AB 94,
as amended, Committee on Budget. begin deleteBudget Act of 2015. end deletebegin insertHealth.end insert
(1) Under existing law, the State Department of Public Health licenses and regulates clinical laboratories and certain clinical laboratory personnel performing clinical laboratory tests or examinations, subject to certain exceptions. Existing law requires a clinical laboratory to perform all clinical laboratory tests or examinations classified as waived under the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) in conformity with the manufacturer’s instructions. Existing law requires a clinical laboratory that performs tests or examinations that are not classified as waived under CLIA to establish and maintain a quality control program that meets specified CLIA standards.
end insertbegin insertThis bill would provide that the quality control program may include the clinical laboratory’s use of an alternative quality testing procedure recognized by the Centers for Medicare and Medicaid Services, including equivalent quality control procedures or an Individual Quality Control Plan, as specified.
end insertbegin insert(2) Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms that took effect January 1, 2014. Among other things, PPACA requires each state, by January 1, 2014, to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers. Existing state law establishes the California Health Benefit Exchange (the Exchange) within state government for the purpose of facilitating the enrollment of qualified individuals and qualified small employers in qualified health plans, and specifies the powers and duties of the board governing the Exchange. Among other things, existing law grants the board the authority to standardize products to be offered through the Exchange, and requires the board to establish and use a competitive process to select participating carriers and any other contractors, as specified.
end insertbegin insertThis bill would require any product standardized by the board to be discussed by the board during at least one properly noticed board meeting prior to the board meeting at which the board adopts the standardized products. The bill would require the board to adopt a Health Benefit Exchange Contracting Manual incorporating procurement and contracting policies and procedures that shall be followed by the Exchange, as specified. The bill would also exempt any regulations adopted, amended, or repealed by the board to implement these provisions from the Administrative Procedure Act.
end insertbegin insert(3) Existing law authorizes the board of the Exchange to adopt emergency regulations until January 1, 2016. Existing law prohibits the Office of Administrative Law from repealing any emergency regulations adopted until revised or repealed by the board, except that existing law also requires any emergency regulation adopted by the board to be repealed by operation of law, except as specified. Existing law allows more than 2 readoptions of those emergency regulations until January 1, 2017, and allows the emergency regulations adopted by the board to remain in effect for 2 years, as specified.
end insertbegin insertThis bill would extend the authority of the board of the Exchange to adopt emergency regulations until January 1, 2017. The bill would delete the prohibition against the office from repealing any emergency regulation of the board, but would continue to require any emergency regulation adopted by the board to be repealed by operation of law, except as specified. The bill would instead authorize the board to allow more than 2 readoptions of those emergency regulations until January 1, 2020, and would allow the emergency regulations adopted by the board to instead remain in effect for 3 years, as specified.
end insertbegin insert(4) Existing law provides for the licensure and regulation of health care facilities, including skilled nursing facilities and long-term health care facilities, as defined, by the State Department of Public Health. Existing law imposes specified fees for the licensure of skilled nursing facilities.
end insertbegin insertThis bill would require the fees for the licensure of skilled nursing facilities to be increased in a specified manner to generate moneys for expenditure by the California Department of Aging for purposes of its Long Term Care Ombudsman Program for work related to investigating complaints against skilled nursing facilities and increasing visits to those facilities.
end insertbegin insert(5) Existing law requires the State Department of Public Health to follow specified procedures when the department receives a written or oral complaint about a long-term health care facility, as specified, including investigation procedures. Existing law requires the issuance of a citation under specified provisions to be served upon a facility within 3 working days of a final determination, unless a licensee agrees to an extension of time.
end insertbegin insertThis bill would make changes to those investigation procedures, as specified, including, but not limited to, changing the time period for investigation of a complaint and authorizing an extension of that time period under extenuating circumstances. The bill would instead require a citation issued under those provisions to be served within 30 days of a final determination or completion of a complaint investigation, as specified. The bill would make conforming changes to a reporting requirement.
end insertbegin insertExisting law requires the State Department of Public Health, when it receives a complaint or report involving a general acute care hospital, acute psychiatric hospital, or special hospital, that indicates an ongoing threat of imminent danger of death or serious bodily harm, to complete an investigation of the complaint or report within 45 days.
end insertbegin insertIf the department fails to meet those requirements, this bill would require the department to document the extenuating circumstances leading to the failure to meet the 45-day time period, and to provide written notice to the facility and the complainant of the extenuating circumstances and an anticipated completion date.
end insertbegin insert(6) Existing law requires the State Department of Health Care Services to perform various health functions, including providing for breast and cervical cancer screening and treatment for low-income individuals, prostate cancer screening and treatment for low-income and uninsured men, and specified family planning services.
end insertbegin insertThis bill would require, with regard to the above health care programs, providers, or the enrolling entity, as applicable, to make available to all applicants and beneficiaries prior to, or concurrent with, enrollment, information on the manner in which to apply for insurance affordability programs, in a manner determined by the department. The information provided would be required to include the manner in which applications can be submitted for insurance affordability programs, information about the open enrollment periods for the Exchange, and the continuous enrollment aspect of the Medi-Cal program.
end insertbegin insert(7) Existing law creates the Food Safety Fund, as a special fund, and requires all moneys collected by the State Department of Public Health, pursuant to specified authority, to be deposited in the fund, for use by the department, upon appropriation by the Legislature, for the purposes of providing funds necessary to carry out and implement, among other things, inspection provisions relating to food, licensing, inspection, enforcement, and specified provisions relating to water.
end insertbegin insertThis bill would require moneys awarded to the department pursuant to court orders or settlements for the use of food safety-related activities to be deposited in the fund for those same health and safety purposes.
end insertbegin insert(8) Existing law authorizes a public entity that receives General Fund money from the State Department of Public Health for HIV prevention and education to use that money to support clean needle and syringe exchange programs authorized pursuant to law. Existing law requires several conditions to be met for the use of funds in this manner, such as the amount used not exceeding 7.5% of the total amount of General Fund money received for HIV prevention and education.
end insertbegin insertThis bill would authorize the State Department of Public Health to purchase sterile hypodermic needles and syringes, and other supplies, for distribution to syringe exchange programs, for the purpose of reducing the spread of HIV, hepatitis C, and other potentially deadly blood-borne pathogens.
end insertbegin insert(9) Existing law requires the State Public Health Officer to establish, and authorizes him or her to administer, a program to provide drug treatments to persons infected with HIV, to the extent that state and federal funds are appropriated. Existing law makes a person financially eligible to receive services under this program if his or her adjusted gross income does not exceed $50,000 per year, and as specified. Existing law establishes a payment schedule to determine the payment obligation of a person receiving drugs under the program, except as specified. Existing law requires the State Department of Public Health and the Franchise Tax Board to exchange prescribed information in order to verify financial eligibility under the program. Existing law provides that this information constitutes confidential public health records, as specified.
end insertbegin insertThis bill would instead make a person financially eligible to receive services under the program if his or her modified adjusted gross income, as defined, does not exceed 500% of the federal poverty level, as defined, per year based on family size and household income, as defined. The bill would make conforming changes to the provisions that establish a payment schedule and that require the department and the board to exchange information for purposes of determining eligibility.
end insertbegin insert(10) Existing law establishes various programs relating to treatment of persons with the human immunodeficiency virus (HIV) and the acquired immune deficiency syndrome (AIDS). Under existing law, the Office of AIDS, State Department of Public Health, is responsible for coordinating state programs, services, and activities relating to HIV and AIDS, and AIDS-related conditions.
end insertbegin insertThis bill would require the State Department of Public Health, upon an appropriation in the annual Budget Act, to establish the Pre-Exposure Prophylaxis (PrEP) Navigator Services Program, under which the department shall provide for specified activities relating to, among other things, oversight of the program and funding for community-based organizations and local health departments to provide outreach and education services to populations affected by HIV.
end insertbegin insert(11) Existing law requires the State Department of Public Health to make available protocols and guidelines developed by the National Institutes of Health, the University of California at San Francisco, and California legislative advisory committees on hepatitis C for educating physicians and health professionals and training community service professionals and training community service providers on the most recent scientific and medical information on hepatitis C detection, transmission, diagnosis, treatment, and therapeutic decisionmaking.
end insertbegin insertThis bill would establish a 3-year Hepatitis C Linkage to Care demonstration pilot project to allow for innovative, evidence-based approaches to provide outreach, hepatitis C screening, and linkage to, and retention in, quality health care for the most vulnerable and underserved individuals living with, or at high risk for, hepatitis C viral infection. The bill would, upon appropriation, require the department to award funding to community-based organizations or local health jurisdictions to operate demonstration pilot projects, as specified.
end insertbegin insert(12) Existing law requires the governing board of a county to establish a community child health and disability prevention program for the purpose of providing early and periodic evaluation of the health status of children in the county. The program plan is required to include screening and evaluation for each child, including referrals to a dentist participating in the Medi-Cal program for all children 3 years of age and older who are eligible for Medi-Cal.
end insertbegin insertThis bill would, instead, require the program plan to include referrals to a dentist for all children eligible for the Medi-Cal program one year of age and older. Because the bill would require expansion of the county program plan, it would create a state-mandated local program.
end insertbegin insert(13) Existing law requires the State Department of Public Health to establish a program for the development, provision, and evaluation of genetic disease testing. Existing law requires the department to charge a fee to all payers for certain genetic disease screening tests and activities. Existing law requires fees charged for prenatal screening and followup services provided to persons enrolled in the Medi-Cal program, health care service plan enrollees, or persons covered by health insurance policies, to be paid in full and deposited in the Genetic Disease Testing Fund or the Birth Defects Monitoring Program Fund, as prescribed, subject to all terms and conditions of each enrollee’s or insured’s health care service plan or insurance coverage, including, but not limited to, applicable copayments and deductibles.
end insertbegin insertExisting law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law also provides for the regulation of health insurers by the Department of Insurance. Under existing law, a group or individual health care service plan contract, with designated exceptions, or a health insurer is required to include coverage for the statewide Expanded Alpha Feto Protein (AFP) genetic testing program.
end insertbegin insertThis bill would prohibit coverage by a health care service plan or health insurer for these genetic testing services from being subject to copayment, coinsurance, deductible, or any other form of cost sharing. The services would be paid according to the fee amounts set under the department’s genetic disease testing programs and applicable regulations. The bill also would make various technical and conforming changes.
end insertbegin insertBecause existing law makes a willful violation of the provisions relating to health care services plans a crime, by expanding the definition of this crime, the bill would impose a state-mandated local program.
end insertbegin insert(14) Under existing law, a health care service plan and a health insurer are required to offer a standard benefit plan, as specified, under which health care service plans and insurers are required to continue to provide coverage under the same terms and conditions prescribed under a previously authorized pilot program. Under existing law, the State Department of Health Care Services is responsible for paying the costs of the coverage, completing periodic reconciliation reports with health care service plans and insurers, and adopting appropriate regulations. Existing law requires the department to complete reconciliation with a health care service program or insurer for a given reporting period within 6 months after receiving the plan’s or insurer’s conciliation report.
end insertbegin insertExisting law establishes the California Major Risk Medical Insurance Program (MRMIP), which is administered by the department, operative July 1, 2014. Under existing law, MRMIP provides major risk medical coverage to certain categories of individuals who have been rejected for coverage by at least one private health plan, and meet other program requirements. Existing law specifies the powers and duties of the department with respect to MRMIP. Existing law creates the Major Risk Medical Insurance Fund as a continuously appropriated fund for purposes of funding services under MRMIP and the standard benefit plans described above.
end insertbegin insertThis bill would extend the time within which the department is required to complete reconciliation with plans and insurers, to 18 months after receiving the conciliation report. The bill would authorize the department to implement these provisions in a specified manner.
end insertbegin insertThe bill would also establish procedures that would apply under circumstances in which the department and a health care service plan or health insurer have not agreed to a final reconciliation of the amount to be expended from the Major Risk Medical Insurance Fund or to be reimbursed to the fund for the purposes described above, including provisions relating to the payment of interest or the negotiation of payment plans, as specified.
end insertbegin insert(15) Existing law establishes the Office of Problem and Pathological Gambling within the State Department of Public Health. Under existing law, the office is responsible for developing programs for problem gambling prevention and treatment services for California residents. Existing law defines the terms “pathological gambling disorder” and “problem gambling” for these purposes.
end insertbegin insertThis bill would rename that office the Office of Problem Gambling and would substitute the term “gambling disorder,” as defined, for the terms “pathological gambling disorder” and “problem gambling.” The bill would, among other things, additionally authorize the gambling disorder prevention and treatment programs to provide services to an affected individual, which the bill would define as a person who experiences adverse psychiatric or physical impacts due to another person’s gambling disorder. The bill would also authorize the treatment program to include research and training components, as specified.
end insertbegin insert(16) 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. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.
end insertbegin insertThe federal Medicaid Program provisions prohibit payment to a state for medical assistance furnished to an alien who is not lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law.
end insertbegin insertThis bill would extend eligibility for full-scope Medi-Cal benefits to individuals under 19 years of age who do not have, or are unable to establish, satisfactory immigration status. The bill would direct the State Department of Health Care Services to seek any necessary federal approvals to obtain federal financial participation for these services, and would require that these services be provided with state-only funds only if federal financial participation is not available. Because counties are required to make Medi-Cal eligibility determinations and this bill would expand Medi-Cal eligibility, the bill would impose a state-mandated local program.
end insertbegin insert(17) Existing law, until July 1, 2015, requires the department to retain or delegate the authority to perform Medi-Cal eligibility determinations as set forth in specified provisions related to electronic determination of eligibility.
end insertbegin insertThis bill would delete the repeal date, and would thereby extend the operation of those provisions indefinitely.
end insertbegin insert(18) Existing law authorizes certain ground emergency medical transportation providers to receive supplemental Medi-Cal reimbursement in addition to the rate of payment that the provider would otherwise receive for those services. Existing law specifies the manner in which the supplemental reimbursement is calculated, and requires the nonfederal share of the supplemental reimbursement to be paid only with funds from specified governmental entities.
end insertbegin insertThis bill would require the State Department of Health Care Services to develop a modified supplemental reimbursement program that would seek to increase the reimbursement to an eligible provider, as specified. The bill would provide that the department shall not implement the modified program unless it determines that the modified program would likely result in an overall increase to the supplemental reimbursement available under existing law, and the department receives all necessary federal approvals.
end insertbegin insert(19) Existing law requires, except as otherwise provided, Medi-Cal provider payments and payments for specified non-Medi-Cal programs to be reduced by 10% for dates of service on and after June 1, 2011, and requires payments to Medi-Cal managed health care plans to be reduced by the actuarial equivalent amount of the payment reductions for fee-for-service Medi-Cal benefits, as specified.
end insertbegin insertThis bill would exempt from the application of those reductions dental services and applicable ancillary services for dates of service on or after July 1, 2015, or the effective date of any necessary federal approvals, whichever is later. The bill would also exempt from the application of those reductions payments to dental managed care plans for contract amendments or change orders effective on or after July 1, 2015, or the effective date of any necessary federal approvals, whichever is later.
end insertbegin insert(20) Existing law authorizes the State Department of Health Care Services, subject to federal approval, to create a Health Home Program for Medi-Cal enrollees with chronic conditions, as prescribed, as authorized under federal law.
end insertbegin insertThis bill would create the Health Home Program Account in the Special Deposit Fund within the State Treasury in order to collect and allocate non-General Fund public or private grant funds, to be expended upon allocation by the Legislature, for the purposes of implementing the Health Home Program. The bill would appropriate $50,000,000 from the Health Home Program Account to the State Department of Health Care Services for the purposes of implementing the Health Home Program.
end insertbegin insert(21) Existing law requires Medi-Cal beneficiaries to make set copayments for specified services and, upon federal approval, existing law revises these copayment rates and makes other related changes, as specified.
end insertbegin insertThis bill would delete the revised copayment rate provisions and would make a conforming change.
end insertbegin insert(22) Under existing law, the Legislature finds and declares that linking appropriate funding for county Medi-Cal administrative operations, including annual cost-of-doing-business adjustments, with performance standards will give counties the incentive to meet the performance standards and enable them to continue to do the work they do on behalf of the state. Existing law provides that it is the intent of the Legislature to provide appropriate funding to the counties for the effectual administration of the Medi-Cal program, except for specified fiscal years in regard to any cost-of-doing-business adjustment.
end insertbegin insertThis bill would additionally provide that it is the intent of the Legislature to not appropriate funds for the cost-of-doing-business adjustment for the 2015-16 fiscal year.
end insertbegin insert(23) One of the methods by which Medi-Cal services are provided is pursuant to contracts with various types of managed care health plans. Existing federal law provides for the federal Medicare Program, which is a public health insurance program for persons who are 65 years of age or older and specified persons with disabilities who are under 65 years of age.
end insertbegin insertExisting law requires the State Department of Health Care Services to seek federal approval pursuant to a Medicare or Medicaid demonstration project or waiver, or a combination thereof, to establish a demonstration project, known as the Coordinated Care Initiative, that enables beneficiaries who are dually eligible for the Medi-Cal program and the Medicare Program to receive a continuum of services that maximizes access to, and coordination of, benefits between these programs. Existing law requires that Medi-Cal beneficiaries who have dual eligibility in the Medi-Cal and Medicare programs be assigned as mandatory enrollees into managed care health plans in counties participating in the demonstration project, and requires, beginning January 1, 2015, or 19 months after commencement of beneficiary enrollment into managed care, whichever is later, all Medi-Cal long-term services and supports, which includes Multipurpose Senior Services Program (MSSP) services, to be covered under managed care health contracts and only available through managed care health plans to beneficiaries residing in counties participating in the Coordinated Care Initiative.
end insertbegin insertThis bill would extend the transition date MSSP services are required to be a Medi-Cal benefit only available through managed care health plans to no later than December 31, 2017, or on the date managed care health plans and MSSP providers jointly satisfy the readiness criteria developed by the department, and would make additional conforming changes. The bill would require the department to notify the appropriate fiscal and policy committees of the Legislature of its intent to transition MSSP services to managed care health plans at least 30 days before this transition occurs. The bill would require the department and the California Department of Aging, in consultation with specified entities, to develop readiness criteria, as specified. The bill would require the department to evaluate the readiness of the managed care health plans and MSSP providers to commence the transition of MSSP services to managed care health plans.
end insertbegin insert(24) Existing law requires 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 Medi-Cal in-person enrollment assistance payments to eligible entities and persons, 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 activities, as specified. Existing law requires the department to seek federal matching funds for those purposes. Existing law establishes the Healthcare Outreach and Medi-Cal Enrollment Account in the Special Deposit Fund within the State Treasury in order to collect and allocate these funds, as specified.
