2) Date.

37(3) Whether advisement was completed.

38(4) If not completed, a statement of good cause.

39If the advisement was not completed at admission, the
40advisement process shall be continued on the ward until completed.
P68   1A record of the matters prescribed by subdivisions (a), (b), and (c)
2shall be kept with the patient’s medical record.

3

SEC. 34.  

Section 5202 of the Welfare and Institutions Code is
4amended to read:

5

5202.  

The person or agency designated by the county shall
6prepare the petition and all other forms required in the proceeding,
7and shall be responsible for filing the petition. Before filing the
8petition, the person or agency designated by the county shall
9request the person or agency designated by the county and
10approved by the State Department of Health Care Services to
11provide prepetition screening to determine whether there is
12probable cause to believe the allegations. The person or agency
13providing prepetition screening shall conduct a reasonable
14investigation of the allegations and make a reasonable effort to
15personally interview the subject of the petition. The screening shall
16also determine whether the person will agree voluntarily to receive
17crisis intervention services or an evaluation in his own home or in
18a facility designated by the county and approved by the State
19Department of Health Care Services. Following prepetition
20screening, the person or agency designated by the county shall file
21the petition if satisfied that there is probable cause to believe that
22the person is, as a result of mental disorder, a danger to others, or
23to himself or herself, or gravely disabled, and that the person will
24not voluntarily receive evaluation or crisis intervention.

25If the petition is filed, it shall be accompanied by a report
26containing the findings of the person or agency designated by the
27county to provide prepetition screening. The prepetition screening
28report submitted to the superior court shall be confidential and
29shall be subject to the provisions of Section 5328.

30

SEC. 35.  

Section 5326.9 of the Welfare and Institutions Code
31 is amended to read:

32

5326.9.  

(a) Any alleged or suspected violation of the rights
33described in Chapter 2 (commencing with Section 5150) shall be
34investigated by the local director of mental health, or his or her
35designee. Violations of Sections 5326.2 to 5326.8, inclusive,
36concerning patients involuntarily detained for evaluation or
37treatment under this part, or as a voluntary patient for psychiatric
38evaluation or treatment to a health facility, as defined in Section
391250 of the Health and Safety Code, in which psychiatric
40evaluation or treatment is offered, shall also be investigated by the
P69   1Director of Health Care Services, or his or her designee. Violations
2of Sections 5326.2 to 5326.8, inclusive, concerning persons
3committed to a state hospital shall also be investigated by the
4Director of State Hospitals, or his or her designee. If it is
5determined by the local director of mental health, the Director of
6Health Care Services, or the Director of State Hospitals that a right
7has been violated, a formal notice of violation shall be issued.

8(b) Either the local director of mental health or the Director of
9Health Care Services, upon issuing a notice of violation, may take
10any or all of the following action:

11(1) Assign a specified time period during which the violation
12shall be corrected.

13(2) Referral to the Medical Board of California or other
14professional licensing agency. Such board shall investigate further,
15if warranted, and shall subject the individual practitioner to any
16penalty the board finds necessary and is authorized to impose.

17(3) Revoke a facility’s designation and authorization under
18Section 5404 to evaluate and treat persons detained involuntarily.

19(4) Refer any violation of law to a local district attorney or the
20Attorney General for prosecution in any court with jurisdiction.

21(c) The Director of State Hospitals, upon issuing a notice of
22violation, may take any or all of the following actions:

23(1) Assign a specified time period during which the violation
24shall be corrected.

25(2) Make a referral to the Medical Board of California or other
26professional licensing agency. The board or agency shall
27investigate further, if warranted, and shall subject the individual
28practitioner to any penalty the board finds necessary and is
29authorized to impose.

30(3) Refer any violation of law to a local district attorney or the
31Attorney General for prosecution in any court with jurisdiction.

32(d) Any physician who intentionally violates Sections 5326.2
33to 5326.8, inclusive, shall be subject to a civil penalty of not more
34than five thousand dollars ($5,000) for each violation. The penalty
35may be assessed and collected in a civil action brought by the
36Attorney General in a superior court. Such intentional violation
37shall be grounds for revocation of license.

38(e) Any person or facility found to have knowingly violated the
39provisions of the first paragraph of Section 5325.1 or to have
40denied without good cause any of the rights specified in Section
P70   15325 shall pay a civil penalty, as determined by the court, of fifty
2dollars ($50) per day during the time in which the violation is not
3 corrected, commencing on the day on which a notice of violation
4was issued, not to exceed one thousand dollars ($1,000), for each
5and every violation, except that any liability under this provision
6shall be offset by an amount equal to a fine or penalty imposed for
7the same violation under the provisions of Sections 1423 to 1425,
8inclusive, or 1428 of the Health and Safety Code. These penalties
9shall be deposited in the general fund of the county in which the
10violation occurred. The local district attorney or the Attorney
11General shall enforce this section in any court with jurisdiction.
12Where the State Department of Public Health, under the provisions
13of Sections 1423 to 1425, inclusive, of the Health and Safety Code,
14determines that no violation has occurred, the provisions of
15paragraph (4) of subdivision (b) shall not apply.

16(f) The remedies provided by this subdivision shall be in addition
17to and not in substitution for any other remedies which an
18individual may have under law.

19

SEC. 36.  

Section 5358 of the Welfare and Institutions Code is
20amended to read:

21

5358.  

(a) (1) When ordered by the court after the hearing
22required by this section, a conservator appointed pursuant to this
23chapter shall place his or her conservatee as follows:

24(A) For a conservatee who is gravely disabled, as defined in
25subparagraph (A) of paragraph (1) of subdivision (h) of Section
265008, in the least restrictive alternative placement, as designated
27by the court.

28(B) For a conservatee who is gravely disabled, as defined in
29subparagraph (B) of paragraph (1) of subdivision (h) of Section
305008, in a placement that achieves the purposes of treatment of
31the conservatee and protection of the public.

32(2) The placement may include a medical, psychiatric, nursing,
33or other state-licensed facility, or a state hospital, county hospital,
34hospital operated by the Regents of the University of California,
35a United States government hospital, or other nonmedical facility
36approved by the State Department of Health Care Services or an
37agency accredited by the State Department of Health Care Services,
38or in addition to any of the foregoing, in cases of chronic
39alcoholism, to a county alcoholic treatment center.

P71   1(b) A conservator shall also have the right, if specified in the
2court order, to require his or her conservatee to receive treatment
3related specifically to remedying or preventing the recurrence of
4the conservatee’s being gravely disabled, or to require his or her
5conservatee to receive routine medical treatment unrelated to
6remedying or preventing the recurrence of the conservatee’s being
7gravely disabled. Except in emergency cases in which the
8conservatee faces loss of life or serious bodily injury, no surgery
9shall be performed upon the conservatee without the conservatee’s
10prior consent or a court order obtained pursuant to Section 5358.2
11specifically authorizing that surgery.

12(c) (1) For a conservatee who is gravely disabled, as defined
13in subparagraph (A) of paragraph (1) of subdivision (h) of Section
145008, if the conservatee is not to be placed in his or her own home
15or the home of a relative, first priority shall be to placement in a
16suitable facility as close as possible to his or her home or the home
17of a relative. For the purposes of this section, suitable facility
18means the least restrictive residential placement available and
19necessary to achieve the purpose of treatment. At the time that the
20court considers the report of the officer providing conservatorship
21investigation specified in Section 5356, the court shall consider
22available placement alternatives. After considering all the evidence
23the court shall determine the least restrictive and most appropriate
24alternative placement for the conservatee. The court shall also
25determine those persons to be notified of a change of placement.
26The fact that a person for whom conservatorship is recommended
27is not an inpatient shall not be construed by the court as an
28indication that the person does not meet the criteria of grave
29disability.

30(2) For a conservatee who is gravely disabled, as defined in
31subparagraph (B) of paragraph (1) of subdivision (h) of Section
325008, first priority shall be placement in a facility that achieves
33the purposes of treatment of the conservatee and protection of the
34public. The court shall determine the most appropriate placement
35 for the conservatee. The court shall also determine those persons
36to be notified of a change of placement, and additionally require
37the conservator to notify the district attorney or attorney
38representing the originating county prior to any change of
39placement.

P72   1(3) For any conservatee, if requested, the local mental health
2director shall assist the conservator or the court in selecting a
3placement facility for the conservatee. When a conservatee who
4is receiving services from the local mental health program is
5placed, the conservator shall inform the local mental health director
6of the facility’s location and any movement of the conservatee to
7another facility.

8(d) (1) Except for a conservatee who is gravely disabled, as
9defined in subparagraph (B) of paragraph (1) of subdivision (h)
10of Section 5008, the conservator may transfer his or her conservatee
11to a less restrictive alternative placement without a further hearing
12and court approval. In any case in which a conservator has
13reasonable cause to believe that his or her conservatee is in need
14of immediate more restrictive placement because the condition of
15the conservatee has so changed that the conservatee poses an
16immediate and substantial danger to himself or herself or others,
17the conservator shall have the right to place his or her conservatee
18in a more restrictive facility or hospital. Notwithstanding Section
195328, if the change of placement is to a placement more restrictive
20than the court-determined placement, the conservator shall provide
21written notice of the change of placement and the reason therefor
22to the court, the conservatee’s attorney, the county patient’s rights
23advocate and any other persons designated by the court pursuant
24to subdivision (c).

25(2) For a conservatee who is gravely disabled, as defined in
26subparagraph (B) of paragraph (1) of subdivision (h) of Section
275008, the conservator may not transfer his or her conservatee
28without providing written notice of the proposed change of
29placement and the reason therefor to the court, the conservatee’s
30attorney, the county patient’s rights advocate, the district attorney
31of the county that made the commitment, and any other persons
32designated by the court to receive notice. If any person designated
33to receive notice objects to the proposed transfer within 10 days
34after receiving notice, the matter shall be set for a further hearing
35and court approval. The notification and hearing is not required
36for the transfer of persons between state hospitals.

37(3) At a hearing where the conservator is seeking placement to
38a less restrictive alternative placement pursuant to paragraph (2),
39the placement shall not be approved where it is determined by a
P73   1preponderance of the evidence that the placement poses a threat
2to the safety of the public, the conservatee, or any other individual.

3(4) A hearing as to placement to a less restrictive alternative
4placement, whether requested pursuant to paragraph (2) or pursuant
5to Section 5358.3, shall be granted no more frequently than is
6provided for in Section 5358.3.

7

SEC. 37.  

Section 5366.1 of the Welfare and Institutions Code
8 is amended to read:

9

5366.1.  

(a) Any person detained as of June 30, 1969, under
10court commitment, in a private institution, a county psychiatric
11hospital, facility of the Veterans Administration, or other agency
12of the United States government, community mental health service,
13or detained in a state hospital or facility of the Veterans
14Administration upon application of a local health officer, pursuant
15to former Section 5567 or Sections 6000 to 6019, inclusive, as
16they read immediately preceding July 1, 1969, may be detained,
17after January 1, 1972, for a period no longer than 180 days, except
18as provided in this section.

19(b) Any person detained pursuant to this section on the effective
20date of this section shall be evaluated by the facility designated
21by the county and approved by the State Department of Health
22Care Services pursuant to Section 5150 as a facility for 72-hour
23treatment and evaluation. The evaluation shall be made at the
24request of the person in charge of the institution in which the person
25is detained. If in the opinion of the professional person in charge
26of the evaluation and treatment facility or his or her designee, the
27evaluation of the person can be made by the professional person
28or his or her designee at the institution in which the person is
29detained, the person shall not be required to be evaluated at the
30evaluation and treatment facility, but shall be evaluated at the
31institution where he or she is detained, or other place to determine
32if the person is a danger to others, himself or herself, or gravely
33disabled as a result of mental disorder.

34(c) Any person evaluated under this section shall be released
35from the institution in which he or she is detained immediately
36upon completion of the evaluation if in the opinion of the
37professional person in charge of the evaluation and treatment
38facility, or his or her designee, the person evaluated is not a danger
39to others, or to himself or herself, or gravely disabled as a result
P74   1of mental disorder, unless the person agrees voluntarily to remain
2in the institution in which he or she has been detained.

3(d) If in the opinion of the professional person in charge of the
4facility or his or her designee, the person evaluated requires
5intensive treatment or recommendation for conservatorship, the
6professional person or his or her designee shall proceed under
7Article 4 (commencing with Section 5250) of Chapter 2, or under
8Chapter 3 (commencing with Section 5350), of Part 1 of Division
95.

10(e) If it is determined from the evaluation that the person is
11gravely disabled and a recommendation for conservatorship is
12made, and if the petition for conservatorship for the person is not
13filed by June 30, 1972, the court commitment or detention under
14a local health officer application for the person shall terminate and
15the patient shall be released unless he or she agrees to accept
16treatment on a voluntary basis.

17

SEC. 38.  

Section 5404 of the Welfare and Institutions Code is
18amended to read:

19

5404.  

(a) Each county may designate facilities, which are not
20hospitals or clinics, as 72-hour evaluation and treatment facilities
21and as 14-day intensive treatment facilities if the facilities meet
22those requirements as the Director of Health Care Services may
23establish by regulation. The Director of Health Care Services shall
24encourage the use by counties of appropriate facilities, which are
25not hospitals or clinics, for the evaluation and treatment of patients
26pursuant to this part.

27(b) All regulations relating to the approval of facilities
28designated by the county for 72-hour treatment and evaluation and
2914-day intensive treatment facilities, heretofore adopted by the
30State Department of Mental Health, or a successor, shall remain
31in effect and shall be fully enforceable by the State Department of
32Health Care Services with respect to any facility or program
33required to be approved as a facility for 72-hour treatment and
34evaluation and 14-day intensive treatment facilities, unless and
35until readopted, amended, or repealed by the Director of Health
36Care Services. The State Department of Health Care Services shall
37succeed to and be vested with all duties, powers, purposes,
38functions, responsibilities, and jurisdiction of the State Department
39of Mental Health, or a successor, as they relate to approval of
P75   1facilities for 72-hour treatment and evaluation and 14-day intensive
2treatment facilities.

3

SEC. 39.  

Section 5405 of the Welfare and Institutions Code is
4amended to read:

5

5405.  

(a) This section shall apply to each facility licensed by
6the State Department of Health Care Services, or its delegated
7agent, on or after January 1, 2003. For purposes of this section,
8“facility” means psychiatric health facilities, as defined in Section
91250.2 of the Health and Safety Code, licensed pursuant to Chapter
109 (commencing with Section 77001) of Division 5 of Title 22 of
11the California Code of Regulations and mental health rehabilitation
12centers licensed pursuant to Chapter 3.5 (commencing with Section
13781.00) of Division 1 of Title 9 of the California Code of
14Regulations.

15(b) (1) (A) Prior to the initial licensure or first renewal of a
16license on or after January 1, 2003, of any person to operate or
17manage a facility specified in subdivision (a), the applicant or
18licensee shall submit fingerprint images and related information
19pertaining to the applicant or licensee to the Department of Justice
20for purposes of a criminal record check, as specified in paragraph
21(2), at the expense of the applicant or licensee. The Department
22of Justice shall provide the results of the criminal record check to
23the State Department of Health Care Services. The State
24Department of Health Care Services may take into consideration
25information obtained from or provided by other government
26agencies. The State Department of Health Care Services shall
27determine whether the applicant or licensee has ever been convicted
28of a crime specified in subdivision (c). The applicant or licensee
29shall submit fingerprint images and related information each time
30the position of administrator, manager, program director, or fiscal
31officer of a facility is filled and prior to actual employment for
32initial licensure or an individual who is initially hired on or after
33January 1, 2003. For purposes of this subdivision, “applicant” and
34“licensee” include the administrator, manager, program director,
35or fiscal officer of a facility.

36(B) Commencing July 1, 2013, upon the employment of, or
37contract with or for, any direct care staff, the direct care staff person
38or licensee shall submit fingerprint images and related information
39pertaining to the direct care staff person to the Department of
40Justice for purposes of a criminal record check, as specified in
P76   1paragraph (2), at the expense of the direct care staff person or
2licensee. The Department of Justice shall provide the results of
3the criminal record check to the State Department of Health Care
4Services. The State Department of Health Care Services shall
5determine whether the direct care staff person has ever been
6convicted of a crime specified in subdivision (c). The State
7Department of Health Care Services shall notify the licensee of
8these results. No direct client contact by the trainee or newly hired
9staff, or by any direct care contractor shall occur prior to clearance
10by the State Department of Health Care Services unless the trainee,
11 newly hired employee, contractor, or employee of the contractor
12is constantly supervised.

13(C) Commencing July 1, 2013, any contract for services
14provided directly to patients or residents shall contain provisions
15to ensure that the direct services contractor submits to the
16Department of Justice fingerprint images and related information
17pertaining to the direct services contractor for submission to the
18State Department of Health Care Services for purposes of a
19criminal record check, as specified in paragraph (2), at the expense
20of the direct services contractor or licensee. The Department of
21Justice shall provide the results of the criminal record check to the
22State Department of Health Care Services. The State Department
23of Health Care Services shall determine whether the direct services
24contractor has ever been convicted of a crime specified in
25subdivision (c). The State Department of Health Care Services
26shall notify the licensee of these results.

27(2) If the applicant, licensee, direct care staff person, or direct
28services contractor specified in paragraph (1) has resided in
29California for at least the previous seven years, the applicant,
30licensee, direct care staff person, or direct services contractor shall
31only submit one set of fingerprint images and related information
32to the Department of Justice. The Department of Justice shall
33charge a fee sufficient to cover the reasonable cost of processing
34the fingerprint submission. Fingerprints and related information
35submitted pursuant to this subdivision include fingerprint images
36captured and transmitted electronically. When requested, the
37Department of Justice shall forward one set of fingerprint images
38to the Federal Bureau of Investigation for the purpose of obtaining
39any record of previous convictions or arrests pending adjudication
40of the applicant, licensee, direct care staff person, or direct services
P77   1contractor. The results of a criminal record check provided by the
2Department of Justice shall contain every conviction rendered
3against an applicant, licensee, direct care staff person, or direct
4services contractor, and every offense for which the applicant,
5licensee, direct care staff person, or direct services contractor is
6presently awaiting trial, whether the person is incarcerated or has
7been released on bail or on his or her own recognizance pending
8trial. The State Department of the Health Care Services shall
9request subsequent arrest notification from the Department of
10Justice pursuant to Section 11105.2 of the Penal Code.

11(3) An applicant and any other person specified in this
12subdivision, as part of the background clearance process, shall
13provide information as to whether or not the person has any prior
14criminal convictions, has had any arrests within the past 12-month
15period, or has any active arrests, and shall certify that, to the best
16of his or her knowledge, the information provided is true. This
17requirement is not intended to duplicate existing requirements for
18individuals who are required to submit fingerprint images as part
19of a criminal background clearance process. Every applicant shall
20provide information on any prior administrative action taken
21against him or her by any federal, state, or local government agency
22and shall certify that, to the best of his or her knowledge, the
23information provided is true. An applicant or other person required
24to provide information pursuant to this section that knowingly or
25willfully makes false statements, representations, or omissions
26may be subject to administrative action, including, but not limited
27to, denial of his or her application or exemption or revocation of
28any exemption previously granted.

29(c) (1) The State Department of Health Care Services shall
30deny any application for any license, suspend or revoke any
31existing license, and disapprove or revoke any employment or
32contract for direct services, if the applicant, licensee, employee,
33or direct services contractor has been convicted of, or incarcerated
34for, a felony defined in subdivision (c) of Section 667.5 of, or
35subdivision (c) of Section 1192.7 of, the Penal Code, within the
36preceding 10 years.

37(2) The application for licensure or renewal of any license shall
38be denied, and any employment or contract to provide direct
39services shall be disapproved or revoked, if the criminal record of
40the person includes a conviction in another jurisdiction for an
P78   1offense that, if committed or attempted in this state, would have
2been punishable as one or more of the offenses referred to in
3paragraph (1).

4(d) (1) The State Department of Health Care Services may
5approve an application for, or renewal of, a license, or continue
6any employment or contract for direct services, if the person has
7been convicted of a misdemeanor offense that is not a crime upon
8the person of another, the nature of which has no bearing upon the
9duties for which the person will perform as a licensee, direct care
10staff person, or direct services contractor. In determining whether
11to approve the application, employment, or contract for direct
12services, the department shall take into consideration the factors
13enumerated in paragraph (2).

14(2) Notwithstanding subdivision (c), if the criminal record of a
15person indicates any conviction other than a minor traffic violation,
16the State Department of Health Care Services may deny the
17application for license or renewal, and may disapprove or revoke
18any employment or contract for direct services. In determining
19whether or not to deny the application for licensure or renewal, or
20to disapprove or revoke any employment or contract for direct
21services, the department shall take into consideration the following
22factors:

23(A) The nature and seriousness of the offense under
24consideration and its relationship to the person’s employment,
25duties, and responsibilities.

26(B) Activities since conviction, including employment or
27participation in therapy or education, that would indicate changed
28behavior.

29(C) The time that has elapsed since the commission of the
30conduct or offense and the number of offenses.

31(D) The extent to which the person has complied with any terms
32of parole, probation, restitution, or any other sanction lawfully
33imposed against the person.

34(E) Any rehabilitation evidence, including character references,
35submitted by the person.

36(F) Employment history and current employer recommendations.

37(G) Circumstances surrounding the commission of the offense
38that would demonstrate the unlikelihood of repetition.

39(H) The granting by the Governor of a full and unconditional
40pardon.

P79   1(I) A certificate of rehabilitation from a superior court.

2(e) Denial, suspension, or revocation of a license, or disapproval
3or revocation of any employment or contract for direct services
4specified in subdivision (c) and paragraph (2) of subdivision (d)
5are not subject to appeal, except as provided in subdivision (f).

6(f) After a review of the record, the director may grant an
7exemption from denial, suspension, or revocation of any license,
8or disapproval of any employment or contract for direct services,
9if the crime for which the person was convicted was a property
10crime that did not involve injury to any person and the director
11has substantial and convincing evidence to support a reasonable
12belief that the person is of such good character as to justify issuance
13or renewal of the license or approval of the employment or contract.

14(g) A plea or verdict of guilty, or a conviction following a plea
15of nolo contendere shall be deemed a conviction within the
16meaning of this section. The State Department of Health Care
17Services may deny any application, or deny, suspend, or revoke a
18license, or disapprove or revoke any employment or contract for
19direct services based on a conviction specified in subdivision (c)
20when the judgment of conviction is entered or when an order
21granting probation is made suspending the imposition of sentence.

22(h) (1) For purposes of this section, “direct care staff” means
23any person who is an employee, contractor, or volunteer who has
24contact with other patients or residents in the provision of services.
25Administrative and licensed personnel shall be considered direct
26care staff when directly providing program services to participants.

27(2) An additional background check shall not be required
28pursuant to this section if the direct care staff or licensee has
29received a prior criminal history background check while working
30in a mental health rehabilitation center or psychiatric health facility
31licensed by the State Department of Health Care Services, and
32provided the department has maintained continuous subsequent
33arrest notification on the individual from the Department of Justice
34since the prior criminal background check was initiated.

35(3) When an application is denied on the basis of a conviction
36pursuant to this section, the State Department of Health Care
37Services shall provide the individual whose application was denied
38with notice, in writing, of the specific grounds for the proposed
39denial.

P80   1

SEC. 40.  

Section 5585.21 of the Welfare and Institutions Code
2 is amended to read:

3

5585.21.  

The Director of Health Care Services may promulgate
4regulations as necessary to implement and clarify the provisions
5of this part as they relate to minors.

6

SEC. 41.  

Section 5585.50 of the Welfare and Institutions Code
7 is amended to read:

8

5585.50.  

(a) When any minor, as a result of mental disorder,
9is a danger to others, or to himself or herself, or gravely disabled
10and authorization for voluntary treatment is not available, a peace
11officer, member of the attending staff, as defined by regulation,
12of an evaluation facility designated by the county, or other
13professional person designated by the county may, upon probable
14cause, take, or cause to be taken, the minor into custody and place
15him or her in a facility designated by the county and approved by
16the State Department of Health Care Services as a facility for
1772-hour treatment and evaluation of minors. The facility shall
18make every effort to notify the minor’s parent or legal guardian
19as soon as possible after the minor is detained.

20(b) The facility shall require an application in writing stating
21the circumstances under which the minor’s condition was called
22to the attention of the officer, member of the attending staff, or
23professional person, and stating that the officer, member of the
24attending staff, or professional person has probable cause to believe
25that the minor is, as a result of mental disorder, a danger to others,
26or to himself or herself, or gravely disabled and authorization for
27voluntary treatment is not available. If the probable cause is based
28on the statement of a person other than the officer, member of the
29attending staff, or professional person, the person shall be liable
30in a civil action for intentionally giving a statement which he or
31she knows to be false.

32

SEC. 42.  

Section 5585.55 of the Welfare and Institutions Code
33 is amended to read:

34

5585.55.  

The minor committed for involuntary treatment under
35this part shall be placed in a mental health facility designated by
36the county and approved by the State Department of Health Care
37Services as a facility for 72-hour evaluation and treatment. Except
38as provided for in Section 5751.7, each county shall ensure that
39minors under 16 years of age are not held with adults receiving
40psychiatric treatment under the provisions of the
P81   1Lanterman-Petris-Short Act (Part 1 (commencing with Section
25000)).

3

SEC. 43.  

Section 5675 of the Welfare and Institutions Code is
4amended to read:

5

5675.  

(a) Mental health rehabilitation centers shall only be
6licensed by the State Department of Health Care Services
7subsequent to application by counties, county contract providers,
8or other organizations. In the application for a mental health
9rehabilitation center, program evaluation measures shall include,
10but not be limited to:

11(1) That the clients placed in the facilities show improved global
12assessment scores, as measured by preadmission and postadmission
13tests.

14(2) That the clients placed in the facilities demonstrate improved
15functional behavior as measured by preadmission and
16postadmission tests.

17(3) That the clients placed in the facilities have reduced
18medication levels as determined by comparison of preadmission
19and postadmission records.

20(b) The State Department of Health Care Services shall conduct
21annual licensing inspections of mental health rehabilitation centers.

22(c) All regulations relating to the licensing of mental health
23rehabilitation centers, heretofore adopted by the State Department
24of Mental Health, or its successor, shall remain in effect and shall
25be fully enforceable by the State Department of Health Care
26Services with respect to any facility or program required to be
27licensed as a mental health rehabilitation center, unless and until
28readopted, amended, or repealed by the Director of Health Care
29Services. The State Department of Health Care Services shall
30succeed to and be vested with all duties, powers, purposes,
31functions, responsibilities, and jurisdiction of the State Department
32of Mental Health, and its successor, if any, as they relate to
33licensing mental health rehabilitation centers.

34

SEC. 44.  

Section 5675.1 of the Welfare and Institutions Code
35 is amended to read:

36

5675.1.  

(a) In accordance with subdivision (b), the State
37Department of Health Care Services may establish a system for
38the imposition of prompt and effective civil sanctions for long-term
39care facilities licensed or certified by the department, including
40facilities licensed under the provisions of Sections 5675 and 5768,
P82   1and including facilities certified as providing a special treatment
2program under Sections 72443 to 72475, inclusive, of Title 22 of
3the California Code of Regulations.

4(b) If the department determines that there is or has been a
5failure, in a substantial manner, on the part of any such facility to
6comply with the applicable laws and regulations, the director may
7 impose the following sanctions:

8(1) A plan of corrective action that addresses all failure identified
9by the department and includes timelines for correction.

10(2) A facility that is issued a plan of corrective action, and that
11fails to comply with the plan and repeats the deficiency, may be
12subject to immediate suspension of its license or certification, until
13the deficiency is corrected, when failure to comply with the plan
14of correction may cause a health or safety risk to residents.

15(c) The department may also establish procedures for the appeal
16of an administrative action taken pursuant to this section, including
17a plan of corrective action or a suspension of license or
18 certification.

19

SEC. 45.  

Section 5675.2 of the Welfare and Institutions Code
20 is amended to read:

21

5675.2.  

(a) There is hereby created in the State Treasury the
22Mental Health Facility Licensing Fund, from which money, upon
23appropriation by the Legislature in the Budget Act, shall be
24expended by the State Department of Health Care Services to fund
25administrative and other activities in support of the mental health
26licensing and certification functions of the State Department of
27Health Care Services. The Mental Health Facility Licensing Fund
28is the successor to the Licensing and Certification Fund, Mental
29Health, which fund is hereby abolished. All references in any law
30to the Licensing and Certification Fund, Mental Health shall be
31deemed to refer to the Mental Health Facility Licensing Fund.

32(b) Commencing January 1, 2005, each new and renewal
33application for a license to operate a mental health rehabilitation
34center shall be accompanied by an application or renewal fee.

35(c) The amount of the fees shall be determined and collected
36by the State Department of Health Care Services, but the total
37amount of the fees collected shall not exceed the actual costs of
38licensure and regulation of the centers, including, but not limited
39 to, the costs of processing the application, inspection costs, and
40other related costs.

P83   1(d) Each license or renewal issued pursuant to this chapter shall
2expire 12 months from the date of issuance. Application for
3renewal of the license shall be accompanied by the necessary fee
4and shall be filed with the department at least 30 days prior to the
5expiration date. Failure to file a timely renewal may result in
6expiration of the license.

7(e) License and renewal fees collected pursuant to this section
8shall be deposited into the Mental Health Facility Licensing Fund.