end insertbegin insertThis bill would require the department to make the in-person enrollment assistance payments described above for submitted applications received through June 30, 2015, that result in approved applications. Once all of those payments have been made, the bill would require the department to allocate any remaining funds accepted pursuant to the in-person enrollment assistance payment provisions to counties to be used for the Medi-Cal outreach and enrollment activities described above. The bill would require those remaining funds that are allocated to those counties to be distributed to community-based organizations providing enrollment assistance to prospective Medi-Cal enrollees, as specified. The bill would authorize those counties to retain a specified amount for administrative costs. The bill would require the department to make an initial allocation to counties for these funds no later than January 1, 2016, and the final allocation no later than June 30, 2016. The bill would make the in-person enrollment assistance provisions inoperative on a specified date.
end insertbegin insert(25) Existing law establishes the California Health Benefit Exchange within state government and specifies the powers and duties of the executive board governing the Exchange. 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. Existing law requires the department to accept specified contributions by private foundations for purposes of making payments to entities and persons for Medi-Cal in-person enrollment assistance and renewal assistance, and to provide allocations for the management and funding of Medi-Cal outreach and enrollment plans, as specified. Existing law further requires the State Department of Health Care Services to immediately seek an equal amount of federal matching funds. Existing law appropriates specified funds to the department from the Healthcare Outreach and Medi-Cal Enrollment Account for the purposes described above, which are available for encumbrance or expenditure until June 30, 2016, and December 31, 2016, as specified.
end insertbegin insertThis bill would make the requirement that the State Department of Health Care Services accept the private foundation funding for outreach and enrollment grants inoperative on June 30, 2018. The bill would extend the availability of amounts previously appropriated from the Healthcare Outreach and Medi-Cal Enrollment Account and the Federal Trust Fund to June 30, 2018, thereby making an appropriation.
end insertbegin insert(26) This bill would require, upon an appropriation of funds by the Legislature for this purpose, the State Department of Health Care Services to provide a grant to health benefit plans that meet certain criteria for purposes of funding health care coverage for agricultural employees and dependents, as specified.
end insertbegin insert(27) This bill, for the 2015-16 fiscal year and upon appropriation of funds by the Legislature for this purpose, would require the State Department of Health Care Services to provide a grant to LifeLong Medical Care, a federally qualified health center in Contra Costa County, to be used to support LifeLong Medical Care.
end insertbegin insert(28) Existing law, the Budget Act of 2013, appropriates $142,000,000 to the California Health Facilities Financing Authority (CHFFA) for mental health wellness grants. Existing law, the Budget Act of 2013, authorizes these funds to be available for encumbrance or expenditure until June 30, 2016.
end insertbegin insertThis bill would authorize CHFFA to use up to $3,000,000 of these funds, if unencumbered, to develop peer respite sites. The bill would require any grant awards authorized by CHFFA for peer respite sites to be used to expand local resources for the development, capital, equipment acquisition, and applicable program startup or expansion costs to increase bed capacity for peer respite support services. The bill would authorize CHFFA to adopt emergency regulations relating to grants for peer respite sites in accordance with the Administrative Procedure Act.
end insertbegin insert(29) This bill would require the Office of System Integration to report to the Legislature by April 1, 2017, on the feasibility, benefits, costs, and risks of installing the Modified Adjusted Gross Income (MAGI) Eligibility Decision Engine in one, two, or all of the Statewide Automated Welfare System consortia systems.
end insertbegin insert(30) Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
end insertbegin insertThis bill would make legislative findings to that effect.
end insertbegin insert(31) This bill would make legislative findings and declarations as to the necessity of a special statute for LifeLong Medical Care and Contra Costa County.
end insertbegin insert(32) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
end insertbegin insertThis bill would provide that with regard to certain mandates no reimbursement is required by this act for a specified reason.
end insertbegin insertWith regard to any other mandates, this bill would provide that, if the Commission on State Mandates determines that the bill contains costs so mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
end insertbegin insert(33) This bill would declare that it is to take effect immediately as a bill providing for appropriations related to the Budget Bill.
end insertThis bill would express the intent of the Legislature to enact statutory changes relating to the Budget Act of 2015.
end deleteVote: majority.
Appropriation: begin deleteno end deletebegin insertyesend insert.
Fiscal committee: begin deleteno end deletebegin insertyesend insert.
State-mandated local program: begin deleteno end deletebegin insertyesend insert.
The people of the State of California do enact as follows:
It is the intent of the Legislature that, in enacting
2the amendments made to Section 1420 of the Health and Safety
3Code by the act that added this section, the State Department of
4Public Health continue to seek to reduce long-term care compliant
5investigation timelines to less than 60 days with a goal of meeting
6a 45-day timeline.
begin insertSection 1220 of the end insertbegin insertBusiness and Professions Codeend insertbegin insert is
2amended to read:end insert
(a) (1) Each clinical laboratory shall maintain records,
4equipment, and facilities that are adequate and appropriate for the
5services rendered.
6(2) (A) Except for tests or examinations classified as waived
7under CLIA, each clinical laboratory shall enroll, and demonstrate
8successful participation, as defined under CLIA, for each specialty
9and subspecialty in which it performs clinical laboratory tests or
10examinations, in a proficiency testing program approved by the
11department or by HCFA, to the same extent as required by CLIA
12in Subpart H (commencing with Section 493.801) of Title 42 of
13the Code of Federal Regulations. This requirement shall not be
14interpreted to prohibit a clinical
laboratory from performing clinical
15laboratory tests or examinations in a specialty or subspecialty for
16which there is no department or HCFA approved proficiency
17testing program.
18(B) Each clinical laboratory shall authorize its proficiency test
19results to be reported to the department in an electronic format that
20is compatible with the department’s proficiency testing data
21monitoring system and shall authorize the release of proficiency
22tests results to the public to the same extent required by CLIA.
23(b) Each clinical laboratory shall be conducted, maintained, and
24operated without injury to the public health.
25(c) (1) The department shall conduct inspections of licensed
26clinical laboratories no less than once every two years. The
27department shall maintain a record of those inspections and shall
28
ensure that every licensed clinical laboratory in California is
29inspected at least that often.
30(2) Registered clinical laboratories shall not be routinely
31inspected by the department.
32(3) The department shall conduct an investigation of complaints
33received concerning any clinical laboratory, which may include
34an inspection of the laboratory.
35(4) Each licensed or registered clinical laboratory shall be
36subject to inspections by HCFA or HCFA agents, as defined by
37CLIA, as a condition of licensure or registration.
38(d) (1) Each clinical laboratory shall perform all clinical
39laboratory tests or examinations classified as waived under CLIA
40in conformity with the manufacturer’s instructions.
P16 1(2) Except for those clinical laboratories performing only tests
2or examinations classified as waived under CLIA, each clinical
3laboratory shall establish and maintain all of the following:
4(A) A patient test management system that meets the standards
5of CLIA in Subpart J (commencing with Sectionbegin delete 493.1101)end delete
6begin insert 493.1100)end insert of Title 42 of the Code of Federal Regulations.
7(B) A quality control program that meets the requirements of
8CLIA in Subpart K (commencing with Sectionbegin delete 493.1201)end delete
9begin insert 493.1200)end insert of Title 42 of the Code of Federalbegin delete Regulations.end delete
10begin insert Regulations as in effect on January 1, 2015, and that may include
11the clinical laboratory’s use of the following alternative quality
12control testing procedures recognized by the federal Centers for
13Medicare and Medicaid Services (CMS):end insert
14(i) Until December 31, 2015, equivalent quality control
15procedures.
16(ii) Commencing January 1, 2016, an Individualized Quality
17Control Plan, as incorporated in Appendix C of the State
18Operations Manual adopted by CMS.
19(C) A comprehensive quality assurance program that meets the
20standards of CLIA in Subpart P (commencing with Section
21493.1701) of Title 42 of the Code of Federal Regulations.
begin insertSection 100504 of the end insertbegin insertGovernment Codeend insertbegin insert is amended
23to read:end insert
(a) The board may do the following:
25(1) With respect to individual coverage made available in the
26Exchange, collect premiums and assist in the administration of
27subsidies.
28(2) Enter into contracts.
29(3) Sue and be sued.
30(4) Receive and accept gifts, grants, or donations of moneys
31from any agency of the United States, any agency of the state, and
32any municipality, county, or other political subdivision of the state.
33(5) Receive and accept gifts, grants, or donations from
34individuals, associations, private
foundations, and corporations,
35in compliance with the conflict of interest provisions to be adopted
36by the board at a public meeting.
37(6) Adopt rules and regulations, as necessary. Until January 1,
38begin delete 2016,end deletebegin insert 2017,end insert any necessary rules and regulations may be adopted
39as emergency regulations in accordance with the Administrative
40Procedure Act (Chapter 3.5 (commencing with Section 11340) of
P17 1Part 1 of Division 3 of Title 2). The adoption of these regulations
2shall be deemed to be an emergency and necessary for the
3immediate preservation of the public peace, health and safety, or
4general welfare. Notwithstanding Chapter 3.5 (commencing with
5Section 11340) of Part 1 of Division 3 of Title 2, including
6subdivisions (e) and (h) of Section 11346.1, any emergency
7regulation adopted pursuant to this section shallbegin delete notend delete be repealed
8bybegin delete the Office of Administrative Law until revised or repealed by operation of law unless the
9the board, except that an emergency regulation adopted pursuant
10to this section shall be repealed byend delete
11adoption, amendment, or repeal of the regulation is promulgated
12by the board pursuant to Chapter 3.5 (commencing with Section
1311340) of Part 1 of Division 3 of Title 2 of the Government Code
14withinbegin delete twoend deletebegin insert threeend insert years of the initial adoption of the emergency
15regulation. Notwithstanding subdivision (h) of Section 11346.1,
16until January 1,begin delete 2017,end deletebegin insert 2020,end insert the Office of Administrative Law may
17approve more than two readoptions of an emergency regulation
18adopted pursuant to this section.begin insert The amendments made to this
19paragraph by the act adding this sentence shall apply to any
20emergency regulation adopted pursuant to this section prior to
21the effective date of the Budget Act of 2015.end insert
22(7) Collaborate with the State Department of Health Care
23Services and the Managed Risk Medical Insurance Board, to the
24extent possible, to allow an individual the option to remain enrolled
25with his or her carrier and provider network in the event the
26individual experiences a loss of eligibility of premium tax credits
27and becomes eligible for
the Medi-Cal program or the Healthy
28Families Program, or loses eligibility for the Medi-Cal program
29or the Healthy Families Program and becomes eligible for premium
30tax credits through the Exchange.
31(8) Share information with relevant state departments, consistent
32with the confidentiality provisions in Section 1411 of the federal
33act, necessary for the administration of the Exchange.
34(9) Require carriers participating in the Exchange to make
35available to the Exchange and regularly update an electronic
36directory of contracting health care providers so that individuals
37seeking coverage through the Exchange can search by health care
38provider name to determine which health plans in the Exchange
39include that health care provider in their network. The board may
40also require a carrier to provide regularly updated information to
P18 1the Exchange as to whether a health care provider is
accepting
2new patients for a particular health plan. The Exchange may
3provide an integrated and uniform consumer directory of health
4care providers indicating which carriers the providers contract with
5and whether the providers are currently accepting new patients.
6The Exchange may also establish methods by which health care
7providers may transmit relevant information directly to the
8Exchange, rather than through a carrier.
9(10) Make available supplemental coverage for enrollees of the
10Exchange to the extent permitted by the federal act, provided that
11no General Fund money is used to pay the cost of that coverage.
12Any supplemental coverage offered in the Exchange shall be
13subject to the charge imposed under subdivision (n) of Section
14100503.
15(b) The Exchange shall only collect information from individuals
16or designees of individuals necessary to administer the Exchange
17and
consistent with the federal act.
18(c) begin insert(1)end insertbegin insert end insert The board shall have the authority to standardize
19products to be offered through the Exchange.begin insert Any products
20standardized by the board pursuant to this subdivision shall be
21discussed by the board during at least one properly noticed board
22meeting prior to the board meeting at which the board adopts the
23standardized products to be offered through the Exchange.end insert
24(2) The adoption, amendment, or repeal of a regulation by the
25
board to implement this subdivision is exempt from the rulemaking
26provisions of the Administrative Procedure Act (Chapter 3.5
27(commencing with Section 11340) of Part 1 of Division 3 of Title
282).
begin insertSection 100505 of the end insertbegin insertGovernment Codeend insertbegin insert is amended
30to read:end insert
begin insert(a)end insertbegin insert end insert The board shall establish and use a competitive
32process to select participating carriers and any other contractors
33under this title. Any contract entered into pursuant to this title shall
34be exempt from Chapterbegin delete 2end deletebegin insert 1end insert (commencing with Section 10100)
35ofbegin insert Part 2 ofend insert Division 2 of the Public Contract Code, and shall be
36exempt from the review or approval of any division of the
37Department of General Services.begin insert The board shall adopt a Health
38Benefit Exchange Contracting Manual incorporating procurement
39and contracting policies and procedures that shall be followed by
40the Exchange. The policies and procedures in the manual shall be
P19 1substantially similar to the provisions contained in the State
2Contracting Manual.end insert
3(b) The adoption, amendment, or repeal of a regulation by the
4board to implement this section, including the adoption of a manual
5pursuant to subdivision (a) and any procurement process conducted
6by the Exchange in accordance with the manual, is exempt from
7the rulemaking provisions of the Administrative Procedure Act
8(Chapter 3.5 (commencing with Section 11340) of Part 1 of
9Division 3 of Title 2).
begin insertSection 1266 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is amended
11to read:end insert
(a) The Licensing and Certification Division shall be
13supported entirely by federal funds and special funds by no earlier
14than the beginning of the 2009-10 fiscal year unless otherwise
15specified in statute, or unless funds are specifically appropriated
16from the General Fund in the annual Budget Act or other enacted
17legislation. For the 2007-08 fiscal year, General Fund support
18shall be provided to offset licensing and certification fees in an
19amount of not less than two million seven hundred eighty-two
20thousand dollars ($2,782,000).
21(b) (1) The Licensing and Certification Program fees for the
222006-07 fiscal year shall be as follows:
|
Type of Facility | Fee | |
|
General Acute Care Hospitals |
$ 134.10 |
per bed |
|
Acute Psychiatric Hospitals |
$ 134.10 |
per bed |
|
Special Hospitals |
$ 134.10 |
per bed |
|
Chemical Dependency Recovery Hospitals |
$ 123.52 |
per bed |
|
Skilled Nursing Facilities |
$ 202.96 |
per bed |
|
Intermediate Care Facilities |
$ 202.96 |
per bed |
|
Intermediate Care Facilities- Developmentally Disabled |
$ 592.29 |
per bed |
|
Intermediate Care Facilities- Developmentally Disabled-Habilitative |
$1,000.00 |
per facility |
|
Intermediate Care Facilities- Developmentally Disabled-Nursing |
$1,000.00 |
per facility |
|
Home Health Agencies |
$2,700.00 |
per facility |
|
Referral Agencies |
$5,537.71 |
per facility |
|
Adult Day Health Centers |
$4,650.02 |
per facility |
|
Congregate Living Health Facilities |
$ 202.96 |
per bed |
|
Psychology Clinics |
$ 600.00 |
per facility |
|
Primary Clinics- Community and Free |
$ 600.00 |
per facility |
|
Specialty Clinics- Rehab Clinics (For profit) |
$2,974.43 |
per facility |
|
(Nonprofit) |
$ 500.00 |
per facility |
|
Specialty Clinics- Surgical and Chronic |
$1,500.00 |
per facility |
|
Dialysis Clinics |
$1,500.00 |
per facility |
|
Pediatric Day Health/Respite Care |
$ 142.43 |
per bed |
|
Alternative Birthing Centers |
$2,437.86 |
per facility |
|
Hospice |
$1,000.00 |
per provider |
|
Correctional Treatment Centers |
$ 590.39 |
per bed |
13(2) (A) In the first year of licensure for intermediate care
14facility/developmentally
disabled-continuous nursing (ICF/DD-CN)
15facilities, the licensure fee for those facilities shall be equivalent
16to the licensure fee for intermediate care facility/developmentally
17disabled-nursing facilities during the same year. Thereafter, the
18licensure fee for ICF/DD-CN facilities shall be established pursuant
19to the same procedures described in this section.
20(B) In the first year of licensure for hospice facilities, the
21licensure fee shall be equivalent to the licensure fee for congregate
22living health facilities during the same year. Thereafter, the
23licensure fee for hospice facilities shall be established pursuant to
24the same procedures described in this section.
25(c) Commencing in the 2015-16 fiscal year, the fees for skilled
26nursing facilities shall be increased so as to generate four hundred
27
thousand dollars ($400,000) for the California Department of
28Aging’s Long-Term Care Ombudsman Program for its work related
29to investigating complaints made against skilled nursing facilities
30and increasing visits to those facilities.
31(c)
end delete
32begin insert(d)end insert Commencing February 1, 2007, and every February 1
33thereafter, the department shall publish a list of estimated fees
34pursuant to this section. The calculation of estimated fees and the
35publication of the report and list of estimated fees shall not be
36subject to the rulemaking requirements of Chapter 3.5
37(commencing with Section 11340) of Part 1 of Division 3 of Title
382 of the Government Code.
39(d)
end delete
P21 1begin insert(e)end insert Notwithstanding Section 10231.5 of the Government Code,
2by February 1 of each year, the department shall prepare the
3following reports and shall make those reports, and the list of
4estimated fees required to be published pursuant to subdivision
5begin delete (c),end deletebegin insert (d),end insert available to the public by submitting them to the
6Legislature and posting them on the department’s Internet Web
7site:
8(1) A report of all costs for activities of the Licensing and
9Certification Program. At a minimum, this report shall include a
10narrative of all baseline adjustments and their calculations, a
11description of how each category of facility was calculated,
12descriptions of assumptions used in any calculations, and shall
13recommend Licensing and Certification Program fees in accordance
14with the following:
15(A) Projected workload and costs shall be grouped for each fee
16category, including workload costs for facility categories that have
17been established by statute and for which licensing regulations
18and
procedures are under development.
19(B) Cost estimates, and the estimated fees, shall be based on
20the appropriation amounts in the Governor’s proposed budget for
21the next fiscal year, with and without policy adjustments to the fee
22methodology.
23(C) The allocation of program, operational, and administrative
24overhead, and indirect costs to fee categories shall be based on
25generally accepted cost allocation methods. Significant items of
26costs shall be directly charged to fee categories if the expenses can
27be reasonably identified to the fee category that caused them.
28Indirect and overhead costs shall be allocated to all fee categories
29using a generally accepted cost allocation method.
30(D) The amount of federal funds and General Fund moneys to
31be received in the budget year shall be estimated and allocated to
32each fee
category based upon an appropriate metric.
33(E) The fee for each category shall be determined by dividing
34the aggregate state share of all costs for the Licensing and
35Certification Program by the appropriate metric for the category
36of licensure. Amounts actually received for new licensure
37applications, including change of ownership applications, and late
38payment penalties, pursuant to Section 1266.5, during each fiscal
39year shall be calculated and 95 percent shall be applied to the
40appropriate fee categories in determining Licensing and
P22 1Certification Program fees for the second fiscal year following
2receipt of those funds. The remaining 5 percent shall be retained
3in the fund as a reserve until appropriated.
4(2) (A) A staffing and systems analysis to ensure efficient and
5effective utilization of fees collected, proper allocation of
6departmental resources to
licensing and certification activities,
7survey schedules, complaint investigations, enforcement and appeal
8activities, data collection and dissemination, surveyor training,
9and policy development.
10(B) The analysis under this paragraph shall be made available
11to interested persons and shall include all of the following:
12(i) The number of surveyors and administrative support
13personnel devoted to the licensing and certification of health care
14facilities.
15(ii) The percentage of time devoted to licensing and certification
16activities for the various types of health facilities.
17(iii) The number of facilities receiving full surveys and the
18frequency and number of followup visits.
19(iv) The number
and timeliness of complaintbegin delete investigations.end delete
20begin insert investigations, including data on the department’s compliance
21with the requirements of paragraphs (3), (4), and (5) of subdivision
22(a) of Section 1420.end insert
23(v) Data on deficiencies and citations issued, and numbers of
24citation review conferences and arbitration hearings.
25(vi) Other applicable activities of the licensing and certification
26division.
27(3) The annual program fee report described in subdivision (d)
28of Section 1416.36.
29(e)
end delete
30begin insert(f)end insert The reports required pursuant to subdivisionbegin delete (d)end deletebegin insert (e)end insert shall be
31submitted in compliance with Section 9795 of the Government
32Code.
33(f)
end delete
34begin insert(g)end insert (1) The department shall adjust the list of estimated fees
35published pursuant to subdivisionbegin delete (c)end deletebegin insert(d)end insert if the annual Budget Act
36or other enacted legislation includes an appropriation that differs
37from those proposed in the Governor’s proposed budget for that
38fiscal year.
39(2) The department shall publish a final fee list, with an
40explanation of any adjustment, by the issuance of an all facilities
P23 1letter, by posting the list on the department’s Internet Web site,
2and by including the final fee list as part of the licensing application
3package, within 14 days of the enactment of the annual Budget
4Act. The adjustment of fees and the publication of the final fee list
5shall not be subject to the rulemaking requirements of Chapter 3.5
6(commencing with Section 11340) of Part 1 of Division 3 of Title
72 of the Government Code.
8(g)
end delete
9begin insert(h)end insert (1) Fees shall not be assessed or collected pursuant to this
10section from any state department, authority, bureau, commission,
11or officer, unless federal financial participation would become
12available by doing so and an appropriation is included in the annual
13Budget Act for that state department, authority, bureau,
14commission, or officer for this purpose. Fees shall not be assessed
15or collected pursuant to this section from any clinic that is certified
16only by the federal government and is exempt from licensure under
17Section 1206, unless federal financial participation would become
18available by doing so.
19(2) For
the 2006-07 state fiscal year, a fee shall not be assessed
20or collected pursuant to this section from any general acute care
21hospital owned by a health care district with 100 beds or less.
22(h)
end delete
23begin insert(i)end insert The Licensing and Certification Program may change annual
24license expiration renewal dates to provide for efficiencies in
25operational processes or to provide for sufficient cashflow to pay
26for expenditures. If an annual license expiration date is changed,
27the renewal fee shall be prorated accordingly. Facilities shall be
28provided with a 60-day notice of any change in their annual license
29renewal date.
30(j) Commencing with the 2018-19 November Program estimate,
31the Licensing and Certification Program shall evaluate the
32feasibility of reducing investigation
timelines based on experience
33with implementing paragraphs (3), (4), and (5) of subdivision (a)
34of Section 1420.
begin insertSection 1279.2 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
36amended to read:end insert
(a) (1) In any case in which the department receives
38a report from a facility pursuant to Section 1279.1, or a written or
39oral complaint involving a health facility licensed pursuant to
40subdivision (a), (b), or (f) of Section 1250, that indicates an
P24 1ongoing threat of imminent danger of death or serious bodily harm,
2the department shall make an onsite inspection or investigation
3within 48 hours or two business days, whichever is greater, of the
4receipt of the report or complaint and shall complete that
5investigation within 45 days.
6(2) Until the department has determined by onsite inspection
7that the adverse event has been resolved, the department shall, not
8less than once a year, conduct an unannounced
inspection of any
9health facility that has reported an adverse event pursuant to
10Section 1279.1.
11(b) In any case in which the department is able to determine
12from the information available to it that there is no threat of
13imminent danger of death or serious bodily harm to that patient or
14other patients, the department shall complete an investigation of
15the report within 45 days.
16(c) If the department does not meet the timeframes established
17in subdivision (a), the department shall document the extenuating
18circumstances explaining why it could not meet the timeframes.
19The department shall provide written notice to the facility and the
20complainant, if any, of the basis for the extenuating circumstances
21and the anticipated completion date.
22(c)
end delete
23begin insert(d)end insert The department shall notify the complainant and licensee
24in writing of the department’s determination as a result of an
25inspection or report.
26(d)
end delete
27begin insert(e)end insert For purposes of this section, “complaint” means any oral or
28written notice to the department, other than a report from the health
29facility, of an alleged violation of applicable requirements of state
30or federal law or an allegation of facts that might constitute a
31violation of applicable requirements of state or federal law.
32(e)
end delete
33begin insert(f)end insert The costs of administering and implementing this section
34shall be paid from funds derived from existing licensing fees paid
35by general acute care hospitals, acute psychiatric hospitals, and
36special hospitals.
37(f)
end delete
38begin insert(g)end insert In enforcing this section and Sections 1279 and 1279.1, the
39department shall take into account the special circumstances of
P25 1small and rural hospitals, as defined in Section 124840, in order
2to protect the quality of patient care in those hospitals.
3(g)
end delete
4begin insert(h)end insert In preparing the staffing and systems analysis required
5pursuant to Section 1266, the department shall also report regarding
6the number and timeliness of investigations of adverse events
7initiated in response to reports of adverse events.
begin insertSection 1367.54 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
9amended to read:end insert
begin insert(a)end insertbegin insert end insert Every group health care service plan contract
11that provides maternity benefits, except for a specialized health
12care service plan contract, that is issued, amended, renewed, or
13delivered on or after January 1, 1999, and every individual health
14care service plan contract of a type and form first offered for sale
15on or after January 1, 1999, that provides maternity benefits, except
16a specialized health care service plan contract, shall provide
17coverage for participation in thebegin delete Expanded Alpha Feto Protein begin insert California Prenatal Screening Program,end insert which
18(AFP) program,end delete
19is a statewide prenatal testing program administered by the State
20Department ofbegin delete Health Services.end deletebegin insert Public Health, pursuant to Section
21124977.end insert Notwithstanding any other provision of law, a health care
22service plan that provides maternity benefits shall not require
23participation in the statewide prenatal testing program administered
24by the State Department ofbegin insert Publicend insert Healthbegin delete Servicesend delete as a prerequisite
25to eligibility for, or receipt of, any other service.
26(b) Coverage required by this section shall not be subject to
27copayment, coinsurance, deductible, or any other form of cost
28sharing.
29(c) Reimbursement for services covered pursuant to this section
30shall be paid at the amount set pursuant to Section 124977 and
31regulations adopted thereunder.
begin insertSection 1373.622 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
33amended to read:end insert
(a) (1) After the termination of the pilot program
35under Section 1373.62, a health care service plan shall continue
36to provide coverage under the same terms and conditions specified
37in Section 1376.62 as it existed on January 1, 2007, including the
38terms of the standard benefit plan and the subscriber payment
39amount, to each individual who was terminated from the program
40pursuant to subdivision (f) of Section 12725 of the Insurance Code
P26 1during the term of the pilot program and who enrolled or applied
2to enroll in a standard benefit plan within 63 days of termination.
3Thebegin delete Managed Risk Medical Insurance Boardend deletebegin insert State Department of
4Health Care Servicesend insert shall continue to pay the amount described
5in Section 1376.62 for each of those individuals. A health care
6service plan shall not be required to offer the coverage described
7in Section 1373.62 after the termination of the pilot program to
8individuals not already enrolled in the program.
9(2) Notwithstanding paragraph (1) of this subdivision or Section
101373.62 as it existed on January 1, 2007, the following rules shall
11apply:
12(A) (i) A health care service plan shall not be obligated to
13provide coverage to any individual pursuant to this section on or
14after January 1, 2014.
15(ii) Thebegin delete Managed Risk Medical Insurance Boardend deletebegin insert State
16Department of Health Care Servicesend insert shall not be obligated to
17provide any payment to any health care service plan under this
18section for (I) health care expenses incurred on or after January 1,
192014, or (II) the standard monthly administrative fee, as defined
20in Section 1373.62 as it existed on January 1, 2007, for any month
21after December 2013.
22(B) Each health care service plan providing coverage pursuant
23to this section shall, on or before October 1, 2013, send a notice
24to each individual enrolled in a standard benefit plan that is in at
25least 12-point type and with, at minimum, the following
26information:
27(i) Notice as to whether or not the plan will terminate as of
28January 1,
2014.
29(ii) The availability of individual health coverage, including
30through Covered California, including at least all of the following:
31(I) That, beginning on January 1, 2014, individuals seeking
32coverage may not be denied coverage based on health status.
33(II) That the premium rates for coverage offered by a health
34care service plan or a health insurer cannot be based on an
35individual’s health status.
36(III) That individuals obtaining coverage through Covered
37California may, depending upon income, be eligible for premium
38subsidies and cost-sharing subsidies.
P27 1(IV) That individuals seeking coverage must obtain this coverage
2during an open or special enrollment period, and a description of
3
the open and special enrollment periods that may apply.
4(C) As a condition of receiving payment for a reporting period
5pursuant to this section, a health care service plan shall provide
6thebegin delete Managed Risk Medical Insurance Boardend deletebegin insert State Department of
7Health Care Servicesend insert with a complete, final annual reconciliation
8report by the earlier of December 31, 2014, or an earlier date as
9prescribed by Section 1373.62, as it existed on January 1, 2007,
10for that reporting period. To the extent that it receives a complete,
11final reconciliation report for a reporting period by the date required
12pursuant to this subparagraph, thebegin delete Managed Risk Medical Insurance begin insert State Department of Health Care Servicesend insert shall complete
13Boardend delete
14reconciliation with the health care service plan for that reporting
15period withinbegin delete sixend deletebegin insert 18end insert monthsbegin delete ofend deletebegin insert afterend insert receiving the report.
16(b) If the state fails to expend, pursuant to this section, sufficient
17funds for the state’s contribution amount to any health care service
18plan, the health care service plan may increase the monthly
19payments that its subscribers are required to pay for any standard
20benefit plan to the amount that thebegin delete Managed Risk Medical begin insert State Department of Health Care Servicesend insert would
21Insurance Boardend delete
22charge without a state subsidy for the same plan issued to the same
23individual within the program.
24(c) begin deleteThe adoption and readoption, by the Managed Risk Medical begin insertNotwithstanding Chapter 3.5 (commencing with
25Insurance Board, end delete
26Section 11340) end insertofbegin delete regulations implementing the amendments to
27this section enacted by the legislation adding this subdivision shall
28be deemed an emergency and necessary to avoid serious harm to
29the public peace, health, safety, or general welfare for purposesend delete
30begin insert Part 1end insert ofbegin delete Sections 11346.1 and 11349.6 ofend deletebegin insert Division 3 of Title 2 ofend insert
31 the Government Code,begin delete andend delete thebegin delete Managed Risk Medical Insurance begin insert State Department of Health
32Board is hereby exempted from the requirement that it describe
33facts showing the need for immediate action and from review by
34the Office of Administrative Law.end delete
35Care Services may implement, interpret, or make specific this
36section by means of all-county letters, plan letters, plan or provider
37bulletins, or similar instructions, without taking regulatory action.end insert
begin insertSection 1420 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is amended
39to read:end insert
(a) (1) Upon receipt of a written or oral complaint, the
2state department shall assign an inspector to make a preliminary
3review of the complaint and shall notify the complainant within
4two working days of the receipt of the complaint of the name of
5the inspector. Unless the state department determines that the
6complaint is willfully intended to harass a licensee or is without
7any reasonable basis, it shall make an onsite inspection or
8investigation within 10 working days of the receipt of the
9complaint. In any case in which the complaint involves a threat of
10imminent danger of death or serious bodily harm, the state
11department shall make an onsite inspection or investigation within
1224 hours of the receipt of the complaint. In any event, the
13complainant shall be
promptly informed of the state department’s
14proposed course of action and of the opportunity to accompany
15the inspector on the inspection or investigation of the facility. Upon
16the request of either the complainant or the state department, the
17complainant or his or her representative, or both, may be allowed
18to accompany the inspector to the site of the alleged violations
19during his or her tour of the facility, unless the inspector determines
20that the privacy of any patient would be violated thereby.
21(2) When conducting an onsite inspection or investigation
22pursuant to this section, the state department shall collect and
23evaluate all available evidence and may issue a citation based
24upon, but not limited to, all of the following:
25(A) Observed conditions.
26(B) Statements of witnesses.
27(C) Facility records.
28(3) begin deleteWithin 10 working end deletebegin insert(A)end insertbegin insert end insertbegin insertForend insertbegin insert a complaint that involves a
29threat of imminent danger of death or serious bodily harm that is
30received on or after July 1, 2016, the state department shall
31complete an investigation of the complaint within 90end insert days ofbegin insert
receipt
32ofend insert thebegin insert complaint. At theend insert completion of the complaint investigation,
33the state department shall notify the complainant and licensee in
34writing of thebegin insert stateend insert department’s determination as a result of the
35inspection or investigation.
36(B) The time period described in subparagraph (A) may be
37extended up to an additional 60 days if the investigation cannot
38be completed due to extenuating circumstances. The state
39department shall document these circumstances in its final
P29 1determination and notify the facility and the complainant in writing
2of the basis for the extension and the estimated completion date.
3(4) (A) For a complaint that does not involve a threat of
4imminent danger of death or serious bodily harm pursuant to
5paragraph (3) and that is received on or after July 1, 2017, and
6prior to July 1, 2018, the state department shall complete an
7investigation of the complaint within 90 days of receipt of the
8complaint. At the completion of the complaint investigation, the
9state department shall notify the complainant and licensee in
10writing of the state department’s determination as a result of the
11inspection or investigation.
12(B) The time period described in subparagraph (A) may be
13extended up to an additional 90 days if the investigation cannot
14be completed due to extenuating circumstances. The state
15department shall document these circumstances in its
final
16determination and notify the facility and the complainant in writing
17of the basis for the extension and the estimated completion date.
18(5) (A) For a complaint that is received on or after July 1, 2018,
19the state department shall complete an investigation of the
20complaint within 60 days of receipt of the complaint. At the
21completion of the complaint investigation, the state department
22shall notify the complainant and licensee in writing of the state
23department’s determination as a result of the inspection or
24investigation.
25(B) The time period described in subparagraph (A) may be
26extended up to an additional 60 days if the investigation cannot
27
be completed due to extenuating circumstances. The state
28department shall document these circumstances in its final
29determination and notify the facility and the complainant in writing
30of the basis for the extension and the estimated completion date.
31(b) Upon being notified of the state department’s determination
32as a result of the inspection or investigation, a complainant who
33is dissatisfied with the state department’s determination, regarding
34a matter which would pose a threat to the health, safety, security,
35welfare, or rights of a resident, shall be notified by the state
36department of the right to an informal conference, as set forth in
37this section. The complainant may, within five business days after
38receipt of the notice, notify the director in writing of his or her
39request for an informal conference. The informal conference shall
40be held with the designee of the director for the county in which
P30 1the long-term
health care facility which is the subject of the
2complaint is located. The long-term health care facility may
3participate as a party in this informal conference. The director’s
4designee shall notify the complainant and licensee of his or her
5determination within 10 working days after the informal conference
6and shall apprise the complainant and licensee in writing of the
7appeal rights provided in subdivision (c).
8(c) If the complainant is dissatisfied with the determination of
9the director’s designee in the county in which the facility is located,
10the complainant may, within 15 days after receipt of this
11determination, notify in writing the Deputy Director of the
12Licensing and Certification Division of the state department, who
13shall assign the request to a representative of the Complainant
14Appeals Unit for review of the facts that led to both determinations.
15As a part of the Complainant Appeals Unit’s independent
16investigation, and at the
request of the complainant, the
17representative shall interview the complainant in the district office
18where the complaint was initially referred. Based upon this review,
19the Deputy Director of the Licensing and Certification Division
20of the state department shall make his or her own determination
21and notify the complainant and the facility within 30 days.
22(d) Any citation issued as a result of a conference or review
23provided for in subdivision (b) or (c) shall be issued and served
24upon the facility withinbegin delete three workingend deletebegin insert 30end insert days of the final
25begin delete determination, unless the licensee agrees in writing to an extension begin insert determination.end insert Service shall be effected either
26of this time.end delete
27personally or by registered or certified mail. A copy of the citation
28shall also be sent to each complainant by registered or certified
29mail.
30(e) A miniexit conference shall be held with the administrator
31or his or her representative upon leaving the facility at the
32completion of the investigation to inform him or her of the status
33of the investigation. Thebegin insert stateend insert department shall also state the items
34of noncompliance and compliance found as a result of a complaint
35and those items found to be in compliance, provided the disclosure
36maintains the
anonymity of the complainant. In any matter in which
37there is a reasonable probability that the identity of the complainant
38will not remain anonymous, the state department shall also notify
39the facility that it is unlawful to discriminate or seek retaliation
40against a resident, employee, or complainant.
P31 1(f) Any citation issued as a result of the complaint investigation
2provided for in paragraph (3), (4), or (5) of subdivision (a), and
3in compliance with Section 1423, shall be issued and served upon
4the facility within 30 days of the completion of the complaint
5investigation.
6(f)
end delete
7begin insert(g)end insert For purposes of this section, “complaint” means any oral or
8written notice to the state department, other than a report from the
9facility of an alleged violation of applicable requirements of state
10or federal law or any alleged facts that might constitute such a
11violation.