9(f) Fees collected by the State Department of Health Care
10Services pursuant to this section shall be expended by the State
11Department of Health Care Services for the purpose of ensuring
12the health and safety of all individuals providing care and
13supervision by licensees and to support activities of the department,
14including, but not limited to, monitoring facilities for compliance
15with applicable laws and regulations.

16(g) The State Department of Health Care Services may make
17additional charges to the facilities if additional visits are required
18to ensure that corrective action is taken by the licensee.

19

SEC. 46.  

Section 5751.7 of the Welfare and Institutions Code
20 is amended to read:

21

5751.7.  

(a) For the purposes of this part and the
22Lanterman-Petris-Short Act (Part 1 (commencing with Section
235000)), the State Department of Health Care Services and the State
24Department of State Hospitals shall ensure that, whenever feasible,
25minors shall not be admitted into psychiatric treatment with adults
26if the health facility has no specific separate housing arrangements,
27treatment staff, and treatment programs designed to serve children
28or adolescents. The Director of Health Care Services shall provide
29waivers to counties, upon their request, if this policy creates undue
30hardship in any county due to inadequate or unavailable alternative
31resources. In granting the waivers, the Director of Health Care
32Services shall require the county to establish specific treatment
33protocols and administrative procedures for identifying and
34providing appropriate treatment to minors admitted with adults.

35(b) However, notwithstanding any other provision of law, no
36minor may be admitted for psychiatric treatment into the same
37treatment ward as any adult receiving treatment who is in the
38custody of any jailor for a violent crime, is a known registered sex
39offender, or has a known history of, or exhibits inappropriate,
P84   1sexual, or other violent behavior which would present a threat to
2the physical safety of minors.

3

SEC. 47.  

Section 5768 of the Welfare and Institutions Code is
4amended to read:

5

5768.  

(a) Notwithstanding any other provision of law, except
6as to requirements relating to fire and life safety of persons with
7mental illness, the State Department of Health Care Services, in
8its discretion, may permit new programs to be developed and
9implemented without complying with licensure requirements
10established pursuant to existing state law.

11(b) Any program developed and implemented pursuant to
12subdivision (a) shall be reviewed at least once each six months,
13as determined by the State Department of Health Care Services.

14(c) The State Department of Health Care Services may establish
15appropriate licensing requirements for these new programs upon
16a determination that the programs should be continued.

17(d) Within six years, any program shall require a licensure
18category if it is to be continued. However, in the event that any
19agency other than the State Department of Health Care Services
20is responsible for developing a licensure category and fails to do
21so within the six years, the program may continue to be developed
22and implemented pursuant to subdivisions (a) and (b) until such
23time that the licensure category is established.

24(e) (1) A nongovernmental entity proposing a program shall
25submit a program application and plan to the local mental health
26director that describes at least the following components: clinical
27treatment programs, activity programs, administrative policies and
28procedures, admissions, discharge planning, health records content,
29health records service, interdisciplinary treatment teams, client
30empowerment, patient rights, pharmaceutical services, program
31space requirements, psychiatric and psychological services,
32rehabilitation services, restraint and seclusion, space, supplies,
33equipment, and staffing standards. If the local mental health
34director determines that the application and plan are consistent
35with local needs and satisfactorily address the above components,
36he or she may approve the application and plan and forward them
37to the department.

38(2) Upon the State Department of Health Care Services’
39approval, the local mental health director shall implement the
40program and shall be responsible for regular program oversight
P85   1and monitoring. The department shall be notified in writing of the
2outcome of each review of the program by the local mental health
3director, or his or her designee, for compliance with program
4requirements. The department shall retain ultimate responsibility
5for approving the method for review of each program, and the
6authority for determining the appropriateness of the local program’s
7oversight and monitoring activities.

8(f) Governmental entities proposing a program shall submit a
9program application and plan to the State Department of Health
10Care Services that describes at least the components described in
11subdivision (e). Upon approval, the department shall be responsible
12for program oversight and monitoring.

13(g) Implementation of a program shall be contingent upon the
14State Department of Health Care Services’ approval, and the
15department may reject applications or require modifications as it
16deems necessary. The department shall respond to each proposal
17within 90 days of receipt.

18(h) The State Department of Health Care Services shall submit
19an evaluation to the Legislature of all pilot projects authorized
20pursuant to this section within five years of the commencement
21of operation of the pilot project, determining the effectiveness of
22that program or facility, or both, based on, but not limited to,
23changes in clinical indicators with respect to client functions.

24

SEC. 48.  

Section 5840 of the Welfare and Institutions Code is
25amended to read:

26

5840.  

(a) The State Department of Health Care Services, in
27coordination with counties, shall establish a program designed to
28prevent mental illnesses from becoming severe and disabling. The
29program shall emphasize improving timely access to services for
30underserved populations.

31(b) The program shall include the following components:

32(1) Outreach to families, employers, primary care health care
33providers, and others to recognize the early signs of potentially
34severe and disabling mental illnesses.

35(2) Access and linkage to medically necessary care provided
36by county mental health programs for children with severe mental
37illness, as defined in Section 5600.3, and for adults and seniors
38with severe mental illness, as defined in Section 5600.3, as early
39in the onset of these conditions as practicable.

P86   1(3) Reduction in stigma associated with either being diagnosed
2with a mental illness or seeking mental health services.

3(4) Reduction in discrimination against people with mental
4illness.

5(c) The program shall include mental health services similar to
6those provided under other programs effective in preventing mental
7illnesses from becoming severe, and shall also include components
8similar to programs that have been successful in reducing the
9duration of untreated severe mental illnesses and assisting people
10in quickly regaining productive lives.

11(d) The program shall emphasize strategies to reduce the
12following negative outcomes that may result from untreated mental
13illness:

14(1) Suicide.

15(2) Incarcerations.

16(3) School failure or dropout.

17(4) Unemployment.

18(5) Prolonged suffering.

19(6) Homelessness.

20(7) Removal of children from their homes.

21(e) Prevention and early intervention funds may be used to
22broaden the provision of community-based mental health services
23by adding prevention and early intervention services or activities
24to these services.

25(f) In consultation with mental health stakeholders, and
26consistent with regulations from the Mental Health Services
27Oversight and Accountability Commission, pursuant to Section
285846, the department shall revise the program elements in Section
29 5840 applicable to all county mental health programs in future
30years to reflect what is learned about the most effective prevention
31and intervention programs for children, adults, and seniors.

32

SEC. 49.  

Section 5845 of the Welfare and Institutions Code is
33amended to read:

34

5845.  

(a) The Mental Health Services Oversight and
35Accountability Commission is hereby established to oversee Part
363 (commencing with Section 5800), the Adult and Older Adult
37Mental Health System of Care Act; Part 3.1 (commencing with
38Section 5820), Human Resources, Education, and Training
39Programs; Part 3.2 (commencing with Section 5830), Innovative
40Programs; Part 3.6 (commencing with Section 5840), Prevention
P87   1and Early Intervention Programs; and Part 4 (commencing with
2Section 5850), the Children’s Mental Health Services Act. The
3commission shall replace the advisory committee established
4pursuant to Section 5814. The commission shall consist of 16
5voting members as follows:

6(1) The Attorney General or his or her designee.

7(2) The Superintendent of Public Instruction or his or her
8designee.

9(3) The Chairperson of the Senate Health and Human Services
10Committee or another member of the Senate selected by the
11President pro Tempore of the Senate.

12(4) The Chairperson of the Assembly Health Committee or
13another member of the Assembly selected by the Speaker of the
14Assembly.

15(5) Two persons with a severe mental illness, a family member
16of an adult or senior with a severe mental illness, a family member
17of a child who has or has had a severe mental illness, a physician
18specializing in alcohol and drug treatment, a mental health
19professional, a county sheriff, a superintendent of a school district,
20a representative of a labor organization, a representative of an
21employer with less than 500 employees and a representative of an
22employer with more than 500 employees, and a representative of
23a health care services plan or insurer, all appointed by the
24Governor. In making appointments, the Governor shall seek
25individuals who have had personal or family experience with
26mental illness.

27(b) Members shall serve without compensation, but shall be
28reimbursed for all actual and necessary expenses incurred in the
29performance of their duties.

30(c) The term of each member shall be three years, to be
31staggered so that approximately one-third of the appointments
32expire in each year.

33(d) In carrying out its duties and responsibilities, the commission
34may do all of the following:

35(1) Meet at least once each quarter at any time and location
36convenient to the public as it may deem appropriate. All meetings
37of the commission shall be open to the public.

38(2) Within the limit of funds allocated for these purposes,
39pursuant to the laws and regulations governing state civil service,
40employ staff, including any clerical, legal, and technical assistance
P88   1as may appear necessary. The commission shall administer its
2operations separate and apart from the State Department of Health
3Care Services and the California Health and Human Services
4Agency.

5(3) Establish technical advisory committees such as a committee
6of consumers and family members.

7(4) Employ all other appropriate strategies necessary or
8convenient to enable it to fully and adequately perform its duties
9and exercise the powers expressly granted, notwithstanding any
10authority expressly granted to any officer or employee of state
11government.

12(5) Enter into contracts.

13(6) Obtain data and information from the State Department of
14Health Care Services, the Office of Statewide Health Planning and
15Development, or other state or local entities that receive Mental
16Health Services Act funds, for the commission to utilize in its
17oversight, review, training and technical assistance, accountability,
18and evaluation capacity regarding projects and programs supported
19with Mental Health Services Act funds.

20(7) Participate in the joint state-county decisionmaking process,
21as contained in Section 4061, for training, technical assistance,
22and regulatory resources to meet the mission and goals of the
23state’s mental health system.

24(8) Develop strategies to overcome stigma and discrimination,
25and accomplish all other objectives of Part 3.2 (commencing with
26Section 5830), 3.6 (commencing with Section 5840), and the other
27provisions of the act establishing this commission.

28(9) At any time, advise the Governor or the Legislature regarding
29actions the state may take to improve care and services for people
30with mental illness.

31(10) If the commission identifies a critical issue related to the
32performance of a county mental health program, it may refer the
33issue to the State Department of Health Care Services pursuant to
34Section 5655.

35(11) Assist in providing technical assistance to accomplish the
36purposes of the Mental Health Services Act, Part 3 (commencing
37with Section 5800), and Part 4 (commencing with Section 5850)
38in collaboration with the State Department of Health Care Services
39and in consultation with the California Mental Health Directors
40Association.

P89   1(12) Work in collaboration with the State Department of Health
2Care Services and the California Mental Health Planning Council,
3and in consultation with the California Mental Health Directors
4Association, in designing a comprehensive joint plan for a
5coordinated evaluation of client outcomes in the community-based
6mental health system, including, but not limited to, parts listed in
7subdivision (a). The California Health and Human Services Agency
8shall lead this comprehensive joint plan effort.

9

SEC. 50.  

Section 5846 of the Welfare and Institutions Code is
10amended to read:

11

5846.  

(a) The commission shall adopt regulations for programs
12and expenditures pursuant to Part 3.2 (commencing with Section
135830), for innovative programs, and Part 3.6 (commencing with
14Section 5840), for prevention and early intervention.

15(b) Any regulations adopted by the department pursuant to
16Section 5898 shall be consistent with the commission’s regulations.

17(c) The commission may provide technical assistance to any
18county mental health plan as needed to address concerns or
19recommendations of the commission or when local programs could
20benefit from technical assistance for improvement of their plans.

21(d) The commission shall ensure that the perspective and
22participation of diverse community members reflective of
23California populations and others suffering from severe mental
24illness and their family members is a significant factor in all of its
25decisions and recommendations.

26

SEC. 51.  

Section 5909 of the Welfare and Institutions Code is
27amended to read:

28

5909.  

(a) The Director of Health Care Services shall retain the
29authority and responsibility to monitor and approve special
30treatment programs in skilled nursing facilities in accordance with
31Sections 72443 to 72475, inclusive, of Title 22 of the California
32Code of Regulations.

33(b) The State Department of Health Care Services shall conduct
34annual certification inspections of special treatment programs for
35the mentally disordered for the purpose of approving the special
36treatment programs that are located in skilled nursing facilities
37licensed pursuant to Section 1265 of the Health and Safety Code.

38

SEC. 52.  

Section 6007 of the Welfare and Institutions Code is
39amended to read:

P90   1

6007.  

(a) Any person detained pursuant to this section shall
2be evaluated by the facility designated by the county and approved
3by the State Department of Health Care Services pursuant to
4Section 5150 as a facility for 72-hour treatment and evaluation.
5The evaluation shall be made at the request of the person in charge
6of the private institution in which the person is detained or by one
7of the physicians who signed the certificate. If in the opinion of
8the professional person in charge of the evaluation and treatment
9facility or his or her designee, the evaluation of the person can be
10made by the professional person or his or her designee at the private
11institution in which the person is detained, the person shall not be
12required to be evaluated at the evaluation and treatment facility,
13but shall be evaluated at the private institution to determine if the
14person is a danger to others, himself or herself, or gravely disabled
15as a result of mental disorder.

16(b) Any person evaluated under this section shall be released
17from the private institution immediately upon completion of the
18evaluation if in the opinion of the professional person in charge
19of the evaluation and treatment facility, or his or her designee, the
20person evaluated is not a danger to others, or to himself or herself,
21or gravely disabled as a result of mental disorder, unless the person
22agrees voluntarily to remain in the private institution.

23(c) If in the opinion of the professional person in charge of the
24facility or his or her designee, the person evaluated requires
25intensive treatment or recommendation for conservatorship, the
26professional person or his or her designee shall proceed under
27Article 4 (commencing with Section 5250) of Chapter 2, or under
28Chapter 3 (commencing with Section 5350), of Part 1 of Division
295.

30

SEC. 53.  

Section 6551 of the Welfare and Institutions Code is
31amended to read:

32

6551.  

(a) If the court is in doubt as to whether the person is
33mentally disordered or intellectually disabled, the court shall order
34the person to be taken to a facility designated by the county and
35approved by the State Department of Health Care Services as a
36facility for 72-hour treatment and evaluation. Thereupon, Article
371 (commencing with Section 5150) of Chapter 2 of Part 1 of
38Division 5 applies, except that the professional person in charge
39of the facility shall make a written report to the court concerning
40the results of the evaluation of the person’s mental condition. If
P91   1the professional person in charge of the facility finds the person
2is, as a result of mental disorder, in need of intensive treatment,
3the person may be certified for not more than 14 days of
4involuntary intensive treatment if the conditions set forth in
5subdivision (c) of Section 5250 and subdivision (b) of Section
65260 are complied with. Thereupon, Article 4 (commencing with
7Section 5250) of Chapter 2 of Part 1 of Division 5 shall apply to
8the person. The person may be detained pursuant to Article 4.5
9(commencing with Section 5260), or Article 4.7 (commencing
10with Section 5270.10), or Article 6 (commencing with Section
115300) of Part 1 of Division 5 if that article applies.