12(h) Nothing in this section shall be interpreted to diminish the
13state department’s authority and obligation to investigate any
14alleged violation of applicable requirements of state or federal
15law, or any alleged facts that might constitute a violation of
16applicable requirements of
state or federal law, and to enforce
17applicable requirements of law.
begin insertSection 1423 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
19amended to read:end insert
(a) If upon inspection or investigation the director
21determines that any nursing facility is in violation of any state or
22federal law or regulation relating to the operation or maintenance
23of the facility, or determines that any other long-term health care
24facility is in violation of any statutory provision or regulation
25relating to the operation or maintenance of the facility, the director
26shall promptly, but not later than 24 hours, excluding Saturday,
27Sunday, and holidays, after the director determines or has
28reasonable cause to determine that an alleged violation has
29occurred, issue a notice to correct the violation and of intent to
30issue a citation to the licensee. Before completing the investigation
31and making thebegin insert finalend insert
determination whether to issue a citation, the
32department shall hold an exit conference with the licensee to
33identify the potential for issuing a citation for any violation, discuss
34investigative findings, and allow the licensee to provide the
35department with additional information related to the violation.
36The department shall consider this additional information, in
37conjunction with information from the inspection or investigation,
38in determining whether to issue a citation, or whether other action
39would be appropriate. If the department determines that the
P32 1violation warrants the issuing of a citation and an exit conference
2has been completed it shall either:
3(1) Recommend the imposition of a federal enforcement remedy
4or remedies on a nursing facility in accordance with federal law;
5or
6(2) Issue a citation pursuant to state licensing laws, and if the
7facility is a
nursing facility, may recommend the imposition of a
8federal enforcement remedy.
9A state citation shall be served upon the licensee withinbegin delete threeend delete
10begin insert 30end insert days after completion of thebegin delete investigation, excluding Saturday, begin insert investigation.end insert Service shall be effected either
11Sunday, and holidays, unless the licensee agrees in writing to an
12extension of time.end delete
13personally or by registered or certified mail. A copy of the citation
14shall also be sent to each complainant. Each citation shall be in
15writing and shall describe with particularity the nature of the
16violation, including a reference to the statutory provision, standard,
17rule, or regulation alleged to have been violated, the particular
18place or area of the facility in which it occurred, as well as the
19amount of any proposed assessment of a civil penalty. The name
20of any patient jeopardized by the alleged violation shall not be
21specified in the citation in order to protect the privacy of the
22patient. However, at the time the licensee is served with the
23citation, the licensee shall also
be served with a written list of each
24of the names of the patients alleged to have been jeopardized by
25the violation, that shall not be subject to disclosure as a public
26record. The citation shall fix the earliest feasible time for the
27elimination of the condition constituting the alleged violation,
28when appropriate.
29(b) Where no harm to patients, residents, or guests has occurred,
30a single incident, event, or occurrence shall result in no more than
31one citation for each statute or regulation violated.
32(c) No citation shall be issued for a violation that has been
33reported by the licensee to the state department, or its designee,
34as an “unusual occurrence,” if all of the following conditions are
35met:
36(1) The violation has not caused harm to any patient, resident,
37or guest, or significantly contributed thereto.
38(2) The licensee has promptly taken reasonable measures to
39correct the violation and to prevent a recurrence.
P33 1(3) The unusual occurrence report was the first source of
2information reported to the state department, or its designee,
3regarding the violation.
begin insertSection 104150 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
5amended to read:end insert
(a) begin insert(1)end insertbegin insert end insert A provider or entity that participates in the
7grant made to the department by the federal Centers for Disease
8Control and Prevention breast and cervical cancer early detection
9program established under Title XV of the federal Public Health
10Service Act (42 U.S.C. Sec. 300k et seq.) in accordance with
11requirements of Section 1504 of that act (42 U.S.C. Sec. 300n)
12may only render screening services under the grant to an individual
13if the provider or entity determines that the individual’s family
14income does not exceed 200 percent of the federal poverty level.
15(2) Providers, or the enrolling entity, shall make available to
16all applicants and beneficiaries prior to, or concurrent with
17enrollment, information on the manner in which to apply for
18insurance affordability programs, in a manner determined by the
19State Department of Health Care Services. The information shall
20include the manner in which applications can be submitted for
21insurance affordability programs, information about the open
22enrollment periods for the California Health Benefit Exchange,
23and the continuous enrollment aspect of the Medi-Cal program.
24(b) The department shall provide for breast cancer and cervical
25cancer screening services under the grant at the level of funding
26budgeted from state and other resources during the fiscal year in
27which the Legislature has appropriated funds to the department
28for this purpose. These screening services shall
not be deemed to
29be an entitlement.
30(c) To implement the federal breast and cervical cancer early
31detection program specified in this section, the department may
32contract, to the extent permitted by Section 19130 of the
33Government Code, with public and private entities, or utilize
34existing health care service provider enrollment and payment
35mechanisms, including the Medi-Cal program’s fiscal intermediary.
36However, the Medi-Cal program’s fiscal intermediary shall only
37be utilized if services provided under the program are specifically
38identified and reimbursed in a manner that does not claim federal
39financial reimbursement. Any contracts with, and the utilization
40of, the Medi-Cal program’s fiscal intermediary shall not be subject
P34 1to Chapter 3 (commencing with Section 12100) of Part 2 of
2Division 2 of the Public Contract Code. Contracts to implement
3the federal breast and cervical cancer early detection program
4entered into by the department with
entities other than the Medi-Cal
5program’s fiscal intermediary shall not be subject to Part 2
6(commencing with Section 10100) of Division 2 of the Public
7Contract Code.
8(d) The department shall enter into an interagency agreement
9with the State Department of Health Care Services to transfer that
10portion of the grant made to the department by the federal Centers
11for Disease Control and Prevention breast and cervical cancer early
12detection program established under Title XV of the federal Public
13Health Service Act (42 U.S.C. Sec. 300k et seq.) to the State
14Department of Health Care Services. The department shall have
15no other liability to the State Department of Health Care Services
16under this article.
begin insertSection 104322 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
18amended to read:end insert
(a) (1) The State Department of Health Care Services
20shall develop and implement a program to provide quality prostate
21cancer treatment for low-income and uninsured men.
22(2) The State Department of Health Care Services shall award
23one or more contracts to provide prostate cancer treatment through
24private or public nonprofit organizations, including, but not limited
25to, community-based organizations, local health care providers,
26the University of California medical centers, and the Charles R.
27Drew University of Medicine and Science, an affiliate of the David
28Geffen School of Medicine at the University of California at Los
29Angeles. Contracts awarded, subsequent to the effective date of
30the amendments to this section made during the 2005 portion
of
31the 2005-06 Regular Session, pursuant to this paragraph shall be
32consistent with both of the following:
33(A) Eighty-seven percent of the total contract funding shall be
34used for direct patient care.
35(B) No less than 70 percent of the total contract funding shall
36be expended on direct patient care treatment costs, which shall be
37defined as funding to fee-for-service providers for Medi-Cal
38eligible services.
39(3) The contracts described in paragraph (2) shall not be subject
40to Part 2 (commencing with Section 10100) of Division 2 of the
P35 1Public Contract Code. Commencing July 1, 2006, those contracts
2shall be entered into on a competitive bid basis.
3(4) It is the intent of the Legislature to support the prostate
4cancer treatment program provided for
pursuant to this section,
5and that the program be cost-effective and maximize the number
6of men served for the amount of funds appropriated. It is further
7the intent of the Legislature to ensure that the program has an
8adequate health care provider network to facilitate reasonable
9access to treatment.
10(b) begin insert(1)end insertbegin insert end insert Treatment provided under this chapter shall be provided
11to uninsured and underinsured men with incomes at or below 200
12percent of the federal poverty level.begin delete Covered services shall be
13limited to prostate cancer treatment and prostate cancer-related
14services. Eligible men shall be enrolled in a 12-month treatment
15regimen.end delete
16(2) The enrolling entity shall make available to all applicants
17and beneficiaries prior to, or concurrent with enrollment,
18information on the manner in which to apply for insurance
19affordability programs, in a manner determined by the State
20Department of Health Care Services. The information provided
21shall include the manner in which applications can be submitted
22for insurance affordability programs, information about the open
23enrollment periods for the California Health Benefit Exchange,
24and the continuous enrollment aspect of the Medi-Cal program.
25(3) Covered services shall be limited to prostate cancer
26treatment and prostate cancer-related services. Eligible men shall
27be enrolled in a 12-month treatment regimen.
28(c) The State Department of Health Care Services shall contract
29for prostate cancer treatment services only at the level of funding
30budgeted from state and other sources during a fiscal year in which
31the Legislature has appropriated funds to the department for this
32purpose.
33(d) Notwithstanding subdivision (a) of Section 2.00 of the
34Budget Act of 2003 and any other provision of law, commencing
35with the 2003-04 fiscal year and for each fiscal year thereafter,
36any amount appropriated to the State Department of Health Care
37Services for the prostate cancer treatment program implemented
38pursuant to this chapter shall be made
available, for purposes of
39that program, for encumbrance for one fiscal year beyond the year
P36 1of appropriation and for expenditure for two fiscal years beyond
2the year of encumbrance.
begin insertSection 110050 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
4amended to read:end insert
The Food Safety Fund is hereby created as a special
6fund in the State Treasury. All moneys collected by the department
7under subdivision (c) of Section 110466 and Sections 110470,
8110471, 110485, 114365, 114365.6, 111130, and 113717, and
9under Article 7 (commencing with Section 110810) of Chapter 5
10begin insert or awarded to the department pursuant to court orders or
11settlements for the use of food safety-related activities,end insert shall be
12deposited in the fund, for use by the department, upon appropriation
13by the Legislature, for the purposes of providing funds necessary
14to carry out and implement the inspection provisions of this part
15relating to food, licensing, inspection, enforcement, and other
16provisions of Article 12 (commencing with Section 111070)begin insert
of
17Chapter 5,end insert relating to water, the provisions relating to education
18and training in the prevention of microbial contamination pursuant
19to Section 110485, and the registration provisions of Article 7
20(commencing with Section 110810) of Chapter 5, and to carry out
21and implement the provisions of the California Retail Food Code
22(Part 7 (commencing with Section 113700) of Division 104).
begin insertSection 120780.2 is added to the end insertbegin insertHealth and Safety
24Codeend insertbegin insert, to read:end insert
In order to reduce the spread of HIV, hepatitis C,
26and other potentially deadly blood-borne pathogens, the State
27Department of Public Health may purchase sterile hypodermic
28needles and syringes, and other supplies, for distribution to syringe
29exchange programs authorized pursuant to law. Supplies provided
30to programs, including those administered by local health
31departments, are not subject to the formulas and limits of Section
32120780.1.
begin insertSection 120960 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
34amended to read:end insert
(a) The department shall establish uniform standards
36of financial eligibility for the drugs under the program established
37under this chapter.
38(b) Nothing in the financial eligibility standards shall prohibit
39drugs to an otherwise eligible person whosebegin insert modifiedend insert adjusted
40gross income does not exceedbegin delete fifty thousand dollars ($50,000)end deletebegin insert 500
P37 1percent of the federal poverty levelend insert perbegin delete year.end deletebegin insert year based on family
2size and household income.end insert However, the director may authorize
3drugs for persons with incomes higher thanbegin delete fifty thousand dollars begin insert 500 percent of the federal poverty levelend insert per yearbegin insert based
4($50,000)end delete
5on family size and household incomeend insert if the estimated cost of those
6drugs in one year is expected to exceed 20 percent of the person’s
7begin insert modifiedend insert adjusted gross income.
8(c) The department shall establish and may administer a payment
9schedule to determine the payment obligation of a person receiving
10drugs. No person shall be obligated for payment whosebegin insert modifiedend insert
11 adjusted gross income
is less than four times the federal poverty
12begin delete level.end deletebegin insert level based on family size and household income.end insert The
13payment obligation shall be the lesser of the following:
14(1) Two times the person’s annual state income tax liability,
15less funds expended by the person for health insurance premiums.
16(2) The cost of drugs.
17(d) Persons who have been determined to have a payment
18obligation pursuant to subdivision (c) shall be advised by the
19department of their right to request a reconsideration of that
20determination to the department. Written notice of the right to
21request a reconsideration shall be provided to the person at the
22time that notification is given that he or she is subject to a payment
23obligation. The
payment determination shall be reconsidered if
24one or more of the following apply:
25(1) The determination was based on an incorrect calculation
26made pursuant to subdivision (b).
27(2) There has been a substantial change in income since the
28previous eligibility determination that has resulted in a current
29income that is inadequate to meet the calculated payment
30obligation.
31(3) Unavoidable family or medical expenses that reduce the
32disposable income and that result in current income that is
33inadequate to meet the payment obligation.
34(4) Any other situation that imposes undue financial hardship
35on the person and would restrict his or her ability to meet the
36payment obligation.
37(e) The department
may exempt a person, who has been
38determined to have a payment obligation pursuant to subdivision
39(c), from the obligation if both of the following criteria are
40satisfied:
P38 1(1) One or more of the circumstances specified in subdivision
2(d) exist.
3(2) The department has determined that the payment obligation
4will impose an undue financial hardship on the person.
5(f) If a person requests reconsideration of the payment obligation
6determination, the person shall not be obligated to make any
7payment until the department has completed the reconsideration
8request pursuant to subdivision (d). If the department denies the
9exemption, the person shall be obligated to make payments for
10drugs received while the reconsideration request is pending.
11(g) A county public
health department administering this
12program pursuant to an agreement with the director pursuant to
13subdivision (b) of Section 120955 shall use no more than 5 percent
14of total payments it collects pursuant to this section to cover any
15administrative costs related to eligibility determinations, reporting
16requirements, and the collection of payments.
17(h) A county public health department administering this
18program pursuant to subdivision (b) of Section 120955 shall
19provide all drugs added to the program pursuant to subdivision (a)
20of Section 120955 within 60 days of the action of the director,
21subject to the repayment obligations specified in subdivision (d)
22of Section 120965.
23(i) For purposes of this section, the following terms shall have
24the following meanings:
25(1) “Family size” has the meaning given to that term in Section
2636B(d)(1) of the Internal Revenue Code of 1986, and shall include
27same or opposite sex married couples, registered domestic
28partners, and any tax dependents, as defined by Section 152 of the
29Internal Revenue Code of 1986, of either spouse or registered
30domestic partner.
31(2) “Federal poverty level” refers to the poverty guidelines
32updated periodically in the Federal Register by the United States
33Department of Health and Human Services under the authority of
34Section 9902(2) of Title 42 of the United States Code.
35(3) “Household income” means the
sum of the applicant’s or
36recipient’s modified adjusted gross income, plus the modified
37adjusted gross income of the applicant’s or recipient’s spouse or
38registered domestic partner, and the modified adjusted gross
39incomes of all other individuals for whom the applicant or
40recipient, or the applicant’s or recipient’s spouse or registered
P39 1domestic partner, is allowed a federal income tax deduction for
2the taxable year.
3(4) “Internal Revenue Code of 1986” means Title 26 of the
4United States Code, including all amendments enacted to that
5code.
6(5) “Modified adjusted gross income” has the meaning given
7to that term in Section 36B(d)(2)(B) of the Internal Revenue Code
8of
1986.
begin insertSection 120962 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
10amended to read:end insert
(a) (1) For the purpose of verifying financial
12eligibility pursuant to Section 120960 and the federal Ryan White
13HIV/AIDS Treatment Extension Act of 2009 (42 U.S.C. Sec. 201
14et seq.), the department shall verify the accuracy of the adjusted
15gross income reported on an AIDS Drug Assistance Program
16application submitted by an applicant or recipient with data, if
17available, from the Franchise Tax Board.
18(2) Notwithstanding any other law, the department shall disclose
19the name and individual taxpayer identification number (ITIN) or
20social security number of an applicant for, or recipient of, services
21under this chapter to the Franchise Tax Board for the purpose of
22verifying the adjusted gross incomebegin insert
of, any tax-exempt interest
23received by, any tax-exempt social security benefits received by,
24and any foreign earned incomeend insert of an applicant or recipient pursuant
25to subdivision (b) of Section 120960.
26(b) (1) The Franchise Tax Board, upon receipt of this
27information, shall inform the department of all of the following:
28(A) The amount of the federal adjusted gross income as reported
29by the taxpayer to the Franchise Tax Board.
30(B) The amount of the California
adjusted gross income as
31reported by the taxpayer to the Franchise Tax Board or as adjusted
32by the Franchise Tax Board.
33(C) The amount of any tax-exempt interest received by the
34taxpayer, as reported to the Franchise Tax Board.
35(D) The amount of any tax-exempt social security benefits
36received by the taxpayer, as reported to the Franchise Tax Board.
37(E) The amount of any foreign earned income of the taxpayer,
38as reported to the Franchise Tax Board.
39(b)
end delete
P40 1begin insert(2)end insert The Franchise Taxbegin delete Board, upon receipt of this information, Board
2shall inform the department of the amount of the federal adjusted
3gross income as reported by the taxpayer to the Franchise Tax
4Board, and the California adjusted gross income as reported by
5the taxpayer to the Franchise Taxend deletebegin delete or as adjusted by the shall provide the
6Franchise Tax Board. The Franchise Tax Boardend delete
7information to the department for the most recent taxable year that
8the Franchise Tax Board has information available, and shall
9include the first and last name, date of birth, and the ITIN or social
10security number of the taxpayer.
11(c) (1) Information provided by the department pursuant to this
12section shall constitute confidential public health records as defined
13in Section 121035, and shall remain subject to the confidentiality
14protections and restrictions on further disclosure by the recipient
15under subdivisions (d) and (e) of Section 121025.
16(2) To the extent possible, verification of financial eligibility
17shall be done in a way to eliminate or minimize, by use of computer
18programs or other electronic means,
Franchise Tax Board staff
19and contractors’ access to confidential public health records.
20(3) Prior to accessing confidential HIV-related public health
21records, Franchise Tax Board staff and contractors shall be required
22to annually sign a confidentiality agreement developed by the
23department that includes information related to the penalties under
24Section 121025 for a breach of confidentiality and the procedures
25for reporting a breach of confidentiality under subdivision (h) of
26Section 121022. Those agreements shall be reviewed annually by
27the department.
28(4) The Franchise Tax Board shall return or destroy all
29information received from the department after completing the
30exchange of information.
31(d) For purposes of this section,
“foreign earned income” also
32includes any deduction taken for the housing expenses of an
33individual while living abroad pursuant to Section 911 of Title 26
34of the Internal Revenue Code.
begin insertThe heading of Chapter 17 (commencing with Section
36121348) of Part 4 of Division 105 of the end insertbegin insertHealth and Safety Codeend insert
37begin insert is amended to read:end insert
38
begin insertSection 121348.4 is added to the end insertbegin insertHealth and Safety
2Codeend insertbegin insert, to read:end insert
Upon an appropriation in the annual Budget Act,
4the State Department of Public Health shall establish the
5Pre-Exposure Prophylaxis (PrEP) Navigator Services Program,
6under which the department shall provide for the following
7activities:
8(a) Oversight and evaluation of the PrEP Navigator Services
9Program.
10(b) Implementation of a process to request applications, and
11award funding on a competitive basis, to community-based
12organizations or local health departments. An eligible entity shall
13collaborate with the Office of AIDS to conduct outcome and
14process evaluation of navigator services. An entity in any county
15shall be eligible to receive funding if it can demonstrate all of the
16following:
17(1) Capacity to ensure access for and serve the most vulnerable
18and underserved Californians at high risk for HIV.
19(2) Ability to develop protocols to conduct outreach to targeted
20populations, to provide PrEP education to clients and providers,
21and to assess and refer persons to appropriate clinical care and
22prevention services.
23(c) Development and distribution of PrEP education materials
24statewide, including providing training for and support of any
25additional activity that is consistent with the goals of this chapter.
begin insertSection 122425 is added to the end insertbegin insertHealth and Safety
27Codeend insertbegin insert, to read:end insert
There is hereby established a three-year Hepatitis C
29Linkage to Care demonstration pilot project to allow for innovative,
30evidence-based approaches to provide outreach, hepatitis C
31screening, and linkage to, and retention in, quality health care for
32the most vulnerable and underserved individuals living with, or
33at high risk for, hepatitis C viral infection (HCV). This
34demonstration pilot project is authorized for fiscal years 2015-16,
352016-17, and 2017-18.
begin insertSection 122430 is added to the end insertbegin insertHealth and Safety
37Codeend insertbegin insert, to read:end insert
(a) Upon an appropriation for the purpose described
39in Section 122425 in the annual Budget Act for the 2015-16,
402016-17, and 2017-18 fiscal years, the department shall award
P42 1funding, on a competitive basis, to community-based organizations
2or local health jurisdictions to operate demonstration pilot projects
3pursuant to this chapter. The department shall determine the
4funding levels of each demonstration project based on scope and
5geographic area. Funds may be used to support other activities
6consistent with the goals of this chapter, including the purchase
7of hepatitis C viral infection (HCV) test kits, syringe exchange
8supplies, or other HCV prevention and linkage to care materials
9and activities.
10(b) An applicant for funding shall demonstrate
each of the
11following qualifications:
12(1) Leadership on access to HCV care and testing issues and
13experience addressing the needs of highly marginalized populations
14in accessing medical care and support.
15(2) Experience with the target population or relationships with
16community-based organizations or nongovernmental organizations,
17or both, that demonstrates expertise, history, and credibility
18working successfully in engaging the target population.
19(3) Experience working with nontraditional collaborators who
20work within and beyond the field of HCV education and outreach,
21including homeless services, veterans medical and service
22programs, substance use disorders treatment, syringe exchange
23programs, women’s health, reproductive health, immigration,
24mental health, or human immunodeficiency virus (HIV) prevention
25and
treatment.
26(4) Strong relationships with community-based HCV health
27care providers that have the trust of the targeted population.
28(5) Strong relationships with the state and local health
29departments.
30(6) Capacity to coordinate a communitywide planning phase
31involving multiple community collaborators.
32(7) Experience implementing evidence-based programs or
33generating innovative strategies, or both, with at least preliminary
34evidence of program effectiveness.
35(8) Administrative systems and accountability mechanisms for
36grant management.
37(9) Capacity to participate in evaluation activities.
38(10) Strong communication systems that are in place to
39participate in public relations activities.
begin insertSection 122435 is added to the end insertbegin insertHealth and Safety
2Codeend insertbegin insert, to read:end insert
During the demonstration pilot project described in
4Section 122425, each demonstration pilot project shall prepare
5and disseminate information regarding best practices for, and the
6lessons learned regarding, providing outreach and education to
7the most vulnerable and underserved individuals living with
8hepatitis C viral infection (HCV) or at a high risk for HCV
9infection, for use by providers, the State Department of Public
10Health, including the Office of AIDS and the Office of Viral
11Hepatitis Prevention, federal departments and agencies, including
12the federal Department of Health and Human Services, and other
13national HIV/AIDS and viral hepatitis groups.
begin insertSection 124040 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
15amended to read:end insert
(a) The governing body of each county or counties
17shall establish a community child health and disability prevention
18program for the purpose of providing early and periodic
19assessments of the health status of children in the county or
20counties by July 1, 1974. However, this shall be the responsibility
21of the department for all counties that contract with the state for
22health services. Contract counties, at the option of the board of
23supervisors, may provide services pursuant to this article in the
24same manner as other county programs,begin delete providedend deletebegin insert ifend insert the option is
25exercised prior to the beginning of each fiscal year. Each plan shall
26include, but is not limited to, the following requirements:
27(1) Outreach and educational services.
28(2) Agreements with public and private facilities and
29practitioners to carry out the programs.
30(3) Health screening and evaluation services for allbegin delete childrenend delete
31begin insert children,end insert including a physical examination, immunizations
32appropriate for the child’s age and health history, and laboratory
33procedures appropriate for the child’s age and population group
34performed by, or under the supervision or responsibility of, a
35physician licensed to practice medicine in California or by a
36certified family nurse practitioner or a certified pediatric nurse
37practitioner.
38(4) Referral for diagnosis or treatment when needed, including,
39for all children eligible for Medi-Cal, referral for treatment by a
P44 1provider participating in the Medi-Cal program of the conditions
2detected, and methods for assuring referral is carried out.
3(5) Recordkeeping and program evaluations.
4(6) The health screening and evaluation part of each community
5child health and disability prevention program plan shall include,
6but is not limited to, the following for each child:
7(A) A health and development history.
8(B) An assessment of physical growth.
9(C) An examination for obvious physical defects.
10(D) Ear, nose, mouth, and throat inspection, including inspection
11of teeth and gums, and for all childrenbegin delete three yearsend deletebegin insert one yearend insert of age
12and older who are eligible for Medi-Cal, referral to a dentist
13participating in the Medi-Cal program.
14(E) Screening tests for vision, hearing, anemia, tuberculosis,
15diabetes, and urinary tract conditions.
16(7) An assessment of nutritional status.
17(8) An assessment of immunization status.
18(9) begin deleteWhere end deletebegin insertIfend insertappropriate, testing for sickle-cell trait, lead
19poisoning, and other tests that
may be necessary to the
20identification of children with potential disabilities requiring
21diagnosis and possibly treatment.
22(10) For all children eligible for Medi-Cal, necessary assistance
23with scheduling appointments for services and with transportation.
24(b) Dentists receiving referrals of children eligible for Medi-Cal
25under this section shall employ procedures to advise the child’s
26parent or parents of the need for and scheduling of annual
27appointments.
28(c) Standards for procedures to carry out health screening and
29evaluation services and to establish the age at which particular
30tests should be carried out shall be established by the director. At
31the discretion of the department, these health screening and
32evaluation services may be provided at the frequency provided
33under the Healthy Families Program and
permitted in managed
34care plans providing services under the Medi-Cal program, and
35shall be contingent upon appropriation in the annual Budget Act.
36Immunizations may be provided at the frequency recommended
37by the Committee on Infectious Disease of the American Academy
38of Pediatrics and the Advisory Committee on Immunization
39Practices of the Centers for Disease Control and Prevention.
P45 1(d) Each community child health and disability prevention
2program shall, pursuant to standards set by the director, establish
3a record system that contains a health case history for each child
4so that costly and unnecessary repetition of screening,
5immunization and referral will not occur and appropriate health
6treatment will be facilitated as specified in Section 124085.
begin insertSection 124977 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
8amended to read:end insert
(a) It is the intent of the Legislature that, unless
10otherwise specified, the genetic disease testing program carried
11out pursuant to this chapter be fully supported from fees collected
12for services provided by the program.
13(b) (1) The department shall charge a fee to all payers for any
14tests or activities performed pursuant to this chapter. The amount
15of the fee shall be established by regulation and periodically
16adjusted by the director in order to meet the costs of this chapter.
17Notwithstanding any other law, any fees charged for prenatal
18screening and followup services provided to persons enrolled in
19the Medi-Cal program, health care service plan enrollees, or
20persons covered by health insurance policies, shall be paid in full
21and
deposited in the Genetic Disease Testing Fund or the Birth
22Defects Monitoringbegin insert Programend insert Fund consistent with thisbegin delete section, begin insert section.end insert
23subject to all terms and conditions of each enrollee’s or insured’s
24health care service plan or insurance coverage, whichever is
25applicable, including, but not limited to, copayments and
26deductibles applicable to these services, and only if these
27copayments, deductibles, or limitations are disclosed to the
28subscriber or enrollee pursuant to the disclosure provisions of
29Section 1363.end delete
30(2) The department shall expeditiously undertake all steps
31necessary to implement the fee collection process, including
32personnel, contracts, and data processing, so as to initiate the fee
33collection process at the earliest opportunity.
34(3) Effective for services provided on and after July 1, 2002,
35the department shall
charge a fee to the hospital of birth, or, for
36births not occurring in a hospital, to families of the newborn, for
37newborn screening and followup services. The hospital of birth
38and families of newborns born outside the hospital shall make
39payment in full to the Genetic Disease Testing Fund. The
P46 1department shall not charge or bill Medi-Cal beneficiaries for
2services provided under this chapter.
3(4) (A) The department shall charge a fee for prenatal screening
4to support the pregnancy blood sample storage, testing, and
5research activities of the Birth Defects Monitoring Program.
6(B) The prenatal screening fee for activities of the Birth Defects
7Monitoring Program shall be ten dollars ($10).
8(5) The department shall set guidelines for invoicing, charging,
9and collecting from approved researchers
the amount necessary
10to cover all expenses associated with research application requests
11made under this section, data linkage, retrieval, data processing,
12data entry, reinventory, and shipping of blood samples or their
13components, and related data management.
14(6) The only funds from the Genetic Disease Testing Fund that
15may be used for the purpose of supporting the pregnancy blood
16sample storage, testing, and research activities of the Birth Defects
17Monitoring Program are those prenatal screening fees assessed
18and collected prior to the creation of the Birth Defects Monitoring
19Program Fund specifically to support those Birth Defects
20Monitoring Program activities.
21(7) The Birth Defects Monitoring Program Fund is hereby
22created as a special fund in the State Treasury. Fee revenues that
23are collected pursuant to paragraph (4) shall be deposited into the
24fund and shall be available
upon appropriation by the Legislature
25to support the pregnancy blood sample storage, testing, and
26research activities of the Birth Defects Monitoring Program.
27Notwithstanding Section 16305.7 of the Government Code, interest
28earned on funds in the Birth Defects Monitoring Program Fund
29shall be deposited as revenue into the fund to support the Birth
30Defects Monitoring Program.
31(c) (1) The Legislature finds that timely implementation of
32changes in genetic screening programs and continuous maintenance
33of quality statewide services requires expeditious regulatory and
34administrative procedures to obtain the most cost-effective
35electronic data processing, hardware, software services, testing
36equipment, and testing and followup services.
37(2) The expenditure of funds from the Genetic Disease Testing
38Fund for these purposes shall not be subject to Section 12102 of,
39and
Chapter 2 (commencing with Section 10290) of Part 2 of
40Division 2 of, the Public Contract Code, or to Division 25.2
P47 1(commencing with Section 38070). The department shall provide
2the Department of Finance with documentation that equipment
3and services have been obtained at the lowest cost consistent with
4technical requirements for a comprehensive high-quality program.
5(3) The expenditure of funds from the Genetic Disease Testing
6Fund for implementation of the Tandem Mass Spectrometry
7screening for fatty acid oxidation, amino acid, and organic acid
8disorders, and screening for congenital adrenal hyperplasia may
9be implemented through the amendment of the Genetic Disease
10Branch Screening Information System contracts and shall not be
11subject to Chapter 3 (commencing with Section 12100) of Part 2
12of Division 2 of the Public Contract Code, Article 4 (commencing
13with Section 19130) of Chapter 5 of Part 2 of Division 5 of Title
142 of the Government
Code, and any policies, procedures,
15regulations, or manuals authorized by those laws.
16(4) The expenditure of funds from the Genetic Disease Testing
17Fund for the expansion of the Genetic Disease Branch Screening
18Information System to include cystic fibrosis, biotinidase, severe
19combined immunodeficiency (SCID), and adrenoleukodystrophy
20(ALD) may be implemented through the amendment of the Genetic
21Disease Branch Screening Information System contracts, and shall
22not be subject to Chapter 2 (commencing with Section 10290) or
23Chapter 3 (commencing with Section 12100) of Part 2 of Division
242 of the Public Contract Code, Article 4 (commencing with Section
2519130) of Chapter 5 of Part 2 of Division 5 of Title 2 of the
26Government Code, or Sections 4800 to 5180, inclusive, of the
27State Administrative Manual as they relate to approval of
28information technology projects or approval of increases in the
29duration or costs of information technology projects.
This
30paragraph shall apply to the design, development, and
31implementation of the expansion, and to the maintenance and
32operation of the Genetic Disease Branch Screening Information
33System, including change requests, once the expansion is
34implemented.
35(d) (1) The department may adopt emergency regulations to
36implement and make specific this chapter in accordance with
37Chapter 3.5 (commencing with Section 11340) of Part 1 of Division
383 of Title 2 of the Government Code. For the purposes of the
39Administrative Procedure Act, the adoption of regulations shall
40be deemed an emergency and necessary for the immediate
P48 1preservation of the public peace, health and safety, or general
2welfare. Notwithstanding Chapter 3.5 (commencing with Section
311340) of Part 1 of Division 3 of Title 2 of the Government Code,
4these emergency regulations shall not be subject to the review and
5approval of the Office of Administrative Law. Notwithstanding
6
Sections 11346.1 and 11349.6 of the Government Code, the
7department shall submit these regulations directly to the Secretary
8of State for filing. The regulations shall become effective
9immediately upon filing by the Secretary of State. Regulations
10shall be subject to public hearing within 120 days of filing with
11the Secretary of State and shall comply with Sections 11346.8 and
1211346.9 of the Government Code or shall be repealed.
13(2) The Office of Administrative Law shall provide for the
14printing and publication of these regulations in the California Code
15of Regulations. Notwithstanding Chapter 3.5 (commencing with
16Section 11340) of Part 1 of Division 3 of Title 2 of the Government
17Code, the regulations adopted pursuant to this chapter shall not be
18repealed by the Office of Administrative Law and shall remain in
19effect until revised or repealed by the department.
20(3) The
Legislature finds and declares that the health and safety
21of California newborns is in part dependent on an effective and
22adequately staffed genetic disease program, the cost of which shall
23be supported by the fees generated by the program.
begin insertSection 10123.184 of the end insertbegin insertInsurance Codeend insertbegin insert is amended
25to read:end insert
begin insert(a)end insertbegin insert end insert Every group policy of disability insurance that
27covers hospital, medical, or surgical expenses, and that provides
28maternity benefits, that is issued, amended, renewed, or delivered
29on or after January 1, 1999, and every individual policy of
30disability insurance that covers hospital, medical, or surgical
31expenses, and that provides maternity benefits, that is of a type
32and form first offered for sale on or after January 1, 1999, shall
33provide coverage for participation in thebegin delete Expanded Alpha Feto begin insert California Prenatal Screening Program,end insert
34Protein (AFP) program,end delete
35 which is a statewide prenatal testing program administered by the
36State Department ofbegin insert Public Health, pursuant to Section 124977
37of theend insert Healthbegin delete Services.end deletebegin insert and Safety Code.end insert Notwithstanding any other
38provision of law, a disability insurer that provides coverage for
39maternity benefits shall not require participation in the statewide
40prenatal testing program administered by the State Department of
P49 1begin insert Publicend insert Healthbegin delete Servicesend delete as a prerequisite to eligibility for, or receipt
2of, any other service.
3(b) Coverage required under this section shall not be subject
4to copayment, coinsurance, deductible, or any other form of cost
5sharing.
6(c) Reimbursement for services covered pursuant to this section
7shall be paid at the amount set pursuant to Section 124977 of the
8Health and Safety Code and regulations adopted thereunder.
begin insertSection 10127.16 of the end insertbegin insertInsurance Codeend insertbegin insert is amended
10to read:end insert
(a) (1) After the termination of the pilot program
12under Section 10127.15, a health insurer shall continue to provide
13coverage under the same terms and conditions specified in Section
1410127.15 as it existed on January 1, 2007, including the terms of
15the standard benefit plan and the subscriber payment amount, to
16each individual who was terminated from the program, pursuant
17to subdivision (f) of Section 12725 of the Insurance Code during
18the term of the pilot program and who enrolled or applied to enroll
19in a standard benefit plan within 63 days of termination. The
20begin delete Managed Risk Medical Insurance Boardend deletebegin insert State Department of
21Health Care Servicesend insert shall continue to pay the amount described
22in Section 10127.15 for each of those individuals. A health insurer
23shall not be required to offer the coverage described in Section
2410127.15 after the termination of the pilot program to individuals
25not already enrolled in the program.
26(2) Notwithstanding paragraph (1) of this subdivision or Section
2710127.15 as it existed on January 1, 2007, the following rules shall
28apply:
29(A) (i) A health insurer shall not be obligated to provide
30coverage to any individual pursuant to this section on or after
31January 1, 2014.
32(ii) Thebegin delete Managed Risk Medical Insurance Boardend deletebegin insert State
33Department of Health Care Servicesend insert shall not be obligated to
34provide any payment to any health insurer under this section for
35(I) health care expenses incurred on or after January 1, 2014, or
36(II) the standard monthly administrative fee, as defined in Section
3710127.15 as it existed on January 1, 2007, for any month after
38December, 2013.
39(B) Each health insurer providing coverage pursuant to this
40section shall, on or before October 1, 2013, send a notice to each
P50 1individual enrolled in a standard benefit plan that is in at least
212-point type and with, at minimum, the following information:
3(i) Notice as to whether or not the plan will terminate as of
4January 1, 2014.
5(ii) The availability of individual health coverage, including
6through Covered California, including at least all of the following:
7(I) That, beginning on January 1, 2014, individuals seeking
8coverage may not be denied coverage based on health status.
9(II) That the premium rates for coverage offered by a health
10care service plan or a health insurer cannot be based on an
11individual’s health status.
12(III) That individuals obtaining coverage through Covered
13California may, depending upon income, be eligible for premium
14subsidies and cost-sharing subsidies.
15(IV) That individuals seeking coverage must obtain this coverage
16during an open or special enrollment period, and a description of
17the open
and special enrollment periods that may apply.