12(b) If the professional person in charge of the facility finds that
13the person is intellectually disabled, the juvenile court may direct
14the filing in any other court of a petition for the commitment of a
15minor as an intellectually disabled person to the State Department
16of Developmental Services for placement in a state hospital. In
17such case, the juvenile court shall transmit to the court in which
18the petition is filed a copy of the report of the professional person
19in charge of the facility in which the minor was placed for
20observation. The court in which the petition for commitment is
21filed may accept the report of the professional person in lieu of
22the appointment, or subpoenaing, and testimony of other expert
23witnesses appointed by the court, if the laws applicable to such
24commitment proceedings provide for the appointment by court of
25medical or other expert witnesses or may consider the report as
26evidence in addition to the testimony of medical or other expert
27witnesses.

28(c) If the professional person in charge of the facility for 72-hour
29evaluation and treatment reports to the juvenile court that the minor
30is not affected with any mental disorder requiring intensive
31treatment or intellectual disability, the professional person in charge
32of the facility shall return the minor to the juvenile court on or
33before the expiration of the 72-hour period and the court shall
34proceed with the case in accordance with the Juvenile Court Law.

35(d) Any expenditure for the evaluation or intensive treatment
36of a minor under this section shall be considered an expenditure
37made under Part 2 (commencing with Section 5600) of Division
385 and shall be reimbursed by the state as are other local
39expenditures pursuant to that part.

P92   1(e) The jurisdiction of the juvenile court over the minor shall
2be suspended during the time that the minor is subject to the
3jurisdiction of the court in which the petition for postcertification
4treatment of an imminently dangerous person or the petition for
5commitment of an intellectually disabled person is filed or under
6remand for 90 days for intensive treatment or commitment ordered
7by the court.

8

SEC. 54.  

Section 7100 of the Welfare and Institutions Code is
9amended to read:

10

7100.  

(a) The board of supervisors of each county may
11maintain in the county hospital or in any other hospital situated
12within or without the county or in any other psychiatric health
13facility situated within or without the county, suitable facilities
14and nonhospital or hospital service for the detention, supervision,
15care, and treatment of persons who are mentally disordered or
16developmentally disabled, or who are alleged to be such.

17(b) The county may contract with public or private hospitals for
18those facilities and hospital service when they are not suitably
19available in any institution, psychiatric facility, or establishment
20maintained or operated by the county.

21(c) The facilities and services for the mentally disordered and
22allegedly mentally disordered shall be subject to the approval of
23the State Department of Health Care Services, and the facilities
24and services for the developmentally disabled and allegedly
25developmentally disabled shall be subject to the approval of the
26State Department of Developmental Services. The professional
27person having charge and control of the hospital or psychiatric
28health facility shall allow the department whose approval is
29required to make investigations thereof as it deems necessary at
30any time.

31(d) Nothing in this chapter means that mentally disordered or
32developmentally disabled persons may not be detained, supervised,
33cared for, or treated, subject to the right of inquiry or investigation
34by the department, in their own homes, or the homes of their
35relatives or friends, or in a licensed establishment.

36

SEC. 55.  

Section 14005.281 is added to the Welfare and
37Institutions Code
, immediately following Section 14005.28, to
38read:

39

14005.281.  

(a) The department shall maintain eligibility for
40all former independent foster care adolescents who were receiving
P93   1services pursuant to Section 14005.28 on or after July 1, 2013, but
2no later than December 31, 2013, and lost Medi-Cal coverage as
3a result of attaining 21 years of age.

4(b) Subdivision (a) shall be implemented using state general
5funds to the extent federal financial participation is not available.

6(c) This section shall remain in effect only until January 1, 2014,
7and as of that date is repealed, unless a later enacted statute, that
8is enacted before January 1, 2014, deletes or extends that date.

9

SEC. 56.  

Section 14100.3 is added to the Welfare and
10Institutions Code
, to read:

11

14100.3.  

(a) The State Department of Health Care Services
12shall post on its Internet Web site all submitted state plan
13amendments and all federal waiver applications and requests for
14new waivers, waiver amendments, and waiver renewals and
15extensions, within 10 business days from the date the department
16submits these documents for approval to the federal Centers for
17Medicare and Medicaid Services (CMS).

18(b) The department shall post on its Internet Web site final
19approval or denial letters and accompanying documents for all
20submitted state plan amendments and federal waiver applications
21and requests within 10 business days from the date the department
22receives notification of final approval or denial from CMS.

23(c) If the department notifies CMS of the withdrawal of a
24submitted state plan amendment or federal waiver application or
25request, as described in subdivisions (a) and (b), the department
26shall post on its Internet Web site the withdrawal notification within
2710 business days from the date the department notifies CMS of
28the withdrawal.

29(d) Unless already posted on the Internet Web site pursuant to
30subdivisions (a) to (c), inclusive, the department shall post on its
31Internet Web site all pending submitted state plan amendments
32and federal waiver applications and requests, that the department
33submitted to CMS in 2009 and every year thereafter.

34

SEC. 57.  

Section 14100.51 is added to the Welfare and
35Institutions Code
, immediately following Section 14100.5, to read:

36

14100.51.  

(a) Each year, by no later than January 10 and
37concurrently with the release of the May Revision, the State
38Department of Health Care Services shall provide to the fiscal
39committees of the Legislature supplemental fiscal information for
40the Medi-Cal Specialty Mental Health Services Program. This
P94   1supplemental fiscal information shall include service-type
2descriptions, children’s and adults’ caseload and fiscal forecast by
3service type, a detailed explanation of changes to these forecasts,
4fiscal charts containing children’s and adults’ claim costs and
5unduplicated client counts, and summary fiscal charts with
6current-year and budget-year proposals.

7(b) For purposes of making the information described in
8subdivision (a) available to the public, the department shall post
9this information on its Internet Web site.

10

SEC. 58.  

Section 14100.52 is added to the Welfare and
11Institutions Code
, immediately following Section 14100.51, to
12read:

13

14100.52.  

(a) Each year, by no later than January 10 and
14concurrently with the release of the May Revision, the State
15Department of Health Care Services shall provide to the fiscal
16committees of the Legislature supplemental fiscal information for
17the Drug Medi-Cal Program. This supplemental fiscal information
18shall include adult, minor-consent, child, and perinatal unique
19client counts and summary fiscal charts with current-year and
20budget-year proposals.

21(b) For purposes of making the information described in
22subdivision (a) available to the public, the department shall post
23this information on its Internet Web site.

24

SEC. 59.  

Section 14105.22 of the Welfare and Institutions
25Code
is amended to read:

26

14105.22.  

(a) (1) Reimbursement for clinical laboratory or
27laboratory services, as defined in Section 51137.2 of Title 22 of
28the California Code of Regulations, shall not exceed 80 percent
29of the lowest maximum allowance established by the federal
30Medicare Program for the same or similar services.

31(2) This subdivision shall be implemented only until the new
32rate methodology under subdivision (b) is approved by the federal
33Centers for Medicare and Medicaid Services (CMS).

34(b) (1) It is the intent of the Legislature that the department
35develop reimbursement rates for clinical laboratory or laboratory
36services that are comparable to the payment amounts received
37from other payers for clinical laboratory or laboratory services.
38Development of these rates will enable the department to reimburse
39clinical laboratory or laboratory service providers in compliance
40with state and federal law.

P95   1(2) (A) The provisions of Section 51501(a) of Title 22 of the
2California Code of Regulations shall not apply to laboratory
3providers reimbursed under the new rate methodology developed
4for clinical laboratories or laboratory services pursuant to this
5subdivision.

6(B) In addition to subparagraph (A), laboratory providers
7reimbursed under any payment reductions implemented pursuant
8to this section shall not be subject to the provisions of Section
951501(a) of Title 22 of the California Code of Regulations for 21
10months following the date of implementation of this reduction.

11(3) Reimbursement to providers for clinical laboratory or
12laboratory services shall not exceed the lowest of the following:

13(A) The amount billed.

14(B) The charge to the general public.

15(C) Eighty percent of the lowest maximum allowance established
16by the federal Medicare Program for the same or similar services.

17(D) A reimbursement rate based on an average of the lowest
18amount that other payers and other state Medicaid programs are
19paying for similar clinical laboratory or laboratory services.

20(4) (A) In addition to the payment reductions implemented
21pursuant to Section 14105.192, payments shall be reduced by up
22to 10 percent for clinical laboratory or laboratory services, as
23defined in Section 51137.2 of Title 22 of the California Code of
24Regulations, for dates of service on and after July 1, 2012. The
25payment reductions pursuant to this paragraph shall continue until
26the new rate methodology under this subdivision has been approved
27by CMS.

28(B) Notwithstanding subparagraph (A), the Family Planning,
29Access, Care, and Treatment (Family PACT) Program pursuant
30to subdivision (aa) of Section 14132 shall be exempt from the
31payment reduction specified in this section.

32(5) (A) For purposes of establishing reimbursement rates for
33clinical laboratory or laboratory services based on the lowest
34amounts other payers are paying providers for similar clinical
35laboratory or laboratory services, laboratory service providers shall
36submit data reports within 11 months of the date the act that added
37this paragraph becomes effective and annually thereafter. The data
38initially provided shall be for the 2011 calendar year, and for each
39subsequent year, shall be based on the previous calendar year and
40shall specify the provider’s lowest amounts other payers are paying,
P96   1including other state Medicaid programs and private insurance,
2minus discounts and rebates. The specific data required for
3submission under this subparagraph and the format for the data
4submission shall be determined and specified by the department
5after receiving stakeholder input pursuant to paragraph (7).

6(B) The data submitted pursuant to subparagraph (A) may be
7used to determine reimbursement rates by procedure code based
8on an average of the lowest amount other payers are paying
9providers for similar clinical laboratory or laboratory services,
10excluding significant deviations of cost or volume factors and with
11consideration to geographical areas. The department shall have
12the discretion to determine the specific methodology and factors
13used in the development of the lowest average amount under this
14subparagraph to ensure compliance with federal Medicaid law and
15regulations as specified in paragraph (10).

16(C) For purposes of subparagraph (B), the department may
17contract with a vendor for the purposes of collecting payment data
18reports from clinical laboratories, analyzing payment information,
19and calculating a proposed rate.

20(D) The proposed rates calculated by the vendor described in
21subparagraph (C) may be used in determining the lowest
22reimbursement rate for clinical laboratories or laboratory services
23in accordance with paragraph (3).

24(E) Data reports submitted to the department shall be certified
25by the provider’s certified financial officer or an authorized
26individual.

27(F) Clinical laboratory providers that fail to submit data reports
28within 30 working days from the time requested by the department
29shall be subject to the suspension provisions of subdivisions (a)
30and (c) of Section 14123.

31(6) Data reports provided to the department pursuant to this
32section shall be confidential and shall be exempt from disclosure
33under the California Public Records Act (Chapter 3.5 (commencing
34with Section 6250) of Division 7 of Title 1 of the Government
35Code).

36(7) The department shall seek stakeholder input on the
37ratesetting methodology.

38(8) (A) Notwithstanding Chapter 3.5 (commencing with Section
3911340) of Part 1 of Division 3 of Title 2 of the Government Code,
40the department shall, without taking any further regulatory action,
P97   1implement, interpret, or make specific this section by means of
2provider bulletins or similar instructions until regulations are
3adopted. It is the intent of the Legislature that the department have
4temporary authority as necessary to implement program changes
5until completion of the regulatory process.

6(B) The department shall adopt emergency regulations no later
7than July 1, 2014. The department may readopt any emergency
8regulation authorized by this section that is the same as or
9substantially equivalent to an emergency regulation previously
10adopted pursuant to this section. The initial adoption of emergency
11regulations implementing the amendments to this section and the
12one readoption of emergency regulations authorized by this section
13shall be deemed an emergency and necessary for the immediate
14preservation of the public peace, health, safety, or general welfare.
15Initial emergency regulations and the one readoption of emergency
16regulations authorized by this section shall be exempt from review
17by the Office of Administrative Law.

18(C) The initial emergency regulations and the one readoption
19of emergency regulations authorized by this section shall be
20submitted to the Office of Administrative Law for filing with the
21Secretary of State and each shall remain in effect for no more than
22180 days, by which time final regulations may be adopted.

23(9) To the extent that the director determines that the new
24methodology or payment reductions are not consistent with the
25requirements of Section 1396a(a)(30)(A) of Title 42 of the United
26States Code, the department may revert to the methodology under
27subdivision (a) to ensure access to care is not compromised.

28(10) (A) The department shall implement this section in a
29manner that is consistent with federal Medicaid law and
30regulations. The director shall seek any necessary federal approvals
31for the implementation of this section. This section shall be
32implemented only to the extent that federal approval is obtained.

33(B) In determining whether federal financial participation is
34available, the director shall determine whether the rates and
35payments comply with applicable federal Medicaid requirements,
36including those set forth in Section 1396a(a)(30)(A) of Title 42 of
37the United States Code.

38(C) To the extent that the director determines that the rates and
39payments do not comply with applicable federal Medicaid
40requirements or that federal financial participation is not available
P98   1with respect to any reimbursement rate, the director retains the
2discretion not to implement that rate or payment and may revise
3the rate or payment as necessary to comply with federal Medicaid
4requirements. The department shall notify the Joint Legislative
5Budget Committee 10 days prior to revising the rate or payment
6to comply with federal Medicaid requirements.

7

SEC. 60.  

Section 14105.3 of the Welfare and Institutions Code
8 is amended to read:

9

14105.3.  

(a) The department is considered to be the purchaser,
10but not the dispenser or distributor, of prescribed drugs under the
11Medi-Cal program for the purpose of enabling the department to
12obtain from manufacturers of prescribed drugs the most favorable
13price for those drugs furnished by one or more manufacturers,
14based upon the large quantity of the drugs purchased under the
15Medi-Cal program, and to enable the department, notwithstanding
16any other provision of state law, to obtain from the manufacturers
17discounts, rebates, or refunds based on the quantities purchased
18under the program, insofar as may be permissible under federal
19law. Nothing in this section shall interfere with usual and
20customary distribution practices in the drug industry.

21(b) The department may enter into exclusive or nonexclusive
22contracts on a bid or negotiated basis with manufacturers,
23distributors, dispensers, or suppliers of appliances, durable medical
24equipment, medical supplies, and other product-type health care
25services and with laboratories for clinical laboratory services for
26the purpose of obtaining the most favorable prices to the state and
27to assure adequate quality of the product or service. Except as
28provided in subdivision (f), this subdivision shall not apply to
29prescribed drugs dispensed by pharmacies licensed pursuant to
30Article 7 (commencing with Section 4110) of Chapter 9 of Division
312 of the Business and Professions Code.

32(c) Notwithstanding subdivision (b), the department may not
33enter into a contract with a clinical laboratory unless the clinical
34laboratory operates in conformity with Chapter 3 (commencing
35with Section 1200) of Division 2 of the Business and Professions
36Code and the regulations adopted thereunder, and Section 263a of
37Title 42 of the United States Code and the regulations adopted
38thereunder.

P99   1(d) The department shall contract with manufacturers of
2single-source drugs on a negotiated basis, and with manufacturers
3of multisource drugs on a bid or negotiated basis.

4(e) In order to ensure and improve access by Medi-Cal
5beneficiaries to both hearing aid appliances and provider services,
6and to ensure that the state obtains the most favorable prices, the
7department, by June 30, 2008, shall enter into exclusive or
8nonexclusive contracts, on a bid or negotiated basis, for purchasing
9 hearing aid appliances.

10(f) In order to provide specialized care in the distribution of
11specialized drugs, as identified by the department and that include,
12but are not limited to, blood factors and immunizations, the
13department may enter into contracts with providers licensed to
14dispense dangerous drugs or devices pursuant to Chapter 9
15(commencing with Section 4000) of Division 2 of the Business
16and Professions Code, for programs that qualify for federal funding
17pursuant to the Medicaid state plan, or waivers, and the programs
18authorized by Article 5 (commencing with Section 123800) of
19Chapter 3 of Part 2 of, and Article 1 (commencing with Section
20125125) of Chapter 2 of Part 5 of, Division 106 of the Health and
21Safety Code, in accordance with this subdivision.

22(1) The department shall, for purposes of ensuring proper patient
23care, consult current standards of practice when executing a
24provider contract.

25(2) The department shall, for purposes of ensuring quality of
26care to people with unique conditions requiring specialty drugs,
27contract with a nonexclusive number of providers that meet the
28needs of the affected population, covers all geographic regions in
29California, and reflects the distribution of the specialty drug in the
30community. The department may use a single provider in the event
31the product manufacturer designates a sole-source delivery
32mechanism. The department shall consult with interested parties
33and appropriate stakeholders in implementing this section with
34respect to all of the following:

35(A) Notifying stakeholder representatives of the potential
36inclusion or exclusion of drugs in the specialty pharmacy program.

37(B) Allowing for written input regarding the potential inclusion
38or exclusion of drugs into the specialty pharmacy program.

P100  1(C) Scheduling at least one public meeting regarding the
2potential inclusion or exclusion of drugs into the specialty
3pharmacy program.

4(D) Obtaining a recommendation from the Medi-Cal Drug
5Utilization Review Advisory Committee, established pursuant to
6Section 1927 of the federal Social Security Act (42 U.S.C. Sec.
71396r-8), on the inclusion or exclusion of drugs into the specialty
8pharmacy program distribution based on clinical best practices
9related to each drug considered.

10(3) For purposes of this subdivision, the definition of “blood
11factors” has the same meaning as that term is defined in Section
1214105.86.

13(4) The department shall make every reasonable effort to ensure
14all medically necessary clotting factor therapies are available for
15the treatment of people with bleeding disorders.

16(g) The department may contract with an intermediary to
17establish provider contracts pursuant to this section for programs
18that qualify for federal funding pursuant to the Medicaid state plan,
19or waivers, and the programs authorized by Article 5 (commencing
20with Section 123800) of Chapter 3 of Part 2 of, and Article 1
21(commencing with Section 125125) of Chapter 2 of Part 5 of,
22Division 106 of the Health and Safety Code.

23(h) In carrying out contracting activity for this or any section
24associated with the Medi-Cal list of contract drugs, notwithstanding
25Section 19130 of the Government Code, the department may
26contract, either directly or through the fiscal intermediary, for
27 pharmacy consultant staff necessary to accomplish the contracting
28process or treatment authorization request reviews. The fiscal
29intermediary contract, including any contract amendment, system
30change pursuant to a change order, and project or systems
31development notice shall be exempt from Part 2 (commencing
32with Section 10100) of Division 2 of the Public Contract Code
33and any policies, procedures, or regulations authorized by these
34provisions.

35(i) In order to achieve maximum cost savings, the Legislature
36hereby determines that an expedited contract process for contracts
37under this section is necessary. Therefore, contracts under this
38section shall be exempt from Chapter 2 (commencing with Section
3910290) of Part 2 of Division 2 of the Public Contract Code.

P101  1(j) For purposes of implementing the contracting provisions
2specified in this section, the department shall do all of the
3following:

4(1) Ensure adequate access for Medi-Cal patients to quality
5laboratory testing services in the geographic regions of the state
6where contracting occurs.

7(2) Consult with the statewide association of clinical laboratories
8and other appropriate stakeholders on the implementation of the
9contracting provisions specified in this section to ensure maximum
10access for Medi-Cal patients consistent with the savings targets
11projected by the 2002-03 budget conference committee for clinical
12laboratory services provided under the Medi-Cal program.

13(3) Consider which types of laboratories are appropriate for
14implementing the contracting provisions specified in this section,
15including independent laboratories, outreach laboratory programs
16of hospital-based laboratories, clinic laboratories, physician office
17laboratories, and group practice laboratories.

18

SEC. 61.  

Section 14131.07 of the Welfare and Institutions
19Code
is repealed.

20

SEC. 62.  

Section 14131.10 of the Welfare and Institutions
21Code
is amended to read:

22

14131.10.  

(a) Notwithstanding any other provision of this
23chapter, Chapter 8 (commencing with Section 14200), or Chapter
248.75 (commencing with Section 14591), in order to implement
25changes in the level of funding for health care services, specific
26optional benefits are excluded from coverage under the Medi-Cal
27program.

28(b) (1) The following optional benefits are excluded from
29coverage under the Medi-Cal program:

30(A) Adult dental services, except as specified in paragraph (2).

31(B) Acupuncture services.

32(C) Audiology services and speech therapy services.

33(D) Chiropractic services.

34(E) Optometric and optician services, including services
35provided by a fabricating optical laboratory.

36(F) Podiatric services.

37(G) Psychology services.

38(H) Incontinence creams and washes.

39(2) (A) Medical and surgical services provided by a doctor of
40dental medicine or dental surgery, which, if provided by a
P102  1physician, would be considered physician services, and which
2services may be provided by either a physician or a dentist in this
3state, are covered.

4(B) Emergency procedures are also covered in the categories
5of service specified in subparagraph (A). The director may adopt
6regulations for any of the services specified in subparagraph (A).

7(C) Effective May 1, 2014, or the effective date of any necessary
8federal approvals as required by subdivision (f), whichever is later,
9for persons 21 years of age or older, adult dental benefits, subject
10to utilization controls, are limited to all the following medically
11necessary services:

begin delete

12(i)

end delete
begin insert

13(i) Examinations, radiographs/photographic images,
14prophylaxis, and fluoride treatments.

end insert

15begin insert(ii)end insert Amalgam and composite restorations.

begin delete

16(ii)

end delete

17begin insert(iii)end insert Stainless steel, resin, and resin window crowns.

begin insert

18(iv) Anterior root canal therapy.

end insert
begin delete

19(iii)

end delete

20begin insert(v)end insert Complete dentures, including immediate dentures.

begin delete

21(iv)

end delete

22begin insert(vi)end insert Complete denture adjustments, repairs, and relines.

23(D) Services specified in this paragraph shall be included as a
24covered medical benefit under the Medi-Cal program pursuant to
25Section 14132.89.

26(3) Pregnancy-related services and services for the treatment of
27other conditions that might complicate the pregnancy are not
28excluded from coverage under this section.

29(c) The optional benefit exclusions do not apply to either of the
30following:

31(1) Beneficiaries under the Early and Periodic Screening
32Diagnosis and Treatment Program.

33(2) Beneficiaries receiving long-term care in a nursing facility
34that is both:

35(A) A skilled nursing facility or intermediate care facility as
36defined in subdivisions (c) and (d) of Section 1250 of the Health
37and Safety Code.

38(B) Licensed pursuant to subdivision (k) of Section 1250 of the
39Health and Safety Code.

P103  1(d) This section shall only be implemented to the extent
2permitted by federal law.

3(e) Notwithstanding Chapter 3.5 (commencing with Section
411340) of Part 1 of Division 3 of Title 2 of the Government Code,
5the department may implement the provisions of this section by
6means of all-county letters, provider bulletins, or similar
7instructions, without taking further regulatory action.

8(f) The department shall seek approval for federal financial
9participation and coverage of services specified inbegin insert subparagraph
10(C) ofend insert
paragraph (2) of subdivision (b) under the Medi-Cal
11program.

12(g) This section, except as specified in subparagraph (C) of
13paragraph (2) of subdivision (b), shall be implemented on the first
14 day of the month following 90 days after the operative date of this
15section.

16

SEC. 63.  

Section 14132.86 is added to the Welfare and
17Institutions Code
, to read:

18

14132.86.  

(a) Notwithstanding subdivision (ab) of Section
1914132, effective May 1, 2014, purchase of prescribed enteral
20nutrition products is covered, subject to the Medi-Cal list of enteral
21nutrition products pursuant to Section 14105.8 and utilization
22controls pursuant to Section 14105.395.

23(b) Notwithstanding Chapter 3.5 (commencing with Section
2411340) of Part 1 of Division 3 of Title 2 of the Government Code,
25the department shall implement this section by means of a provider
26bulletin or similar instruction, without taking regulatory action.

27(c) This section shall only be implemented to the extent
28permitted by federal law.

29(d) The department shall seek approval for federal financial
30participation and coverage of the service specified in subdivision
31(a) under the Medi-Cal program.

32

SEC. 64.  

Section 14132.89 is added to the Welfare and
33Institutions Code
, to read:

34

14132.89.  

(a) Notwithstanding subdivision (h) of Section
3514132, effective May 1, 2014, or the effective date of any necessary
36federal approvals as required by subdivision (d), all of the
37following are covered benefits for persons 21 years of age or older,
38subject to utilization controls and medically necessary services:

begin insert

39(1)  Examinations, radiographs/photographic images,
40prophylaxis, and fluoride treatments.

end insert
begin delete

P104  1(1)

end delete

2begin insert(end insertbegin insert2)end insert Amalgam and composite restorations.

begin delete

3(2)

end delete

4begin insert(end insertbegin insert3)end insert Stainless steel, resin, and resin window crowns.

begin insert

5(4) Anterior root canal therapy.

end insert
begin delete

6(3)

end delete

7begin insert(end insertbegin insert5)end insert Complete dentures, including immediate dentures.

begin delete

8(4)

end delete

9begin insert(end insertbegin insert6)end insert Complete denture adjustments, repairs, and relines.

begin delete

10(5)

end delete

11begin insert(end insertbegin insert7)end insert Emergency procedures are also covered in the above
12categories of service.

13(b) This section shall only be implemented to the extent
14permitted by federal law.

15(c) Notwithstanding Chapter 3.5 (commencing with Section
1611340) of Part 1 of Division 3 of Title 2 of the Government Code,
17the department shall implement this section by means of a provider
18bulletin or similar instruction, without taking regulatory action.

19(d) The department shall seek approval for federal financial
20participation and coverage of services specified in subdivision (a)
21under the Medi-Cal program.

22

SEC. 65.  

Section 14134 of the Welfare and Institutions Code,
23as amended by Section 84 of Chapter 23 of the Statutes of 2012,
24is amended to read:

25

14134.  

(a) Except for any prescription, refill, visit, service,
26device, or item for which the program’s payment is ten dollars
27($10) or less, in which case no copayment shall be required, a
28recipient of services under this chapter shall be required to make
29copayments not to exceed the maximum permitted under federal
30regulations or federal waivers as follows:

31(1) Copayment of five dollars ($5) shall be made for
32nonemergency services received in an emergency department or
33emergency room when the services do not result in the treatment
34of an emergency medical condition or inpatient admittance. For
35the purposes of this section, “nonemergency services” means
36services not required to, as appropriate, medically screen, examine,
37evaluate, or stabilize an emergency medical condition that
38manifests itself by acute symptoms of sufficient severity, including
39severe pain, such that the absence of immediate medical attention
40could reasonably be expected to result in any of the following:

P105  1(A) Placing the individual’s health, or, with respect to a pregnant
2woman, the health of the woman or her unborn child, in serious
3jeopardy.

4(B) Serious impairment to bodily functions.

5(C) Serious dysfunction of any bodily organ or part.

6(2) Copayment of one dollar ($1) shall be made for each drug
7prescription or refill.

8(3) Copayment of one dollar ($1) shall be made for each visit
9for services under subdivisions (a) and (h) of Section 14132.

10(4) The copayment amounts set forth in paragraphs (1), (2), and
11(3) may be collected and retained or waived by the provider.

12(5) The department shall not reduce the reimbursement otherwise
13due to providers as a result of the copayment. The copayment
14amounts shall be in addition to any reimbursement otherwise due
15the provider for services rendered under this program.

16(6) This section does not apply to emergency services, family
17planning services, or to any services received by:

18(A) Any child in AFDC-Foster Care, as defined in Section
1911400.

20(B) Any person who is an inpatient in a health facility, as defined
21in Section 1250 of the Health and Safety Code.

22(C) Any person 18 years of age or under.

23(D) Any woman receiving perinatal care.

24(7) Paragraph (2) does not apply to any person 65 years of age
25or over.

26(8) A provider of service shall not deny care or services to an
27individual solely because of that person’s inability to copay under
28this section. An individual shall, however, remain liable to the
29provider for any copayment amount owed.

30(9) This section shall not apply to any preventive services that
31are assigned a grade of A or B by the United States Preventive
32Services Task Force provided by a physician or other licensed
33practitioner of the healing arts, or any approved adult vaccines and
34their administration recommended by the Advisory Committee on
35Immunization Practices. Pursuant to Section 1905(b) of the federal
36Social Security Act (42 U.S.C. Sec. 1396d(b)), these services shall
37be provided without any cost sharing by the beneficiary in order
38for the state to receive an increased federal medical assistance
39percentage for these services.

P106  1(10) The department shall seek any federal waivers necessary
2to implement this section. The provisions for which appropriate
3federal waivers cannot be obtained shall not be implemented, but
4provisions for which waivers are either obtained or found to be
5 unnecessary shall be unaffected by the inability to obtain federal
6waivers for the other provisions.

7(11) The director shall adopt any regulations necessary to
8implement this section as emergency regulations in accordance
9with Chapter 3.5 (commencing with Section 11340) of Part 1 of
10Division 3 of Title 2 of the Government Code. The adoption of
11the regulations shall be deemed to be an emergency and necessary
12for the immediate preservation of the public peace, health and
13safety, or general welfare. The director shall transmit these
14emergency regulations directly to the Secretary of State for filing
15and the regulations shall become effective immediately upon filing.
16Upon completion of the formal regulation adoption process and
17prior to the expiration of the 120 day duration period of emergency
18regulations, the director shall transmit directly to the Secretary of
19State for filing the adopted regulations, the rulemaking file, and
20the certification of compliance as required by subdivision (e) of
21Section 11346.1 of the Government Code.