18(C) As a condition of receiving payment for a reporting period
19pursuant to this section, a health insurer shall provide thebegin delete Managed begin insert State Department of Health Care
20Risk Medical Insurance Boardend delete
21Servicesend insert with a complete, final annual reconciliation report by the
22earlier of December 31, 2014, or an earlier date as prescribed by
23Section 10127.15, as it existed on January 1, 2007, for that
24reporting period. To the extent that it receives a complete, final
25reconciliation report for a reporting period by the date required
26pursuant to this subparagraph, thebegin delete Managed Risk Medical Insurance begin insert State Department of Health Care Servicesend insert shall complete
27Boardend delete
28reconciliation with the health insurer for that reporting period
29withinbegin delete sixend deletebegin insert 18end insert monthsbegin delete ofend deletebegin insert afterend insert receiving the report.
30(b) If the state fails to expend, pursuant to this section, sufficient
31funds for the state’s contribution amount to any health insurer, the
32health insurer may increase the monthly payments that its
33subscribers are required to pay for any standard benefit plan to the
34amount that thebegin delete Managed Risk Medical Insurance Boardend deletebegin insert State
35Department of Health Care Servicesend insert would charge without a state
36subsidy for the same insurance product issued to the same
37individual within the program.
38(c) begin deleteThe adoption and readoption, by the Managed Risk Medical begin insertNotwithstanding Chapter 3.5 (commencing with
39Insurance Board, end delete
40Section 11340end insertbegin insert) end insertofbegin delete regulations implementing the amendments to
P51 1this section enacted by the legislation adding this subdivision shall
2be deemed an emergency and necessary to avoid serious harm to
3the public peace, health, safety, or general welfare for purposesend delete
4begin insert Part 1end insert ofbegin delete Sections 11346.1 and 11349.6 ofend deletebegin insert Division 3 of Title 2 ofend insert
5 the Government Code,begin delete andend delete thebegin delete Managed Risk Medical Insurance begin insert State Department of Health
6Board is hereby exempted from the requirement that it describe
7facts showing the need for immediate action and from review by
8the Office of Administrative Law.end delete
9Care Services may implement, interpret, or make specific this
10section by means of all-county letters, plan letters, plan or provider
11bulletins, or similar instructions, without taking regulatory action.end insert
begin insertSection 19548.2 of the end insertbegin insertRevenue and Taxation Codeend insert
13begin insert is amended to read:end insert
(a) Notwithstanding any other law and in accordance
15with Section 120962 of the Health and Safety Code, the State
16Department of Public Health shall disclose the name and individual
17taxpayer identification number (ITIN) or social security number
18of an applicant for, or recipient of services pursuant to Chapter 6
19(commencing with Section 120950) of Part 4 of Division 105 of
20the Health and Safety Code to the Franchise Tax Board for the
21purpose of verifying the adjusted gross incomebegin insert of, any tax-exempt
22interest received by, any tax-exempt social security benefits
23received by, and any foreign earned incomeend insert of an applicant or
24recipient.
25(b) (1) The Franchise Tax Board, upon receipt of this
26information, shall inform the State Department of Public Health
27of all of the following:
28(A) The amounts of the federal adjusted gross income as
29reported by the taxpayer to the Franchise Tax Board.
30(B) The amounts of the California adjusted gross income as
31reported by the taxpayer to the Franchise Tax Board or as adjusted
32by the Franchise Tax Board.
33(C) The amount of any tax-exempt interest received by the
34
taxpayer, as reported to the Franchise Tax Board.
35(D) The amount of any tax-exempt social security benefits
36received by the taxpayer, as reported to the Franchise Tax Board.
37(E) The amount of any foreign earned income of the taxpayer,
38as reported to the Franchise Tax Board.
39(b)
end delete
P52 1begin insert(2)end insert The Franchise Taxbegin delete Board, upon receipt of this information, Board
2shall inform the State Department of Public Health of the amounts
3of the federal adjusted gross income as reported by the taxpayer
4to the Franchise Tax Board, and the California adjusted gross
5income as reported by the taxpayer to the Franchise Taxend deletebegin delete or
6as adjusted by the Franchise Tax Board. The Franchise Tax Boardend delete
7 shall provide the information to the State Department of Public
8Health for the most recent taxable year that the Franchise Tax
9Board has information available, and shall include the first and
10last name, date of birth, and the ITIN or social security number of
11the taxpayer.
12(c) (1) Information provided by the State Department of Public
13Health pursuant to this section shall constitute confidential public
14health records as defined in Section 121035 of the Health and
15Safety Code, and shall remain subject to the confidentiality
16protections and restrictions on further disclosure by the recipient
17under subdivisions (d) and (e) of Section 121025.
18(2) Prior to accessing confidential HIV-related public health
19records, Franchise Tax Board staff and
contractors shall be required
20to annually sign a confidentiality agreement developed by the State
21Department of Public Health that includes information related to
22the penalties under Section 121025 of the Health and Safety Code
23for a breach of confidentiality and the procedures for reporting a
24breach of confidentiality under subdivision (h) of Section 121022
25of the Health and Safety Code. Those agreements shall be reviewed
26annually by the State Department of Public Health.
27(3) The Franchise Tax Board shall return or destroy all
28information received from the State Department of Public Health
29after completing the exchange of information.
30(d) For purposes of this section, “foreign earned income” also
31includes any deduction taken for the housing expenses of an
32individual while living abroad pursuant to
Section 911 of Title 26
33of the Internal Revenue Code.
begin insertSection 4369 of the end insertbegin insertWelfare and Institutions Codeend insertbegin insert is
35amended to read:end insert
There is within the State Department of Public Health,
37the Office of Problembegin delete and Pathologicalend delete Gambling.
begin insertSection 4369.1 of the end insertbegin insertWelfare and Institutions Codeend insert
39begin insert is amended to read:end insert
As used in this chapter, the following definitions shall
2apply:
3(a) “Affected individual” means a person who experiences
4adverse psychiatric or physical impacts due to another person’s
5gambling disorder.
6(a)
end delete7begin insert(b)end insert “Department” means the State Department of Public Health.
8(b) “Office” means the Office of Problem and Pathological
9Gambling.
10(c) begin delete“Pathological gambling end deletebegin insert“Gamblingend insertdisorder” means a
11begin delete progressive mental disorder meetingend deletebegin insert condition that causesend insert the
12begin insert person to be unable to resist impulses to gamble, which can lead
13to harmful negative consequences, and that meets theend insert diagnostic
14criteria set forthbegin delete byend deletebegin insert inend insert the American Psychiatric Association’s
15Diagnostic and Statisticalbegin delete Manual, Fourthend deletebegin insert Manual of Mental
16Disorders, Fifthend insert Edition.begin insert Gambling disorder includes both
17pathological and problem gambling behavior.end insert
18(d) begin delete“Problem gambling”end deletebegin insert“Office”end insertbegin insert end insertmeansbegin delete participation in any the
19form of gambling toend deletebegin delete extent that it creates a negative begin insert Officeend insert of
20consequence to the gambler, the gambler’s family, placeend delete
21begin delete employment, or community. This includes patterns of gambling begin insert Problem Gambling.end insert
22and subsequent related behaviors that compromise, disrupt, or
23damage personal, family, educational, financial, or vocational
24interests. The problem gambler does not meet the diagnostic criteria
25for pathological gambling disorder.end delete
26(e) begin delete“Problem gambling prevention programs” end deletebegin insert“Prevention
27program”end insertbegin insert end insertmeansbegin delete programsend deletebegin insert a programend insert designed to reduce the
28prevalence ofbegin delete problem and pathologicalend delete gamblingbegin insert disordersend insert among
29California residents.begin delete These programsend deletebegin insert The programend insert shall include,
30butbegin delete areend deletebegin insert isend insert not limited to, public education and awareness, outreach
31to high-risk populations, early identification and responsible
32gambling programs.
33(f) “Treatment program” means a program designed to assist
34individuals who experience harmful negative consequences related
35to gambling disorders. This program shall include, but is not
36limited to, training and educating providers, establishing a
37provider network for the provision of treatment services, and
38conducting research to ensure the delivery of evidence-based
39practices.
begin insertSection 4369.2 of the end insertbegin insertWelfare and Institutions Codeend insert
2begin insert is amended to read:end insert
(a) The office shall develop abegin delete problemend delete gambling
4begin insert disorderend insert prevention program, which shallbegin delete be the first priority for consist of all of the following:
5funding appropriated to this office. The prevention program shall
6be based upon the allocation priorities established by the
7department and subject to funding being appropriated for the
8purpose of this subdivision, and shallend delete
9(1) A toll-free telephone service for immediate crisis
10managementbegin delete and containmentend delete with subsequentbegin delete referralend deletebegin insert referralsend insert
11 ofbegin delete problemend deletebegin insert gamblersend insert andbegin delete pathological gamblersend deletebegin insert affected
12individualsend insert to health providersbegin insert at various levels of careend insert who can
13provide treatment for gamblingbegin insert disorders andend insert related problems
14and to self-help groups.
15(2) Public awareness campaigns that focus on prevention and
16education among the general public including, for example,
17dissemination of youth oriented preventive literature, educational
18experiences, and public service announcements in the media.
19(3) Empirically driven research programs focusing on
20epidemiology/prevalence,
etiology/causation, and best practices
21in prevention and treatment.
22(4) Training of health care professionals and educators, and
23training for law enforcement agencies and nonprofit organizations
24in the identification ofbegin delete problemend delete gamblingbegin delete behaviorend deletebegin insert disordersend insert and
25knowledge of referral services and treatment programs.
26(5) Training of gambling industry personnel in identifying
27customers at risk forbegin delete problem and pathologicalend delete gamblingbegin insert disordersend insert
28 and knowledge of referral and treatment services.
29(b) The office shall develop abegin delete program to supportend delete treatment
30begin delete servicesend deletebegin insert programend insert for California residentsbegin delete with problem and begin insert who have aend insert gambling
31pathologicalend deletebegin delete issues. The program shall be begin insert disorder or
32based upon the allocation priorities established by the department
33and subject to funding being appropriated for the purposes of this
34subdivision. These priorities shall also be based on the best
35available existing state programs as well as on continuing research
36into best practices and on the needs of California. Theend delete
37who are affected individuals. Theend insert treatment programbegin delete shallend deletebegin insert mayend insert
38 consist of all of the following components:
39(1) Training for licensed health providers, including screening
40and assessment of gambling disorders, the use of evidence-based
P55 1treatment modalities, and the administrative practices for treatment
2services implemented under this chapter.
3(1) Treatment services
end delete
4begin insert(2)end insertbegin insert end insertbegin insertA network of licensed health providers authorized to receive
5reimbursement from the stateend insert forbegin delete problem and pathological begin insert the
6gamblers and directly involved family members. Theseend delete
7provision ofend insert treatmentbegin delete services willend deletebegin insert services. This network mayend insert be
8created through partnerships with established healthbegin insert or substance
9use disorderend insert facilitiesbegin insert or individuals in private practiceend insert that can
10provide treatment for gamblingbegin delete related problems, substance abuse begin insert disorders.end insert State funded treatmentbegin insert servicesend insert
11facilities, and providers.end delete
12 may include, butbegin delete isend deletebegin insert areend insert not limited to, the following:
13self-administered, home-based educational programs;begin insert telephone
14counseling; group treatment;end insert outpatient treatment;begin delete residential and inpatientbegin insert residentialend insert treatment when medically
15treatment;end delete
16necessary.
17(3) A research program to conduct studies and develop
18evidence-based tools for use in treating gambling disorders.
19(2)
end delete
20begin insert(4)end insert A funding allocation methodology that ensures treatment
21services are delivered efficiently and effectively to areas of the
22state most in need.
23(3)
end delete
24begin insert(5)end insert Appropriate review and monitoring ofbegin insert theend insert treatment
25begin delete programsend deletebegin insert programend insert by the director of the office or a designated
26institution, including grant oversight andbegin delete monitoring,end deletebegin insert monitoring
27of contracts, theend insert standards for treatment, and outcome monitoring.
28(4)
end delete
29begin insert(6)end insert Treatment efforts shall provide services that are relevant to
30the needs of a diverse multicultural population with attention to
31groups with unique needs, including female gamblers, underserved
32ethnic groups, the elderly, and the physically challenged.
33(c) The office shall make information available as requested by
34the Governor and the Legislature with respect to the comprehensive
35program.
begin insertSection 4369.3 of the end insertbegin insertWelfare and Institutions Codeend insert
37begin insert is amended to read:end insert
In designing and developing the overall program, the
39office shall do all of the following:
P56 1(a) Develop a statewide plan to addressbegin delete problem and begin insert gambling disorders.end insert
2pathological gambling.end delete
3(b) Adopt any regulations necessary to administer the program.
4(c) Develop priorities for funding services and criteria for
5distributing program funds.
6(d) Monitor the expenditures of state funds by agencies and
7organizations receiving program funding.
8(e) Evaluate the effectiveness of services provided through the
9program.begin insert The department is authorized to contract with academic
10experts to perform these evaluations.end insert
11(f) Notwithstanding any other provision of law, any contracts
12required to meet the requirements of this chapter are exempt from
13the requirements contained in the Public Contract Code and the
14State Administrative Manual, and are exempt from the approval
15of the Department of General Services.
16(g) The first and highest priority of the office with respect to
17the use of any funds appropriated for the purposes of this chapter
18shall be to carry out subdivision (a).
19(h)
end delete
20begin insert(g)end insert Administrative costs for the program may not exceed 10
21percent of the total funding budgeted for the program.
begin insertSection 4369.4 of the end insertbegin insertWelfare and Institutions Codeend insert
23begin insert is amended to read:end insert
All state agencies, including, but not limited to, the
25California Horse Racing Board, the California Gambling Control
26Commission, the Department of Justice, and any other agency that
27regulates casino gambling or cardrooms within the state, and the
28Department of Corrections and Rehabilitation, the State Department
29of Public Health, the State Department of Health Care Services,
30and the California State Lottery, shall coordinate with the office
31to ensure that state programs take into account, as much as
32practicable,begin delete problem and pathological gamblers.end deletebegin insert gambling
33disorders.end insert The office shall also coordinate and work with other
34entities involved in gambling and the treatment ofbegin delete problem and begin insert gambling disorders.end insert
35pathological gamblers.end delete
begin insertSection 4369.5 of the end insertbegin insertWelfare and Institutions Codeend insert
37begin insert is amended to read:end insert
(a) It is the intent of the Legislature that the Office of
39Problembegin delete and Pathologicalend delete Gambling establish and maintain
40ongoing venues for system stakeholders to provide input into public
P57 1policy issues related tobegin delete problem gambling,end deletebegin insert gambling disorders,end insert
2 including, but not limited to, consumers of services and their
3families, providers of services and supports, and county
4representatives. It is further the intent of the Legislature that the
5Office of Problembegin delete and Pathologicalend delete Gambling shall have input
6into policy discussions at the State Department of Public Health
7and at the California Health and Human Services Agency, when
8appropriate.
9(b) It is the intent of the Legislature to ensure that the impacts
10of the transition of the Office of Problembegin delete and Pathologicalend delete
11 Gambling from the State Department of Alcohol and Drug
12Programs to the State Department of Public Health are identified
13and evaluated, initially and over time. It is further the intent of the
14Legislature to establish a baseline for evaluating, on an ongoing
15basis, how and why services provided and overseen by the Office
16of Problembegin delete and Pathologicalend delete Gambling were improved, or
17otherwise changed, as a result of this transition.
18(c) begin insert(1)end insertbegin insert end insert By April 1, 2014, and March 1 annually thereafter, the
19State Department of Public Health shall report to the Joint
20Legislative Budget Committee and the appropriate budget
21subcommittees and policy committees of the Legislature, and
22publicly post a report on the Office of Problembegin delete and Pathologicalend delete
23 Gambling on its Internet Web site.
24(1)
end delete25begin insert(2)end insert The report shall contain all of the following:
26(A) A description of education and outreach activities related
27to the prevention program and how the Office of Problembegin delete and Gambling establishes linkages with State Department
28Pathologicalend delete
29of Public Health partners, including local health officers and other
30relevant entities, in order to increase awareness of, and provide
31input to, the Office of Problembegin delete and Pathologicalend delete Gambling, and
32how stakeholder involvement was changed, maintained, or
33enhanced after the transition.
34(B) Beginning in the 2012-13 fiscal year, a description of
35year-over-year changes in the following: access to services,
36demographics of people served, the number of providers, and
37treatment program outcomes. The description of access to services
38shall include, but not be limited to, information regarding
39utilization of services and waiting lists for services. The description
40of providers shall include, but not be limited to, types and numbers
P58 1of providers, includingbegin delete problemend delete gamblingbegin insert disorderend insert counselors,
2training protocols for providers, and workforce trends. The
3description of demographics of people served shall include, but
4not be limited to, age, sex, ethnicity, economic status, and
5geographic regions. The description of treatment program outcomes
6shall include, but not be limited to, participation levels in programs,
7recidivism rates, and quality of life measures.
8(2) By November 30, 2013, the State Department of Public
9Health shall consult with legislative staff and with system
10stakeholders, including county representatives, to develop a
11reporting format consistent with the Legislature’s desired level of
12outcome and reporting detail.
13(d) This section shall become inoperative on July 1, 2018, and,
14as of January 1, 2019, is repealed, unless a later enacted statute,
15that becomes operative on or before January 1, 2019, deletes or
16extends the dates on which it becomes inoperative and is repealed.
begin insertSection 14007.2 of the end insertbegin insertWelfare and Institutions Codeend insert
18begin insert is amended to read:end insert
(a) Any individual who is otherwise eligible for
20Medi-Cal services, but who does not meet the documentation
21requirements described in subdivision (e) of Section 14011.2, shall
22be eligible only for the scope of services made available to aliens
23under subdivision (d) of Section 14007.5, and Sectionsbegin delete 14007.65end delete
24begin insert 14007.65, 14007.7,end insert andbegin delete 14007.7.end deletebegin insert 14007.8.end insert
25(b) To the extent that federal financial participation is available
26to fund services described under subdivision (a), the department
27shall file all necessary state plan amendmentsbegin insert or waiversend insert to obtain
28that funding.
begin insertSection 14007.5 of the end insertbegin insertWelfare and Institutions Codeend insert
30begin insert is amended to read:end insert
(a) Aliens shall be eligible for Medi-Cal, whether
32federally funded or state-funded, only to the same extent as
33permitted under federal law and regulations for receipt of federal
34financial participation under Title XIX of the federal Social
35Security Act, except as otherwise provided in this section and
36begin delete Section 14007.7.end deletebegin insert elsewhere in this chapter.end insert
37(b) In accordance with Section 1903(v)(1) of the federal Social
38Security Act (42 U.S.C. Sec. 1396b(v)(1)), an alien shall only be
39eligible for the full scope of Medi-Cal benefits, if the alien has
P59 1been lawfully admitted for permanent residence, or is otherwise
2permanently residing in the United States under color of law.