22(b) This section, or subdivisions thereof, if applicable, shall
23become inoperative on the implementation date for copayments
24stated in the declaration executed by the director pursuant to
25Section 14134 as added by Section 101.5 of Chapter 3 of the
26Statutes of 2011.

27

SEC. 66.  

Section 14134 of the Welfare and Institutions Code,
28as amended by Section 85 of Chapter 23 of the Statutes of 2012,
29is amended to read:

30

14134.  

(a) The Legislature finds and declares all of the
31following:

32(1) Costs within the Medi-Cal program continue to grow due
33to the rising cost of providing health care throughout the state and
34also due to increases in enrollment, which are more pronounced
35during difficult economic times.

36(2) In order to minimize the need for drastically cutting
37enrollment standards or benefits or imposing further reductions
38on Medi-Cal providers during times of economic crisis, it is crucial
39to find areas within the program where beneficiaries can share
40responsibility for utilization of health care, whether they are
P107  1participating in the fee-for-service or the managed care model of
2service delivery.

3(3) The establishment of cost-sharing obligations within the
4Medi-Cal program is complex and is subject to close supervision
5by the United States Department of Health and Human Services.

6(4) As the single state agency for Medicaid in California, the
7State Department of Health Care Services has unique expertise
8that can inform decisions that set or adjust cost-sharing
9responsibilities for Medi-Cal beneficiaries receiving health care
10services.

11(b) Therefore, it is the intent of the Legislature for the
12department to obtain federal approval to implement cost-sharing
13for Medi-Cal beneficiaries and permit providers to require that
14individuals meet their cost-sharing obligation prior to receiving
15care or services.

16(c) A Medi-Cal beneficiary shall be required to make
17copayments as described in this section. These copayments
18represent a contribution toward the rate of payment made to
19providers of Medi-Cal services and shall be as follows:

20(1) Copayment of up to fifty dollars ($50) shall be made for
21nonemergency services received in an emergency department or
22emergency room when the services do not result in the treatment
23of an emergency condition or inpatient admittance. For the
24purposes of this section, “nonemergency services” means services
25not required to, as appropriate, medically screen, examine, evaluate,
26or stabilize an emergency medical condition that manifests itself
27by acute symptoms of sufficient severity, including severe pain,
28such that the absence of immediate medical attention could
29reasonably be expected to result in any of the following:

30(A) Placing the individual’s health, or, with respect to a pregnant
31woman, the health of the woman or her unborn child, in serious
32jeopardy.

33(B) Serious impairment to bodily functions.

34(C) Serious dysfunction of any bodily organ or part.

35(2) Copayment of up to fifty dollars ($50) shall be made for
36emergency services received in an emergency department or
37emergency room when the services result in the treatment of an
38emergency medical condition or inpatient admittance. For purposes
39of this section, “emergency services” means services required to,
40as appropriate, medically screen, examine, evaluate, or stabilize
P108  1an emergency medical condition that manifests itself by acute
2symptoms of sufficient severity, including severe pain, such that
3the absence of immediate medical attention could reasonably be
4expected to result in any of the following:

5(A) Placing the individual’s health, or, with respect to a pregnant
6woman, the health of the woman or her unborn child, in serious
7jeopardy.

8(B) Serious impairment to bodily functions.

9(C) Serious dysfunction of any bodily organ or part.

10(3) Copayment of up to one hundred dollars ($100) shall be
11made for each hospital inpatient day, up to a maximum of two
12hundred dollars ($200) per admission.

13(4) Copayment of up to three dollars ($3) shall be made for each
14preferred drug prescription or refill. A copayment of up to five
15dollars ($5) shall be made for each nonpreferred drug prescription
16or refill. Except as provided in subdivision (g), “preferred drug”
17shall have the same meaning as in Section 1916A of the Social
18Security Act (42 U.S.C. Sec. 1396o-1).

19(5) Copayment of up to five dollars ($5) shall be made for each
20visit for services under subdivision (a) of Section 14132 and for
21dental services received on an outpatient basis provided as a
22Medi-Cal benefit pursuant to this chapter or Chapter 8
23(commencing with Section 14200), as applicable.

24(6) This section does not apply to services provided pursuant
25to subdivision (aa) of Section 14132.

26(d) The copayments established pursuant to subdivision (c) shall
27be set by the department, at the maximum amount provided for in
28the applicable paragraph, except that each copayment amount shall
29not exceed the maximum amount allowable pursuant to the state
30plan amendments or other federal approvals.

31(e) The copayment amounts set forth in subdivision (c) may be
32collected and retained or waived by the provider. The department
33shall deduct the amount of the copayment from the payment the
34department makes to the provider whether retained, waived, or not
35collected by the provider.

36(f) Notwithstanding any other provision of law, and only to the
37extent allowed pursuant to federal law, a provider of service has
38no obligation to provide services to a Medi-Cal beneficiary who
39does not, at the point of service, pay the copayment assessed
40pursuant to this section. If the provider provides services without
P109  1collecting the copayment, and has not waived the copayment, the
2provider may hold the beneficiary liable for the copayment amount
3owed.

4(g) (1) Notwithstanding any other provision of law, except as
5described in paragraph (2), this section shall apply to Medi-Cal
6beneficiaries enrolled in a health plan contracting with the
7department pursuant to this chapter or Chapter 8 (commencing
8with Section 14200), except for the Senior Care Action Network
9or AIDS Healthcare Foundation. To the extent permitted by federal
10law and pursuant to any federal waivers or state plan adjustments
11obtained, a managed care health plan may establish a lower
12copayment or no copayment.

13(2) For the purpose of paragraph (4) of subdivision (c),
14copayments assessed against a beneficiary who receives Medi-Cal
15services through a health plan described in paragraph (1) shall be
16based on the plan’s designation of a drug as preferred or
17nonpreferred.

18(3) To the extent provided by federal law, capitation payments
19shall be calculated on an actuarial basis as if copayments described
20in this section were collected.

21(h) This section shall not apply to any preventive services that
22are assigned a grade of A or B by the United States Preventive
23Services Task Force provided by a physician or other licensed
24practitioner of the healing arts, or any approved adult vaccines and
25their administration recommended by the Advisory Committee on
26Immunization Practices. Pursuant to Section 1905(b) of the federal
27Social Security Act (42 U.S.C. Sec. 1396d(b)), these services shall
28be provided without any cost sharing by the beneficiary in order
29for the state to receive an increased federal medical assistance
30percentage for these services.

31(i) This section shall be implemented only to the extent that
32federal financial participation is available. The department shall
33seek and obtain any federal waivers or state plan amendments
34necessary to implement this section. The provisions for which
35appropriate federal waivers or state plan amendments cannot be
36obtained shall not be implemented, but provisions for which
37waivers or state plan amendments are either obtained or found to
38 be unnecessary shall be unaffected by the inability to obtain federal
39waivers or state plan amendments for the other provisions.

P110  1(j) Notwithstanding Chapter 3.5 (commencing with Section
211340) of Part 1 of Division 3 of Title 2 of the Government Code,
3the department may implement, interpret, or make specific this
4section by means of all-county letters, all-plan letters, provider
5bulletins, or similar instructions, without taking further regulatory
6actions.

7(k) (1) This section shall become operative on the date that the
8act adding this section is effective, but shall not be implemented
9until the date in the declaration executed by the director pursuant
10to paragraph (2). In no event shall the director set an
11implementation date prior to the date federal approval is received.

12(2) The director shall execute a declaration that states the date
13that implementation of the copayments described in this section
14or subdivisions thereof, if applicable, will commence and shall
15post the declaration on the department’s Internet Web site and
16provide a copy of the declaration to the Chair of the Joint
17Legislative Budget Committee, the Chief Clerk of the Assembly,
18the Secretary of the Senate, the Office of the Legislative Counsel,
19and the Secretary of State.

20

SEC. 67.  

Section 14707.5 of the Welfare and Institutions Code
21 is amended to read:

22

14707.5.  

(a) It is the intent of the Legislature to develop a
23performance outcome system for Early and Periodic Screening,
24Diagnosis, and Treatment (EPSDT) mental health services that
25will improve outcomes at the individual and system levels and will
26inform fiscal decision making related to the purchase of services.

27(b) The State Department of Health Care Services, in
28collaboration with the California Health and Human Services
29Agency, and in consultation with the Mental Health Services
30Oversight and Accountability Commission, shall create a plan for
31a performance outcome system for EPSDT mental health services
32provided to eligible Medi-Cal beneficiaries under the age of 21
33pursuant to 42 U.S.C. Section 1396d(a)(4)(B).

34(1) Commencing no later than September 1, 2012, the
35department shall convene a stakeholder advisory committee
36comprised of representatives of child and youth clients, family
37members, providers, counties, and the Legislature. This
38consultation shall inform the creation of a plan for a performance
39outcome system for EPSDT mental health services.

P111  1(2) In developing a plan for a performance outcomes system
2for EPSDT mental health services, the department shall consider
3the following objectives, among others:

4(A) High quality and accessible EPSDT mental health services
5for eligible children and youth, consistent with federal law.

6(B) Information that improves practice at the individual,
7program, and system levels.

8(C) Minimization of costs by building upon existing resources
9to the fullest extent possible.

10(D) Reliable data that are collected and analyzed in a timely
11fashion.

12(3) At a minimum, the plan for a performance outcome system
13for EPSDT mental health services shall consider evidence-based
14models for performance outcome systems, such as the Child and
15Adolescent Needs and Strengths (CANS), federal requirements,
16including the review by the External Quality Review Organization
17(EQRO), and, timelines for implementation at the provider, county,
18and state levels.

19(c) The State Department of Health Care Services shall provide
20the performance outcomes system plan, including milestones and
21timelines, for EPSDT mental health services described in
22subdivision (a) to all fiscal committees and appropriate policy
23committees of the Legislature no later than October 1, 2013.

24(d) The State Department of Health Care Services shall propose
25how to implement the performance outcomes system plan for
26EPSDT mental health services described in subdivision (a) no later
27than January 10, 2014.

28(e) Commencing no later than February 1, 2014, the department
29shall convene a stakeholder advisory committee comprised of
30advocates for and representatives of, child and youth clients, family
31members, managed care health plans, providers, counties, and the
32Legislature. The committee shall develop methods to routinely
33measure, assess, and communicate program information regarding
34informing, identifying, screening, assessing, referring, and linking
35Medi-Cal eligible beneficiaries to mental health services and
36supports. The committee shall also review health plan screenings
37for mental health illness, health plan referrals to Medi-Cal
38fee-for-service providers, and health plan referrals to county mental
39health plans, among others. The committee shall make
40recommendations to the department regarding performance and
P112  1outcome measures that will contribute to improving timely access
2to appropriate care for Medi-Cal eligible beneficiaries.

3(1) The department shall incorporate into the performance
4outcomes system established pursuant to this section the screenings
5and referrals described in this subdivision, including milestones
6and timelines, and shall provide an updated performance outcomes
7system plan to all fiscal committees and the appropriate policy
8committees of the Legislature no later than October 1, 2014.

9(2) The department shall propose how to implement the updated
10performance systems outcome plan described in paragraph (1) no
11later than January 10, 2015.

12

SEC. 68.  

Part 3.3 (commencing with Section 15800) is added
13to Division 9 of the Welfare and Institutions Code, to read:

14 

15PART 3.3.  Health Care Coverage Assistance

16

 

17Chapter  1. General Provisions
18

 

19

15800.  

(a) (1) Commencing October 1, 2013, the State
20Department of Health Care Services shall administer the
21AIM-Linked Infants Program to address the health care needs of
22children formerly covered pursuant to clause (ii) of subparagraph
23(A) of paragraph (6) of subdivision (a) of Section 12693.70 of the
24Insurance Code. The department is vested with the same powers,
25purposes, responsibilities, and jurisdiction exercised by the
26Managed Risk Medical Insurance Board as they relate to those
27children. Nothing in this paragraph shall be construed to alter,
28diminish, or supersede the authority of the Managed Risk Medical
29Insurance Board to exercise the same powers, purposes,
30responsibilities, and jurisdiction within the Healthy Families
31Program established under Part 6.2 (commencing with Section
32 12693) of Division 2 of the Insurance Code.

33(2) The department may, before October 1, 2013, conduct
34 transition activities necessary to ensure the efficient transfer of the
35program identified in subdivision (a) and populations served by
36that program.

37(b) The department shall seek any federal waivers, approvals,
38and state plan amendments necessary to implement this part. This
39part shall only be implemented to the extent that necessary federal
P113  1approvals are obtained and federal financial participation is
2available for eligible programs and services.

3

15801.  

The terms of all regulations and orders adopted by the
4Managed Risk Medical Insurance Board in effect immediately
5preceding October 1, 2013, that relate to the operation of the
6program and to the children transferred by the act that added this
7section and are not rendered legally unenforceable by the act that
8added this section shall be fully enforceable by the State
9Department of Health Care Services within the AIM-Linked Infants
10Program unless and until the department adopts regulations for
11the AIM-Linked Infants Program. Nothing in this section shall be
12construed to alter, diminish, or supersede the authority of the
13Managed Risk Medical Insurance Board to interpret, enforce,
14maintain, or amend the same regulations for purposes of the
15Healthy Families Program established under Part 6.2 (commencing
16with Section 12693) of Division 2 of the Insurance Code.

17

15802.  

(a) The State Department of Health Care Services may
18issue rules and regulations to carry out the purposes of this part.

19(b) Notwithstanding subdivision (a) or Chapter 3.5 (commencing
20with Section 11340) of Part 1 of Division 3 of Title 2 of the
21Government Code, the department, without taking any further
22regulatory actions, may implement, interpret, or make specific this
23part and amend or repeal regulations and orders adopted by the
24Managed Risk Medical Insurance Board as provided in Section
2515801 by means of all-county letters, plan letters, plan or provider
26bulletins, or similar instructions, without taking regulatory action
27during the transition of the programs to the department. Thereafter,
28the adoption and readoption of regulations to implement, interpret,
29or make specific this part shall be deemed to be an emergency that
30calls for immediate action to avoid serious harm to the public
31peace, health, safety, or general welfare for purposes of Sections
3211346.1 and 11349.6 of the Government Code, and the department
33is exempted from the requirement that it describe facts showing
34the need for immediate action. The regulations shall become
35effective immediately upon filing with the Secretary of State.

36

15803.  