3For purposes of this section, aliens “permanently residing in the
4United States under color of law” shall be interpreted to include
5all aliens residing in the United States with the knowledge and
6permission of the United States Immigration and Naturalization
7Service and whose departure the United States Immigration and
8Naturalization Service does not contemplate enforcing and with
9
respect to whom federal financial participation is available under
10Title XIX of the federal Social Security Act.
11(c) Any alien whose immigration status has been adjusted either
12to lawful temporary resident or lawful permanent resident in
13accordance with the provisions of Section 210, 210A, or 245A of
14the federal Immigration and Nationality Act, and who meets all
15other eligibility requirements, shall be eligible only for care and
16services under Medi-Cal for which the alien is not disqualified
17pursuant to those sections of the federal act.
18(d) Any alien who is otherwise eligible for Medi-Cal services,
19but who does not meet the requirements under subdivision (b) or
20(c), shall only be eligible for care and services that are necessary
21for the treatment of an emergency medical condition and medical
22care directly related to the emergency, as defined in federal law.
23For purposes of this
section, the term “emergency medical
24condition” means a medical condition manifesting itself by acute
25symptoms of sufficient severity, including severe pain, such that
26the absence of immediate medical attention could reasonably be
27expected to result in any of the following:
28(1) Placing the patient’s health in serious jeopardy.
29(2) Serious impairment to bodily functions.
30(3) Serious dysfunction to any bodily organ or part. It is the
31intent of this section to entitle eligible individuals to inpatient and
32outpatient services that are necessary for the treatment of the
33emergency medical condition in the same manner as administered
34by the department through regulations and provisions of federal
35law.
36(e) Pursuant to Section 14001.2, each county department
shall
37require that each applicant for, or beneficiary of, Medi-Cal,
38including a child, shall provide his or her social security number
39account number, or numbers, if he or she has more than one social
40security number.
P60 1(f) (1) In order to be eligible for benefits under subdivision (b)
2or (c), an alien applicant or beneficiary shall present alien
3registration documentation or other proof of satisfactory
4immigration status from the United States Immigration and
5Naturalization Service.
6(2) Any alien who meets all other program requirements but
7who lacks documentation of alien registration or other proof of
8satisfactory immigration status shall be provided a reasonable
9opportunity to submit the evidence. For purposes of this paragraph,
10“reasonable opportunity” means 30 days or the time it actually
11takes the county to process the Medi-Cal application, whichever
12is
longer.
13(3) During the reasonable opportunity period under paragraph
14(2), the county department shall process the applicant’s application
15for medical assistance in a manner that conforms to its normal
16processing procedures and timeframes.
17(g) (1) The county department shall grant only the Medi-Cal
18benefits set forth in subdivision (d) of this section or in Section
1914007.7 to any individual who, after 30 calendar days or the time
20it actually takes the county to process the Medi-Cal application,
21whichever is longer, has failed to submit documents constituting
22reasonable evidence indicating a satisfactory immigration status
23for Medi-Cal purposes, or who is reported by the United States
24Immigration and Naturalization Service to lack a satisfactory
25immigration status for Medi-Cal purposes.
26(2) If an
alien has been receiving Medi-Cal benefits based on
27eligibility established prior to the effective date of this section and
28that individual, upon redetermination of eligibility for benefits,
29fails to submit documents constituting reasonable evidence
30indicating a satisfactory immigration status for Medi-Cal purposes,
31the county department shall discontinue the Medi-Cal benefits,
32except for the care and services set forth in subdivision (d) of this
33section or in Section 14007.7. The county department shall provide
34adequate notice to the individual of any adverse action and shall
35accord the individual an opportunity for a fair hearing if he or she
36requests one.
37(h) To the extent permitted by federal law and regulations, an
38alien applying for services under subdivisions (b) and (c) shall be
39granted eligibility for the scope of services to which he or she
40would otherwise be entitled if, at the time the county department
P61 1makes the determination about
his or her eligibility, the alien meets
2either of the following requirements:
3(1) He or she has not had a reasonable opportunity to submit
4documents constituting reasonable evidence indicating satisfactory
5immigration status.
6(2) He or she has provided documents constituting reasonable
7evidence indicating a satisfactory immigration status, but the
8county department has not received timely verification of the
9alien’s immigration status from the United States Immigration and
10Naturalization Service.
11(3) The verification process shall protect the privacy of all
12participants. An alien’s immigration status shall be subject to
13verification by the United States Immigration and Naturalization
14Service, to the extent required for receipt of federal financial
15participation in the Medi-Cal program.
16(i) If an alien does not declare status as a lawful permanent
17resident or alien permanently residing under color of law, or as an
18alien legalized under Section 210, 210A, or 245A of the federal
19Immigration and Nationality Actbegin delete (P.L.end deletebegin insert (Public Lawend insert 82-414),
20Medi-Cal coverage under subdivision (d) of this section or in
21Section 14007.7 shall be provided to the individual if he or she is
22otherwise eligible.
23(j) If an alien subject to this section is not fluent in English, the
24county department shall provide an understandable explanation of
25the requirements of this section in a language in which the alien
26is fluent.
27(k) Aliens who were receiving long-term care or renal dialysis
28services (1) on the day prior to the effective date of the amendment
29to paragraph (1) of subdivision (f) of Section 1 of Chapter 1441
30of the Statutes of 1988 at the 1991-92 Regular Session of the
31Legislature and (2) under the authority of paragraph (1) of
32subdivision (f) of
Section 1 of Chapter 1441 of the Statutes of 1988
33as it read on June 30, 1992, shall continue to receive these services.
34The authority for continuation of long-term care or renal dialysis
35services in this subdivision shall not apply to any person whose
36long-term care or renal dialysis services end for any reason after
37the effective date of the amendment described in this subdivision.
begin insertSection 14007.8 is added to the end insertbegin insertWelfare and
39Institutions Codeend insertbegin insert, to read:end insert
(a) After the director determines, and communicates
2that determination in writing to the Department of Finance, that
3systems have been programmed for implementation of this section,
4but no sooner than May 1, 2016, an individual who is under 19
5years of age and who does not have satisfactory immigration status
6or is unable to establish satisfactory immigration status as required
7by Section 14011.2 shall be eligible for the full scope of Medi-Cal
8benefits, if he or she is otherwise eligible for benefits under this
9chapter.
10(b) To the extent permitted by state and federal law, an
11individual eligible under this section shall be required to enroll
12in a Medi-Cal managed care health plan in those counties in which
13a Medi-Cal managed care health plan
is available.
14(c) The department shall seek any necessary federal approvals
15to obtain federal financial participation in implementing this
16section. Benefits for services under this section shall be provided
17with state-only funds only if federal financial participation is not
18available for those services.
19(d) The department shall maximize federal financial
20participation in implementing this section to the extent allowable.
21(e) This section shall be implemented only to the extent it is in
22compliance with Section 1621(d) of Title 8 of the United States
23Code.
24(f) (1) Notwithstanding Chapter 3.5 (commencing with Section
2511340) of Part 1 of Division 3 of Title 2 of the Government Code,
26the department, without taking any further
regulatory action, shall
27implement, interpret, or make specific this section by means of
28all-county letters, plan letters, plan or provider bulletins, or similar
29instructions until the time any necessary regulations are adopted.
30Thereafter, the department shall adopt regulations in accordance
31with the requirements of Chapter 3.5 (commencing with Section
3211340) of Part 1 of Division 3 of Title 2 of the Government Code.
33(2) Commencing six months after the effective date of this
34section, and notwithstanding Section 10231.5 of the Government
35Code, the department shall provide a status report to the
36Legislature on a semiannual basis, in compliance with Section
379795 of the Government Code, until regulations have been adopted.
38(g) In implementing this section, the department may contract,
39as necessary, on a bid or nonbid basis. This subdivision establishes
40an accelerated process for
issuing contracts pursuant to this
P63 1section. Those contracts, and any other contracts entered into
2pursuant to this subdivision, may be on a noncompetitive bid basis
3and shall be exempt from the following:
4(1) Part 2 (commencing with Section 10100) of Division 2 of
5the Public Contract Code and any policies, procedures or
6regulations authorized by that part.
7(2) Article 4 (commencing with Section 19130) of Chapter 5 of
8Part 2 of Division 5 of Title 2 of the Government Code.
9(3) Review or approval of contracts by the Department of
10General Services.
begin insertSection 14015.5 of the end insertbegin insertWelfare and Institutions Codeend insert
12begin insert is amended to read:end insert
(a) Notwithstanding any otherbegin delete provision ofend delete state law,
14the department shall retain or delegate the authority to perform
15Medi-Cal eligibility determinations as set forth in this section.
16(b) If after an assessment and verification for potential eligibility
17for Medi-Cal benefits using the applicable MAGI-based income
18standard of all persons that apply through an electronic or a paper
19application processed by CalHEERS, which is jointly managed
20by the department and the Exchange, and to the extent required
21by federal law and regulation is completed, the Exchange and the
22department is able to electronically determine the applicant’s
23eligibility for Medi-Cal benefits using only the information initially
24provided online, or through the written application submitted by,
25or on behalf of, the applicant, and without further staff review to
26verify the accuracy of the submitted information, the Exchange
27and the department shall
determine that applicant’s eligibility for
28the Medi-Cal program using the applicable MAGI-based income
29standard.
30(c) Except as provided in subdivision (b) and Section 14015.7,
31the county of residence shall be responsible for eligibility
32determinations and ongoing case management for the Medi-Cal
33program.
34(d) (1) Notwithstanding any otherbegin delete provision ofend delete state law, the
35Exchange shall be authorized to provide information regarding
36available Medi-Cal managed health care plan selection options to
37applicants determined to be eligible for Medi-Cal benefits using
38the MAGI-based income standard and allow those applicants to
39choose an available managed health care plan.
P64 1(2) The Exchange is authorized to record an applicant’s health
2plan selection into CalHEERS for reporting to the department.
3CalHEERS shall have the ability to report to the department the
4results of an applicant’s health plan selection.
5(e) Notwithstanding Chapter 3.5 (commencing with Section
611340) of Part 1 of Division 3 of Title 2 of the Government Code,
7the department, without taking any further regulatory action, shall
8implement, interpret, or make specific this section by means of
9all-county
letters, plan letters, plan or provider bulletins, or similar
10instructions until the time regulations are adopted. Thereafter, the
11department shall adopt regulations in accordance with the
12requirements of Chapter 3.5 (commencing with Section 11340) of
13Part 1 of Division 3 of Title 2 of the Government Code. Beginning
14six months after the effective date of this section, and
15notwithstanding Section 10231.5 of the Government Code, the
16department shall provide a status report to the Legislature on a
17semiannual basis until regulations have been adopted.
18(f) For the purposes of this section, the following definitions
19shall apply:
20(1) “ACA” means the federal Patient Protection and Affordable
21Care Act (Public Law 111-148), as amended by the federal Health
22Care and Education Reconciliation Act of 2010 (Public Law
23111-152).
24(2) “CalHEERS” means the California Healthcare Eligibility,
25Enrollment, and Retention System developed under Section 15926.
26(3) “Exchange” means the California Health Benefit Exchange
27established pursuant to Section 100500 of the Government Code.
28(4) “MAGI-based income” means income calculated using the
29financial methodologies described in Section 1396a(e)(14) of Title
3042 of the United States Code as added by ACA and any subsequent
31amendments.
32(g) This section shall be implemented only if and to the extent
33that federal financial participation is available and any necessary
34federal approvals have been obtained.
35(h) This section shall become operative on October 1, 2013.
36(i) This section shall remain in effect only until July 1, 2015,
37and as of that date is repealed, unless a later enacted statute, that
38is enacted before July 1, 2015, deletes or extends that date.
begin insertSection 14105.94 of the end insertbegin insertWelfare and Institutions Codeend insert
40begin insert is amended to read:end insert
(a) An eligible provider, as described in subdivision
2(b), may, in addition to the rate of payment that the provider would
3otherwise receive for Medi-Cal ground emergency medical
4transportation services, receive supplemental Medi-Cal
5reimbursement to the extent provided in this section.
6(b) A provider shall be eligible for supplemental reimbursement
7only if the provider has all of the following characteristics
8continuously during a state fiscal year:
9(1) Provides ground emergency medical transportation services
10to Medi-Cal beneficiaries.
11(2) Is a provider that is enrolled as a Medi-Cal provider for the
12period being claimed.
13(3) Is owned or operated by the state, a city, county, city and
14county, fire protection district organized pursuant to Part 2.7
15(commencing with Section 13800) of Division 12 of the Health
16and Safety Code, special district organized pursuant to Chapter 1
17(commencing with Section 58000) of Division 1 of Title 6 of the
18Government Code, community services district organized pursuant
19to Part 1 (commencing with Section 61000) of Division 3 of Title
206 of the Government Code, health care district organized pursuant
21to Chapter 1 (commencing with Section 32000) of Division 23 of
22the Health and Safety Code, or a federally recognized Indian tribe.
23(c) An eligible provider’s supplemental reimbursement pursuant
24to this section shall be calculated and paid as follows:
25(1) The supplemental reimbursement to an eligible provider, as
26
described in subdivision (b), shall be equal to the amount of federal
27financial participation received as a result of the claims submitted
28pursuant to paragraph (2) of subdivision (f).
29(2) In no instance shall the amount certified pursuant to
30paragraph (1) of subdivision (e), when combined with the amount
31received from all other sources of reimbursement from the
32Medi-Cal program, exceed 100 percent of actual costs, as
33determined pursuant to the Medi-Cal State Plan, for ground
34emergency medical transportation services.
35(3) The supplemental Medi-Cal reimbursement provided by this
36section shall be distributed exclusively to eligible providers under
37a payment methodology based on ground emergency medical
38transportation services provided to Medi-Cal beneficiaries by
39eligible providers on a per-transport basis or other federally
40permissible basis. The department shall obtain approval
from the
P66 1federal Centers for Medicare and Medicaid Services for the
2payment methodology to be utilized, and may not make any
3payment pursuant to this section prior to obtaining that approval.
4(d) (1) It is the Legislature’s intent in enacting this section to
5provide the supplemental reimbursement described in this section
6without any expenditure from the General Fund. An eligible
7provider, as a condition of receiving supplemental reimbursement
8pursuant to this section, shall enter into, and maintain, an agreement
9with the department for the purposes of implementing this section
10and reimbursing the department for the costs of administering this
11section.
12(2) The nonfederal share of the supplemental reimbursement
13submitted to the federal Centers for Medicare and Medicaid
14Services for purposes of claiming federal financial participation
15shall be paid only with
funds from the governmental entities
16described in paragraph (3) of subdivision (b) and certified to the
17state as provided in subdivision (e).
18(e) Participation in the program by an eligible provider described
19in this section is voluntary. If an applicable governmental entity
20elects to seek supplemental reimbursement pursuant to this section
21on behalf of an eligible provider owned or operated by the entity,
22as described in paragraph (3) of subdivision (b), the governmental
23entity shall do all of the following:
24(1) Certify, in conformity with the requirements of Section
25433.51 of Title 42 of the Code of Federal Regulations, that the
26claimed expenditures for the ground emergency medical
27transportation services are eligible for federal financial
28participation.
29(2) Provide evidence supporting the certification as
specified
30by the department.
31(3) Submit data as specified by the department to determine the
32appropriate amounts to claim as expenditures qualifying for federal
33financial participation.
34(4) Keep, maintain, and have readily retrievable, any records
35specified by the department to fully disclose reimbursement
36amounts to which the eligible provider is entitled, and any other
37records required by the federal Centers for Medicare and Medicaid
38Services.
39(f) (1) The department shall promptly seek any necessary federal
40approvals for the implementation of this section. The department
P67 1may limit the program to those costs that are allowable
2expenditures under Title XIX of the federal Social Security Act
3(42 U.S.C. 1396 et seq.). If federal approval is not obtained for
4implementation of this section, this
section shall not be
5implemented.
6(2) The department shall submit claims for federal financial
7participation for the expenditures for the services described in
8subdivision (e) that are allowable expenditures under federal law.
9(3) The department shall, on an annual basis, submit any
10necessary materials to the federal government to provide assurances
11that claims for federal financial participation will include only
12those expenditures that are allowable under federal law.
13(g) (1) If either a final judicial determination is made by any
14court of appellate jurisdiction or a final determination is made by
15the administrator of the federal Centers for Medicare and Medicaid
16Services that the supplemental reimbursement provided for in this
17section must be made to any provider not described in this
section,
18the director shall execute a declaration stating that the
19determination has been made and on that date this section shall
20become inoperative.
21(2) The declaration executed pursuant to this subdivision shall
22be retained by the director, provided to the fiscal and appropriate
23policy committees of the Legislature, the Secretary of State, the
24Secretary of the Senate, the Chief Clerk of the Assembly, and the
25Legislative Counsel, and posted on the department’s Internet Web
26site.
27(h) Notwithstanding Chapter 3.5 (commencing with Section
2811340) of Part 1 of Division 3 of Title 2 of the Government Code,
29the department may implement and administer this section by
30means of provider bulletins, or similar instructions, without taking
31regulatory action.
32(i) (1) Upon the effective date of the act that added this
33subdivision, the department shall develop, in consultation with the
34providers described in subdivision (b), and seek any necessary
35federal approvals for, a modified program for the supplemental
36reimbursement authorized by this section that will seek to provide
37increased reimbursement to an eligible provider that participates
38in the program. The nonfederal share of any supplemental
39reimbursement provided under the modified program shall be
40derived from voluntary intergovernmental transfers of local funds.
P68 1The department shall otherwise develop the modified program
2consistent with the requirements of this section, except for
3paragraph (2) of subdivision (c), and only to the extent that federal
4financial participation is available.
5(2) The
department shall be reimbursed for costs associated
6with administering the modified program described in paragraph
7(1) in accordance with subdivision (d). The department shall not
8otherwise assess a percentage fee in connection with any
9intergovernmental transfer of funds made pursuant to this
10subdivision.
11(3) The department shall not implement the modified program
12described in paragraph (1) until it obtains all necessary federal
13approvals. Until those federal approvals are obtained,
14supplemental reimbursement shall continue to be available
15pursuant to the provisions of this section that were operative prior
16to the effective date of the act that added this subdivision.
17(j) The department shall not implement the modified program
18described in paragraph (1) of subdivision (i) unless it determines
19that the modified program will likely result in an overall increase
20to the supplemental reimbursement available pursuant to the
21provisions of this section that were operative prior to the effective
22date of the act that added this subdivision.
begin insertSection 14105.192 of the end insertbegin insertWelfare and Institutions
24Codeend insertbegin insert is amended to read:end insert
(a) The Legislature finds and declares the
26following:
27(1) Costs within the Medi-Cal program continue to grow due
28to the rising cost of providing health care throughout the state and
29also due to increases in enrollment, which are more pronounced
30during difficult economic times.