(a) To implement this part and clause (ii) of
37subparagraph (A) of paragraph (6) of subdivision (a) of Section
3812693.70 of the Insurance Code, the State Department of Health
39Care Services may contract with public or private entities, including
40the Managed Risk Medical Insurance Board, which administers
P114  1the Access for Infants and Mothers Program pursuant to Part 6.3
2(commencing with Section 12695) of Division 2 of the Insurance
3Code. Contracts entered into under this part may be on a
4noncompetitive bid basis and shall be exempt from the following:

5(1) Part 2 (commencing with Section 10100) of Division 2 of
6the Public Contract Code and any policies, procedures, or
7regulations authorized by that part.

8(2) Article 4 (commencing with Section 19130) of Chapter 5
9of Part 2 of Division 5 of Title 2 of the Government Code.

10(3) Review or approval of contracts by the Department of
11General Services.

12(b) During the transition of the programs to the department, the
13department shall also be exempt from the review or approval of
14feasibility study reports and the requirements of Sections 4819.35
15to 4819.37, inclusive, and 4920 to 4928, inclusive, of the State
16Administrative Manual.

17

15804.  

On October 1, 2013, or when the State Department of
18Health Care Services has implemented Chapter 2 (commencing
19with Section 15850), whichever occurs later, the Managed Risk
20Medical Insurance Board shall cease to provide coverage to the
21children transferred to the AIM-Linked Infants Program, pursuant
22to Section 15800.

23

15805.  

(a) The Managed Risk Medical Insurance Board shall
24provide the State Department of Health Care Services any data,
25information, or record concerning the Healthy Families Program
26or the Access for Infants and Mothers Program as are necessary
27to implement this part and clause (ii) of subparagraph (A) of
28paragraph (6) of subdivision (a) of Section 12693.70 of the
29Insurance Code.

30(b) Notwithstanding any other law, all of the following shall
31apply:

32(1) The term “data, information, or record” shall include, but is
33not limited to, personal information as defined in Section 1798.3
34of the Civil Code.

35(2) Any data, information, or record shall be exempt from
36disclosure under the California Public Records Act (Chapter 3.5
37(commencing with Section 6250) of Division 7 of the Government
38Code) and any other law, to the same extent that it was exempt
39from disclosure or privileged prior to the provision of the data,
40information, or record to the department.

P115  1(3) The provision of any data, information, or record to the
2department shall not constitute a waiver of any evidentiary
3privilege or exemption from disclosure.

4(4) The department shall keep all data, information, or records
5provided by the Managed Risk Medical Insurance Board
6confidential to the full extent permitted by law, including, but not
7limited to, the California Public Records Act (Chapter 3.5
8(commencing with Section 6250) of Division 7 of the Government
9Code), and consistent with the Managed Risk Medical Insurance
10Board’s contractual obligations to keep data, information, or
11records confidential.

12 

13Chapter  2. AIM-Linked Infants Program
14

 

15

15810.  

This chapter shall be known, and may be cited, as the
16AIM-Linked Infants Program.

17

15811.  

The definitions contained in this section govern the
18construction of this chapter, unless the context requires otherwise.

19(a) “AIM-linked infant” means any infant born to a woman
20whose enrollment in the Access for Infants and Mothers Program
21under Part 6.3 (commencing with Section 12695) of Division 2 of
22the Insurance Code begins after June 30, 2004.

23(b) “Department” means the State Department of Health Care
24Services.

25(c) “Program” means the AIM-Linked Infants Program.

26(d) “Subscriber” means an individual who is eligible for and
27enrolled in the program.

28(e) “Subscriber contribution” means the cost to the subscriber
29to participate in the program.

30

15822.  

Health care services under the program shall include,
31but are not limited to, all of the following:

32(a) Preventive, screening, diagnostic, and treatment services
33furnished directly by a licensed clinic, either onsite or by formal
34written contract, on a case-managed basis, to patients who remain
35less than 24 hours at the clinic for an illness or injury, advice,
36counseling, outreach, and translation as needed.

37(b) Physician services.

38(c) Emergency first aid, perinatal, obstetric, radiology,
39laboratory, and nutrition services.

P116  1(d) Services of advanced practice nurses or mid-level
2practitioners who are authorized to perform any of the services
3listed in this section within the scope of their licensure.

4(e) All services and benefits set forth in Chapter 7 (commencing
5with Section 14000) of Part 3.

6

15824.  

To the extent permitted by federal law, services for
7individuals eligible under this chapter shall be provided, at the
8department’s discretion and to the extent the department determines
9the selected delivery system is cost effective, through the Medi-Cal
10fee-for-service or managed care delivery system, or both.

11

15826.  

The department shall administer the program and may
12do all of the following:

13(a) Determine eligibility criteria for the program. These criteria
14shall include the requirements set forth in Section 15832.

15(b) Determine the eligibility of AIM-linked infants.

16(c) Determine when subscribers are covered and the extent and
17scope of coverage.

18(d) Determine subscriber contribution amounts schedules.
19Subscriber contributions shall not be greater than those applicable
20on March 23, 2010, for infants enrolled pursuant to clause (ii) of
21subparagraph (A) of paragraph (6) of subdivision (a) of Section
2212693.70 of the Insurance Code.

23(e) Provide coverage through Medi-Cal delivery systems and
24contract for the administration of the program and the enrollment
25of subscribers. Any contract entered into pursuant to this chapter
26shall be exempt from any provision of law relating to competitive
27bidding, and shall be exempt from the review or approval of any
28division of the Department of General Services. The department
29shall not be required to specify the amounts encumbered for each
30contract, but may allocate funds to each contract based on projected
31and actual subscriber enrollments in a total amount not to exceed
32the amount appropriated for the program.

33(f) Authorize expenditures to pay program expenses that exceed
34subscriber contributions, and to administer the program as
35necessary.

36(g) Develop a promotional component of the program to make
37Californians aware of the program and the opportunity that it
38presents.

39(h) (1) Issue rules and regulations as necessary to administer
40the program.

P117  1(2) During the 2011-12 to 2014-15 fiscal years, inclusive, the
2adoption and readoption of regulations pursuant to this chapter
3shall be deemed to be an emergency that calls for immediate action
4to avoid serious harm to the public peace, health, safety, or general
5welfare for purposes of Sections 11346.1 and 11349.6 of the
6Government Code, and the department is hereby exempted from
7the requirement that the department describe facts showing the
8need for immediate action.

9(i) Exercise all powers reasonably necessary to carry out the
10powers and responsibilities expressly granted or imposed by this
11chapter.

12

15828.  

The department shall coordinate with other state
13agencies, as appropriate, to help ensure continuity of health care
14services.

15

15830.  

(a) The department may contract with a variety of
16health plans and types of health care service delivery systems in
17order to offer subscribers a choice of plans, providers, and types
18of service delivery.

19(b) Participating health plans contracting with the department
20pursuant to this chapter shall provide benefits or coverage to
21subscribers only as determined by the department pursuant to
22subdivision (b) of Section 15826.

23

15832.  

To be eligible to participate in the program, a person
24shall meet all of the following requirements:

25(a) (1) Be a child under two years of age who is delivered by
26a mother enrolled in the program under Part 6.3 (commencing with
27Section 12695) of Division 2 of the Insurance Code. Except as
28stated in this section, these infants shall be automatically enrolled
29in the program.

30(2) For the applicable month, not be enrolled in
31employer-sponsored health care coverage, or have been enrolled
32in that health care coverage in the prior three months or enrolled
33in full-scope Medi-Cal without a share of cost. Exceptions may
34be identified in regulations or other guidance and shall, at
35minimum, include all exceptions applicable to the Healthy Families
36Program on and after March 23, 2010.

37(3) Be subject to subscriber contributions as determined by the
38department. The subscriber contributions shall not be greater than
39those applicable on March 23, 2010, for infants enrolled in the
40Healthy Families Program pursuant to clause (ii) of subparagraph
P118  1(A) of paragraph (6) of subdivision (a) of Section 12693.70 of the
2Insurance Code.

3(b) For AIM-linked infants identified in subdivision (a), all of
4the following shall apply:

5(1) Enrollment shall cover the first 12 months of the infant’s
6life unless he or she is eligible for Medi-Cal benefits under Section
714005.26. If the infant is eligible under Section 14005.26, he or
8she shall be automatically enrolled in the Medi-Cal program on
9that basis.

10(2) (A) At the end of the 12 months, as a condition of continued
11eligibility, the subscriber shall provide income information. The
12infant shall be disenrolled from the program if the annual household
13income exceeds 300 percent of the federal poverty level, or if the
14infant is eligible for full-scope Medi-Cal with no share of cost.

15(B) Effective January 1, 2014, when determining eligibility for
16benefits under the program, income shall be determined, counted,
17and valued in accordance with the requirements of Section
181397bb(b)(1)(B) of Title 42 of the United States Code as added
19by the federal Patient Protection and Affordable Care Act (Public
20Law 111-148) and as amended by the federal Health Care and
21Education Reconciliation Act of 2010 (Public Law 111-152) and
22any subsequent amendments.

23(3) At the end of their first and second year in the program,
24infants shall be screened for eligibility for the Medi-Cal program.

25(c) If at any time the director determines that the eligibility
26criteria established under this chapter for the program may
27jeopardize the state’s ability to receive federal financial
28participation under the federal Patient Protection and Affordable
29Care Act (Public Law 111-148), or any amendment or extension
30of that act, the director may alter the eligibility criteria to the extent
31necessary for the state to receive that federal financial participation.

32

15834.  

A person shall not be eligible for covered services under
33the program if those services are covered through private health
34care coverage arrangements at the time of eligibility.

35

15836.  

(a) If a subscriber is dissatisfied with any action, or
36failure to act, that has occurred in connection with eligibility or
37covered services under this chapter, the subscriber may appeal to
38the department and shall be accorded an opportunity for a fair
39hearing. Hearings may be conducted pursuant to the provisions of
P119  1Chapter 5 (commencing with Section 11500) of Part 1 of Division
23 of Title 2 of the Government Code.

3(b) The department may place a lien on compensation or benefits
4that are recovered or recoverable by a subscriber for whom benefits
5have been provided under a policy or plan issued under this chapter
6from any party or parties responsible for the compensation or
7benefits.

8

15838.  

(a) A provider who is furnished documentation of a
9subscriber’s enrollment in the program shall not seek
10reimbursement or attempt to obtain payment for any covered
11services provided to that subscriber other than from the
12participating health plan or insurer covering the subscriber or from
13the department.

14(b) Subdivision (a) shall not apply to any copayment required
15by the department under this chapter for the covered services
16provided to the subscriber.

17(c) For purposes of this chapter, “provider” means any
18professional person, organization, health facility, or other person
19or institution licensed by the state to deliver or furnish health care
20services and includes as that term is defined in subdivision (o) of
21Section 14043.1.

22

15840.  

(a) At a minimum, coverage provided pursuant to this
23chapter shall be provided to eligible AIM-linked infants less than
24two years of age.

25(b) Coverage provided pursuant to this chapter shall include, at
26a minimum, those services required to be provided by health care
27service plans approved by the Secretary of Health and Human
28Services as a federally qualified health care service plan pursuant
29to Section 417.101 of Title 42 of the Code of Federal Regulations.

30(c) Medically necessary prescription drugs shall be a required
31benefit in the coverage provided pursuant to this chapter.

32

15842.  

Notwithstanding any other law, for a subscriber who
33is determined by the California Children’s Services Program to be
34eligible for benefits under the program pursuant to Article 5
35(commencing with Section 123800) of Chapter 3 of Part 2 of
36Division 106 of the Health and Safety Code, a provider shall not
37be responsible for the provision of, or payment for, the particular
38services authorized by the California Children’s Services Program
39for the particular subscriber for the treatment of a California
40Children’s Services Program eligible medical condition. Providers
P120  1shall refer a child whom they reasonably suspect of having a
2medical condition that is eligible for services under the California
3Children’s Services Program to the California Children’s Services
4Program. The California Children’s Services Program shall provide
5case management and authorization of services if the child is found
6to be medically eligible for the California Children’s Services
7Program. Diagnosis and treatment services that are authorized by
8the California Children’s Services Program shall be performed by
9paneled providers for that program and approved special care
10centers of that program in accordance with treatment plans
11approved by the California Children’s Services Program. All other
12services provided under this chapter shall be available to the
13subscriber.

14

15844.  

A child enrolled in the program under this chapter who
15has a medical condition that is eligible for services pursuant to the
16California Children’s Services Program, and whose family is not
17financially eligible for the California Children’s Services Program,
18shall have the medically necessary treatment services for his or
19her California Children’s Services Program eligible medical
20condition authorized and paid for by the California Children’s
21Services Program. County expenditures for the payment of services
22for the child shall be waived and these expenditures shall be paid
23 for by the state from Title XXI of the federal Social Security Act
24(42 U.S.C. Sec. 1397aa et seq.) funds and state general funds.

25

15846.  

The department shall encourage all providers who
26provide services under the program to have viable protocols for
27screening and referring children needing supplemental services
28outside of the scope of the screening, preventive, and medically
29necessary and therapeutic services covered by the contract to public
30programs providing such supplemental services for which they
31may be eligible, as well as for coordination of care between the
32provider and the public programs. The public programs for which
33providers may be required to develop screening, referral, and care
34coordination protocols may include the California Children’s
35Services Program, the regional centers, county mental health
36programs, programs administered by the Department of Alcohol
37and Drug Programs or its successor agency or agencies, and
38programs administered by local education agencies.

39

SEC. 69.  

Section 15911 of the Welfare and Institutions Code
40 is amended to read:

P121  1

15911.  

(a) Funding for each LIHP shall be based on all of the
2following:

3(1) The amount of funding that the participating entity
4voluntarily provides for the nonfederal share of LIHP expenditures.

5(2) For a LIHP that had in operation a Health Care Coverage
6Initiative program under Part 3.5 (commencing with Section 15900)
7as of November 1, 2010, and elects to continue funding the
8program, the amount of funds requested to ensure that eligible
9enrollees continue to receive health care services for persons
10enrolled in the Health Care Coverage Initiative program as of
11November 1, 2010.

12(3) Any limitations imposed by the Special Terms and
13Conditions of the demonstration project.

14(4) The total allocations requested by participating entities for
15Health Care Coverage Initiative eligible individuals.

16(5) Whether funding under this part would result in the reduction
17of other payments under the demonstration project.

18(b) Nothing in this part shall be construed to require a political
19subdivision of the state to participate in a LIHP as set forth in this
20part, and those local funds expended or transferred for the
21nonfederal share of LIHP expenditures under this part shall be
22considered voluntary contributions for purposes of the federal
23Patient Protection and Affordable Care Act (Public Law 111-148),
24as amended by the federal Health Care and Education
25Reconciliation Act of 2010 (Public Law 111-152), and the federal
26American Recovery and Reinvestment Act of 2009 (Public Law
27111-5), as amended by the federal Patient Protection and
28Affordable Care Act.

29(c) No state General Fund moneys shall be used to fund LIHP
30services, nor to fund any related administrative costs incurred by
31counties or any other political subdivision of the state.

32(d) Subject to the Special Terms and Conditions of the
33demonstration project, if a participating entity elects to fund the
34nonfederal share of a LIHP, the nonfederal funding and payments
35to the LIHP shall be provided through one of the following
36mechanisms, at the options of the participating entity:

37(1) On a quarterly basis, the participating entity shall transfer
38to the department for deposit in the LIHP Fund established for the
39participating counties and pursuant to subparagraph (A), the
40amount necessary to meet the nonfederal share of estimated
P122  1 payments to the LIHP for the next quarter under subdivision (g)
2Section 15910.3.

3(A) The LIHP Fund is hereby created in the State Treasury.
4Notwithstanding Section 13340 of the Government Code, all
5moneys in the fund shall be continuously appropriated to the
6department for the purposes specified in this part. The fund shall
7contain all moneys deposited into the fund in accordance with this
8paragraph.

9(B) The department shall obtain the related federal financial
10participation and pay the rates established under Section 15910.3,
11provided that the intergovernmental transfer is transferred in
12accordance with the deadlines imposed under the Medi-Cal
13Checkwrite Schedule, no later than the next available warrant
14release date. This payment shall be a nondiscretionary obligation
15of the department, enforceable under a writ of mandate pursuant
16to Section 1085 of the Code of Civil Procedure. Participating
17entities may request expedited processing within seven business
18days of the transfer as made available by the Controller’s office,
19provided that the participating entity prepay the department for
20the additional administrative costs associated with the expedited
21processing.

22(C) Total quarterly payment amounts shall be determined in
23accordance with estimates of the number of enrollees in each rate
24category, subject to annual reconciliation to final enrollment data.

25(2) If a participating entity operates its LIHP through a contract
26with another entity, the participating entity may pay the operating
27entity based on the per enrollee rates established under Section
2815910.3 on a quarterly basis in accordance with estimates of the
29number of enrollees in each rate category, subject to annual
30reconciliation to final enrollment data.

31(A) (i) On a quarterly basis, the participating entity shall certify
32the expenditures made under this paragraph and submit the report
33of certified public expenditures to the department.

34(ii) The department shall report the certified public expenditures
35of a participating entity under this paragraph on the next available
36quarterly report as necessary to obtain federal financial
37participation for the expenditures. The total amount of federal
38financial participation associated with the participating entity’s
39expenditures under this paragraph shall be reimbursed to the
40participating entity.

P123  1(B) At the option of the participating entity, the LIHP may be
2reimbursed on a cost basis in accordance with the methodology
3applied to Health Care Coverage Initiative programs established
4under Part 3.5 (commencing with Section 15900) including interim
5quarterly payments.

6(e) Notwithstanding Section 15910.3 and subdivision (d) of this
7section, if the participating entity cannot reach an agreement with
8the department as to the appropriate rate to be paid under Section
915910.3, at the option of the participating entity, the LIHP shall
10be reimbursed on a cost basis in accordance with the methodology
11applied to Health Care Coverage Initiative programs established
12under Part 3.5 (commencing with Section 15900), including interim
13quarterly payments. If the participating entity and the department
14reach an agreement as to the appropriate rate, the rate shall be
15applied no earlier than the first day of the LIHP year in which the
16parties agree to the rate.

17(f) If authorized under the Special Terms and Conditions of the
18demonstration project, pending the department’s development of
19rates in accordance with Section 15910.3, the department shall
20make interim quarterly payments to approved LIHPs for
21expenditures based on estimated costs submitted for rate setting.

22(g) Participating entities that operate a LIHP directly or through
23contract with another entity shall be entitled to any federal financial
24participation available for administrative expenditures incurred in
25the operation of the Medi-Cal program or the demonstration
26project, including, but not limited to, outreach, screening and
27enrollment, program development, data collection, reporting and
28quality monitoring, and contract administration, but only to the
29extent that the expenditures are allowable under federal law and
30only to the extent the expenditures are not taken into account in
31the determination of the per enrollee rates under Section 15910.3.

32(h) On and after January 1, 2014, the state shall implement
33comprehensive health care reform for the populations targeted by
34the LIHP in compliance with federal health care reform law,
35regulation, and policy, including the federal Patient Protection and
36Affordable Care Act (Public Law 111-148), as amended by the
37federal Health Care and Education Reconciliation Act of 2010
38(Public Law 111-152), and subsequent amendments.

39(i) Subject to the Special Terms and Conditions of the
40demonstration project, a participating entity may elect to include,
P124  1in collaboration with the department, as the nonfederal share of
2LIHP expenditures, voluntary intergovernmental transfers or
3certified public expenditures of another governmental entity, as
4long as the intergovernmental transfer or certified public
5expenditure is consistent with federal law.

6(j) Participation in the LIHP under this part is voluntary on the
7part of the eligible entity for purposes of all applicable federal
8laws. As part of its voluntary participation under this article, the
9participating entity shall agree to reimburse the state for the
10nonfederal share of state staffing and administrative costs directly
11attributable to the cost of administering that LIHP, including, but
12not limited to, the state administrative costs related to certified
13public expenditures and intergovernmental transfers. This section
14shall be implemented only to the extent federal financial
15participation is not jeopardized.

16

SEC. 70.  

(a) The State Department of Health Care Services
17shall accept contributions by private foundations in the amount of
18at least fourteen million dollars ($14,000,000) for the purpose of
19this section and shall immediately seek an equal amount of federal
20matching funds.

21(b) Entities and persons that are eligible for Medi-Cal in-person
22enrollment assistance payments of fifty-eight dollars ($58) per
23approved Medi-Cal application and payment processing costs shall
24be those trained and eligible for in-person enrollment assistance
25payments by the California Health Benefit Exchange. The
26payments may be made by the State Department of Health Care
27Services or through the California Health Benefit Exchange
28in-person assistance payment system.

29(c) Enrollment assistance payments shall be made only for
30Medi-Cal applicants newly eligible for coverage pursuant to the
31federal Patient Protection and Affordable Care Act (Public Law
32111-148), as amended by the Health Care and Education
33Reconciliation Act of 2010 (Public Law 111-152), or those who
34have not been enrolled in the Medi-Cal program during the
35previous 12 months prior to making the application.

36(d) The commencement of enrollment assistance payments shall
37be consistent with those of the California Health Benefit Exchange.

38(e) The State Department of Health Care Services or the
39California Health Benefit Exchange shall provide monthly and
P125  1cumulative payment updates and number of persons enrolled
2through in-person assistance payments on its Internet Web site.

3

SEC. 71.  

(a) (1) The State Department of Health Care Services
4shall accept funding from private foundations in the amount of at
5least $12.5 million to provide allocations for the management and
6funding of Medi-Cal outreach and enrollment plans specific to the
7provisions contained in this section.

8(2) The department shall seek necessary federal approval for
9purposes of obtaining federal funding for activities conducted
10under this section.

11(3) Notwithstanding any other law, and in a manner that the
12Director of Health Care Services shall provide, the department
13may make allocations to fund Medi-Cal outreach and enrollment
14activities as described in this section.

15(b) (1) Funds appropriated by the Legislature to the department
16for the purposes of this section shall be made available to selected
17counties, counties acting jointly, and the County Medical Services
18Program Governing Board pursuant to Section 16809 of the
19Welfare and Institutions Code.

20(2) Selected counties, counties acting jointly, and the County
21Medical Services Program Governing Board may partner with
22community-based organizations as applicable to conduct outreach
23and enrollment to the target population as contained in subdivision
24(d).

25(3) The director may, at his or her discretion, also give
26consideration to community-based organizations in an area or
27region of the state if a county, or counties acting jointly do not
28seek an allocation or funds are made available.

29(4) For purposes of this section only, “county” shall be defined
30as county, city and county, a consortium of counties serving a
31region consisting of more than one county, the County Medical
32Services Program Governing Board, or a health authority.

33(c) (1) The allocations shall be apportioned geographically, by
34the entities identified in subdivision (b), according to the estimated
35number of persons who are eligible but not enrolled in Medi-Cal
36and who will be newly Medi-Cal eligible as of January 1, 2014.

37(2) The department may determine the number of allocations
38and the application process. The director may consult or obtain
39technical assistance from private foundations in implementation
40of the application and allocation process.

P126  1(3) The department shall coordinate and partner with the
2California Health Benefit Exchange on certified application assister
3and outreach, enrollment, and marketing activities related to the
4federal Patient Protection and Affordable Care Act.

5(d) Notwithstanding any other law, the department shall develop
6selection criteria to allocate funds for the Medi-Cal outreach and
7enrollment activities with special emphasis targeting all of the
8following populations:

9(1) Persons with mental health disorder needs.

10(2) Persons with substance use disorder needs.

11(3) Persons who are homeless.

12(4) Young men of color.

13(5) Persons who are in county jail, in state prison, on state
14parole, on county probation, or under postrelease community
15supervision.

16(6) Families of mixed-immigration status.

17(7) Persons with limited English proficiency.

18(e) (1) The funds allocated under this section shall be used only
19for the Medi-Cal outreach and enrollment activities and may
20supplement, but shall not supplant, existing local, state, and
21foundation funding of county outreach and enrollment activities.

22(2) Notwithstanding Section 10744 of the Welfare and
23Institutions Code, the department may recoup or withhold all or
24part of an allocation for failure to comply with any requirements
25 or standards set forth by the department for the purposes of this
26section.

27(f) The department shall begin the payment for the outreach and
28enrollment allocation program no later than February 1, 2014.

29(g) Under the terms of the approved allocation for the outreach
30and enrollment program, funded entities under this section shall
31not receive payment for in-person assister payments for assisting
32potential Medi-Cal enrollees.

33(h) The department shall require progress reports, in a manner
34as determined by the department, from those receiving allocations
35under this section.

36(i) To the extent federal funding is received for the services
37specified in this section, reimbursements for costs incurred under
38the approved allocations shall be made in compliance with federal
39law.

P127  1(j) Notwithstanding Chapter 3.5 (commencing with Section
211340) of Part 1 of Division 3 of Title 2 of the Government Code,
3the department may implement, interpret, or make specific this
4section by means of all-county letters, provider bulletins, or similar
5instructions.

6(k) The department may use a portion of the private foundation
7funding pursuant to paragraph (a) to carry out the activities under
8this section.

9

SEC. 72.  

Commencing no later than August 1, 2013, the State
10Department of Health Care Services shall convene a series of
11stakeholder meetings to receive input from clients, family members,
12providers, counties, and representatives of the Legislature
13concerning the development of the Behavioral Health Services
14Plan, as required by paragraph 25.d of the Special Terms and
15Conditions of California’s Bridge to Reform Section 1115(a)
16Medicaid Demonstration.

17

SEC. 73.  

Given the uncertainty within which persons diagnosed
18with HIV/AIDS from federal Ryan White HIV/AIDS Treatment
19Extension Act of 2009 funded programs may transition to Medi-Cal
20or other health insurance coverage, the State Department of Public
21Health shall report to the Joint Legislative Budget Committee by
22October 1, 2013, on whether any of the projections or assumptions
23used to develop the AIDS Drug Assistance Program (ADAP)
24estimated budget for the Budget Act of 2013 may result in an
25inability of ADAP to provide services to ADAP eligible clients.
26If the State Department of Public Health determines, before
27October 1, 2013, that ADAP is unable to provide services to ADAP
28eligible clients, the State Department of Public Health shall provide
29notification to the Joint Legislative Budget Committee within 15
30calendar days of making this determination.

31

SEC. 74.  

By October 1, 2013, the State Department of Public
32Health shall submit to the fiscal and appropriate policy committees
33of the Legislature a report describing how it plans to address the
34findings and recommendations described in its “Zero-Based
35Budgeting Review” report dated May 14, 2013, regarding the
36Infant Botulism Treatment and Prevention Program (BabyBIG
37program).

38

SEC. 75.  

As part of the Governor’s annual budget release to
39the Legislature in January and May, the State Department of Health
40Care Services shall identify as a separate policy change within the
P128  1Medi-Cal Local Assistance Estimate, the projected General Fund
2savings attributable to the receipt of enhanced federal funding for
3Medi-Cal eligibles, subject to the use of Modified Adjusted Gross
4Income as the basis for their income eligibility, who were
5previously calculated as being currently eligible and for whom the
6state received only a 50 percent federal matching assistant payment.
7The identified savings shall be attributed to the receipt of enhanced
8federal funding under Title XIX of the federal Social Security Act.
9The State Department of Health Care Services shall confer with
10applicable fiscal and policy staff of the Legislature by no later than
11October 1, 2013, regarding the potential content and attributes of
12the information provided in this policy change. This separate policy
13change format shall be provided through 2019-20.

14

SEC. 76.  

Notwithstanding any other law, the balance of Item
154150-001-0890 of the Budget Act of 2012 is reappropriated to the
16Department of Managed Health Care for the purposes of continuing
17operation of consumer assistance programs to help uninsured
18individuals obtain health care coverage pursuant to the terms of
19the federal Consumer Assistance Program Grant. These funds shall
20be available for encumbrance and expenditure until June 30, 2014.

21

SEC. 77.  

The adoption and readoption of regulations
22implementing portions of this act by the Managed Risk Medical
23Insurance Board shall be deemed an emergency and necessary to
24avoid serious harm to the public peace, health, safety, or general
25welfare for purposes of Sections 11346.1 and 11349.6 of the
26Government Code, and the board is hereby exempted from the
27requirement that it describe facts showing the need for immediate
28action and from review by the Office of Administrative Law.

29

SEC. 78.  

The Legislature finds and declares that Section 2 of
30this act, which amends Section 6254 to the Government Code, and
31Section 68 of this act, which adds Part 3.3 (commencing with
32Section 15800) to Division 9 of the Welfare and Institution Code,
33impose a limitation on the public’s right of access to the meetings
34of public bodies or the writings of public officials and agencies
35within the meaning of Section 3 of Article I of the California
36Constitution. Pursuant to that constitutional provision, the
37Legislature makes the following findings to demonstrate the interest
38protected by this limitation and the need for protecting that interest:

39(a) In order to ensure that the State Department of Health Care
40Services is not constrained in exercising its fiduciary powers and
P129  1obligations to negotiate on behalf of the public as it implements
2the provisions of Part 3.3 (commencing with Section 15800) of
3Division 9 of the Welfare and Institutions Code, the limitations
4on the public’s right of access imposed by Section 2 of this act are
5necessary.

6(b) To ensure the continued confidentiality of otherwise
7privileged or confidential information, the limitations on the
8public’s right of access imposed by Section 68 of this act are
9necessary.

10

SEC. 79.  

This act is a bill providing for appropriations related
11to the Budget Bill within the meaning of subdivision (e) of Section
1212 of Article IV of the California Constitution, has been identified
13as related to the budget in the Budget Bill, and shall take effect
14immediately.



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