31(2) In order to minimize the need for drastically cutting
32enrollment standards or benefits during times of economic crisis,
33it is crucial to find areas within the program where reimbursement
34levels are higher than required under the standard provided in
35Section 1902(a)(30)(A) of the federal Social Security Act and can
36be reduced in accordance with federal law.
37(3) The Medi-Cal program delivers its services and benefits to
38Medi-Cal beneficiaries through a wide variety of health care
39providers, some of which deliver care via managed care or other
P69 1contract models while others do so through fee-for-service
2arrangements.
3(4) The setting of rates within the Medi-Cal program is complex
4and is subject to close supervision by the United States Department
5of Health and Human Services.
6(5) As the single state agency for Medicaid in California, the
7department has unique expertise that can inform decisions that set
8or adjust reimbursement methodologies and levels consistent with
9the requirements of federal law.
10(b) Therefore, it is the intent of the Legislature for the
11department to analyze and identify where reimbursement levels
12can be reduced consistent with the standard
provided in Section
131902(a)(30)(A) of the federal Social Security Act and consistent
14with federal and state law and policies, including any exemptions
15contained in the provisions of the act that added this section,
16provided that the reductions in reimbursement shall not exceed 10
17percent on an aggregate basis for all providers, services and
18products.
19(c) Notwithstanding any otherbegin delete provision ofend delete law, the director
20shall adjust provider payments, as specified in this section.
21(d) (1) Except as otherwise provided in this section, payments
22shall be reduced by 10 percent for Medi-Cal fee-for-service benefits
23for dates of service on and after June 1, 2011.
24(2) For managed health care plans that contract with the
25department pursuant to this chapter or Chapter 8 (commencing
26with Section 14200), except contracts with Senior Care Action
27Network and AIDS Healthcare Foundation, payments shall be
28reduced by the actuarial equivalent amount of the payment
29reductions specified in this section pursuant to contract
30amendments or change orders effective on July 1, 2011, or
31thereafter.
32(3) Payments shall be reduced by 10 percent for
non-Medi-Cal
33programs described in Article 6 (commencing with Section 124025)
34of Chapter 3 of Part 2 of Division 106 of the Health and Safety
35Code, and Section 14105.18, for dates of service on and after June
361, 2011. This paragraph shall not apply to inpatient hospital
37services provided in a hospital that is paid under contract pursuant
38to Article 2.6 (commencing with Section 14081).
39(4) (A) Notwithstanding any otherbegin delete provision ofend delete law, the director
40may adjust the payments specified in paragraphs (1) and (3) of
P70 1this subdivision with respect to one or more categories of Medi-Cal
2providers, or for one or more products or services rendered, or any
3combination thereof, so long as the resulting reductions to any
4category of Medi-Cal providers, in the aggregate, total no more
5than 10 percent.
6(B) The adjustments authorized in subparagraph (A) shall be
7implemented only if the director determines that, for each affected
8product, service, or provider category, the payments resulting from
9the adjustment comply with subdivision (m).
10(e) Notwithstanding any other provision of this section,
11payments to hospitals that are not under contract with the State
12Department of Health Care Services pursuant to Article 2.6
13(commencing with Section 14081) for
inpatient hospital services
14provided to Medi-Cal beneficiaries and that are subject to Section
1514166.245 shall be governed by that section.
16(f) Notwithstanding any other provision of this section, the
17following shall apply:
18(1) Payments to providers that are paid pursuant to Article 3.8
19(commencing with Section 14126) shall be governed by that article.
20(2) (A) Subject to subparagraph (B), for dates of service on and
21after June 1, 2011, Medi-Cal reimbursement rates for intermediate
22care facilities for the developmentally disabled licensed pursuant
23to subdivision (e), (g), or (h) of Section 1250 of the Health and
24Safety Code, and facilities providing continuous skilled nursing
25care to developmentally disabled individuals pursuant to the pilot
26project established by Section 14132.20, as determined
by the
27applicable methodology for setting reimbursement rates for these
28facilities, shall not exceed the reimbursement rates that were
29applicable to providers in the 2008-09 rate year.
30(B) (i) If Section 14105.07 is added to the Welfare and
31Institutions Code during the 2011-12 Regular Session of the
32Legislature, subparagraph (A) shall become inoperative.
33(ii) If Section 14105.07 is added to the Welfare and Institutions
34Code during the 2011-12 Regular Session of the Legislature, then
35for dates of service on and after June 1, 2011, payments to
36intermediate care facilities for the developmentally disabled
37licensed pursuant to subdivision (e), (g), or (h) of Section 1250 of
38the Health and Safety Code, and facilities providing continuous
39skilled nursing care to developmentally disabled individuals
40pursuant to the pilot project established by Section 14132.20,
shall
P71 1be governed by the applicable methodology for setting
2reimbursement rates for these facilities and by Section 14105.07.
3(g) The department may enter into contracts with a vendor for
4the purposes of implementing this section on a bid or nonbid basis.
5In order to achieve maximum cost savings, the Legislature declares
6that an expedited process for contracts under this subdivision is
7necessary. Therefore, contracts entered into to implement this
8section and all contract amendments and change orders shall be
9exempt from Chapter 2 (commencing with Section 10290) of Part
102 Division 2 of the Public Contract Code.
11(h) To the extent applicable, the services, facilities, and
12payments listed in this subdivision shall be exempt from the
13payment reductions specified in subdivision (d) as follows:
14(1) Acute hospital inpatient
services that are paid under contracts
15pursuant to Article 2.6 (commencing with Section 14081).
16(2) Federally qualified health center services, including those
17facilities deemed to have federally qualified health center status
18pursuant to a waiver pursuant to subsection (a) of Section 1115 of
19the federal Social Security Act (42 U.S.C. Sec. 1315(a)).
20(3) Rural health clinic services.
21(4) Payments to facilities owned or operated by the State
22Department of State Hospitals or the State Department of
23Developmental Services.
24(5) Hospice services.
25(6) Contract services, as designated by the director pursuant to
26subdivision (k).
27(7) Payments to providers to the extent that the payments are
28funded by means of a certified public expenditure or an
29intergovernmental transfer pursuant to Section 433.51 of Title 42
30of the Code of Federal Regulations. This paragraph shall apply to
31payments described in paragraph (3) of subdivision (d) only to the
32extent that they are also exempt from reduction pursuant to
33subdivision (l).
34(8) Services pursuant to local assistance contracts and
35interagency agreements to the extent the funding is not included
36in the funds appropriated to the department in the annual Budget
37Act.
38(9) Breast and cervical cancer treatment provided pursuant to
39Section 14007.71 and as described in paragraph (3) of subdivision
40(a) of Section 14105.18 or Article 1.5 (commencing with Section
P72 1104160) of Chapter 2 of Part 1 of Division 103 of the Health and
2Safety Code.
3(10) The Family Planning, Access, Care, and Treatment (Family
4PACT) Program pursuant to subdivision (aa) of Section 14132.
5(11) (A) Effective for dates of service on or after July 1, 2015,
6or the effective date of any necessary federal approvals as required
7by subdivisions (n) and (o), whichever is later, dental services and
8applicable ancillary services.
9(B) For dental managed care plans that contract with the
10department pursuant to this chapter or Chapter 8 (commencing
11with Section 14200), payments pursuant to contract amendments
12or change orders effective on or after July 1, 2015, or the effective
13date of
any necessary federal approvals as required by subdivisions
14(n) and (o), whichever is later.
15(i) Subject to the exception for services listed in subdivision
16(h), the payment reductions required by subdivision (d) shall apply
17to the benefits rendered by any provider who may be authorized
18to bill for the service, including, but not limited to, physicians,
19podiatrists, nurse practitioners, certified nurse-midwives, nurse
20anesthetists, and organized outpatient clinics.
21(j) Notwithstanding any otherbegin delete provision ofend delete law, for dates of
22service on and after June 1, 2011, Medi-Cal reimbursement rates
23applicable to the following classes of providers shall not exceed
24the reimbursement rates that were applicable to those classes of
25providers in the 2008-09 rate year, as described in subdivision (f)
26of Section 14105.191, reduced by 10 percent:
27(1) Intermediate care facilities, excluding those facilities
28identified in paragraph (2) of subdivision (f). For purposes of this
29section, “intermediate care facility” has the same meaning as
30defined in Section 51118 of Title 22 of the California Code of
31Regulations.
32(2) Skilled nursing facilities that are distinct parts of general
33acute care hospitals. For purposes of this section, “distinct part”
34has the same meaning as defined in Section 72041 of Title 22 of
35the California Code of
Regulations.
36(3) Rural swing-bed facilities.
37(4) Subacute care units that are, or are parts of, distinct parts of
38general acute care hospitals. For purposes of this subparagraph,
39“subacute care unit” has the same meaning as defined in Section
4051215.5 of Title 22 of the California Code of Regulations.
P73 1(5) Pediatric subacute care units that are, or are parts of, distinct
2parts of general acute care hospitals. For purposes of this
3subparagraph, “pediatric subacute care unit” has the same meaning
4as defined in Section 51215.8 of Title 22 of the California Code
5of Regulations.
6(6) Adult day health care centers.
7(7) Freestanding pediatric subacute care units, as defined in
8Section 51215.8 of
Title 22 of the California Code of Regulations.
9(k) Notwithstanding Chapter 3.5 (commencing with Section
1011340) of Part 1 of Division 3 of Title 2 of the Government Code,
11the department may implement and administer this section by
12means of provider bulletins or similar instructions, without taking
13regulatory action.
14(l) The reductions described in this section shall apply only to
15payments for services when the General Fund share of the payment
16is paid with funds directly appropriated to the department in the
17annual Budget Act and shall not apply to payments for services
18paid with funds appropriated to other departments or agencies.
19(m) Notwithstanding any other provision of this section, the
20payment reductions and adjustments provided for in subdivision
21(d) shall be implemented only if the director determines
that the
22payments that result from the application of this section will
23comply with applicable federal Medicaid requirements and that
24federal financial participation will be available.
25(1) In determining whether federal financial participation is
26available, the director shall determine whether the payments
27comply with applicable federal Medicaid requirements, including
28those set forth in Section 1396a(a)(30)(A) of Title 42 of the United
29States Code.
30(2) To the extent that the director determines that the payments
31do not comply with the federal Medicaid requirements or that
32federal financial participation is not available with respect to any
33payment that is reduced pursuant to this section, the director retains
34the discretion to not implement the particular payment reduction
35or adjustment and may adjust the payment as necessary to comply
36with federal Medicaid requirements.
37(n) The department shall seek any necessary federal approvals
38for the implementation of this section.
P74 1(o) (1) The payment reductions and adjustments set forth in
2this section shall not be implemented until federal approval is
3obtained.
4(2) To the extent that federal approval is obtained for one or
5more of the payment reductions and adjustments in this section
6and Section 14105.07, the payment reductions and adjustments
7set forth in Section 14105.191 shall cease to be implemented for
8the same services provided by the same class of providers. In the
9event of a conflict between this section and Section 14105.191,
10other than the provisions setting forth a payment reduction or
11adjustment, this section shall govern.
12(3) When federal
approval is obtained, the payments resulting
13from the application of this section shall be implemented
14retroactively to June 1, 2011, or on any other date or dates as may
15be applicable.
16(4) The director may clarify the application of this subdivision
17by means of provider bulletins or similar instructions, pursuant to
18subdivision (k).
19(p) Adjustments to pharmacy drug product payment pursuant
20to this section shall no longer apply when the department
21determines that the average acquisition cost methodology pursuant
22to Section 14105.45 has been fully implemented and the
23department’s pharmacy budget reduction targets, consistent with
24payment reduction levels pursuant to this section, have been met.
begin insertSection 14127.7 is added to the end insertbegin insertWelfare and
26Institutions Codeend insertbegin insert, to read:end insert
(a) The Health Home Program Account is hereby
28created in the Special Deposit Fund within the State Treasury in
29order to collect and allocate non-General Fund public or private
30grant funds, to be expended, upon appropriation by the Legislature,
31for the purposes of implementing the Health Home Program
32established pursuant to this article.
33(b) The department may accept funding from local governments,
34foundations, or other organizations to provide funding for the
35Health Home Program.
36(c) Any unexpended funds within the Health Home Program
37Account, within the Special Deposit Fund, from a local government,
38foundation, or other organization, shall be returned to the
39contributing
entity.
begin insertSection 14134 of the end insertbegin insertWelfare and Institutions Codeend insertbegin insert,
2as amended
by Section 65 of Chapter 23 of the Statutes of 2013,
3is amended to read:end insert
(a) Except for any prescription, refill, visit, service,
5device, or item for which the program’s payment is ten dollars
6($10) or less, in which case no copayment shall be required, a
7recipient of services under this chapter shall be required to make
8copayments not to exceed the maximum permitted under federal
9regulations or federalbegin delete waiversend deletebegin insert waivers,end insert as follows:
10(1) Copayment of five dollars ($5) shall be made for
11nonemergency services received in an emergency department or
12emergency room when the services do not result in the treatment
13of an emergency medical condition or inpatient admittance. For
14the purposes of this section, “nonemergency services” means
15services not required to, as appropriate, medically screen, examine,
16evaluate, or stabilize an emergency medical condition that
17manifests itself by acute symptoms of sufficient severity, including
18severe pain,begin delete suchend deletebegin insert soend insert that the absence of immediate medical
19attention could reasonably be expected to result in any of the
20following:
21(A) Placing the individual’s health, or, with respect to a pregnant
22woman, the health of the woman or her unborn child, in serious
23jeopardy.
24(B) Serious impairment to bodily functions.
25(C) Serious dysfunction of any bodily organ or part.
26(2) Copayment of one dollar ($1) shall be made for each drug
27prescription or refill.
28(3) Copayment of one dollar ($1) shall be made for each visit
29for services under
subdivisions (a) and (h) of Section 14132.
30(4) The copayment amounts set forth in paragraphs (1), (2), and
31(3) may be collected andbegin delete retainedend deletebegin insert retained,end insert or waived by the
32provider.
33(5) The department shall not reduce the reimbursement otherwise
34due to providers as a result of the copayment. The copayment
35amounts shall be in addition to any reimbursement otherwise due
36begin insert toend insert the provider for services rendered under this program.
37(6) This section does not apply to emergency services, family
38planning services, or to any services receivedbegin delete by:end deletebegin insert by any of the
39following:end insert
P76 1(A) begin deleteAny end deletebegin insertAend insertbegin insert end insertchild in AFDC-Foster Care, as defined in Section
211400.
3(B) begin deleteAny end deletebegin insertAend insertbegin insert end insertperson who is an
inpatient in a health facility, as
4defined in Section 1250 of the Health and Safety Code.
5(C) begin deleteAny end deletebegin insertAend insertbegin insert end insertperson 18 years of age or under.
6(D) begin deleteAny end deletebegin insertAend insertbegin insert end insertwoman receiving perinatal care.
7(7) Paragraph (2) does not apply tobegin delete anyend deletebegin insert aend insert person 65 years of
8age or over.
9(8) A provider of service shall not deny care or services to an
10individual solely because of that person’s inability to copay under
11this section.begin delete Anend deletebegin insert However, anend insert individualbegin delete shall, however,end deletebegin insert shallend insert
12 remain liable to the provider for any copayment amount owed.
13(9) This section shall not apply tobegin delete anyend delete preventive services that
14are assigned a grade of A or B by the United States Preventive
15Services Task Force provided by a physician or other licensed
16practitioner of the healing arts, or any approved adult vaccines and
17their administration recommended by the Advisory Committee on
18Immunization Practices. Pursuant to Section 1905(b) of the federal
19Social Security Act (42 U.S.C. Sec. 1396d(b)), these services shall
20be provided without any cost sharing by the beneficiary in order
21for the state to receive an increased federal medical assistance
22percentage for these services.
23(10)
end delete
24begin insert(b)end insert The department shall seek any federal waivers necessary to
25implement this section. The provisions for which appropriate
26federal waivers cannot be obtained shall not be implemented, but
27provisions for which waivers are either obtained or found to be
28unnecessary shall be unaffected by the inability to obtain federal
29waivers for the other provisions.
30(11)
end delete
31begin insert(c)end insert The director shall adoptbegin delete anyend delete regulations necessary to
32implement this section as emergency regulations in accordance
33with Chapter 3.5 (commencing with Section 11340) of Part 1 of
34Division 3 of Title 2 of the Government Code. The adoption of
35the regulations shall be deemed to be an emergency and necessary
36for the immediate preservation of the public peace, health and
37safety, or general welfare. The director shall transmit these
38emergency regulations directly to the Secretary of State for filing
39and the regulations shall become effective immediately upon filing.
40Upon completion of the formal regulation adoption process and
P77 1prior to the expiration of the 120 day duration period of emergency
2regulations, the director shall transmit directly to the Secretary of
3State for filing the adopted regulations, the rulemaking file, and
4the certification of compliance as required by subdivision (e) of
5Section 11346.1 of the Government Code.
6(b) This section, or subdivisions thereof, if applicable, shall
7become inoperative on the implementation date for copayments
8stated in the declaration executed by the director pursuant to
9Section 14134 as added by Section 101.5 of Chapter 3 of the
10Statutes of 2011.
begin insertSection 14134 of the end insertbegin insertWelfare and Institutions Codeend insertbegin insert,
12as amended
by Section 66 of Chapter 23 of the Statutes of 2013,
13is repealed.end insert
(a) The Legislature finds and declares all of the
15following:
16(1) Costs within the Medi-Cal program continue to grow due
17to the rising cost of providing health care throughout the state and
18also due to increases in enrollment, which are more pronounced
19during difficult economic times.
20(2) In order to minimize the need for drastically cutting
21enrollment standards or benefits or imposing further reductions
22on Medi-Cal providers during times of economic crisis, it is crucial
23to find areas within the program where beneficiaries can share
24responsibility for utilization of health care, whether they are
25participating in the fee-for-service or the managed care model of
26
service delivery.
27(3) The establishment of cost-sharing obligations within the
28Medi-Cal program is complex and is subject to close supervision
29by the United States Department of Health and Human Services.
30(4) As the single state agency for Medicaid in California, the
31State Department of Health Care Services has unique expertise
32that can inform decisions that set or adjust cost-sharing
33responsibilities for Medi-Cal beneficiaries receiving health care
34services.
35(b) Therefore, it is the intent of the Legislature for the
36department to obtain federal approval to implement cost-sharing
37for Medi-Cal beneficiaries and permit providers to require that
38individuals meet their cost-sharing obligation prior to receiving
39care or services.
P78 1(c) A Medi-Cal beneficiary
shall be required to make
2copayments as described in this section. These copayments
3represent a contribution toward the rate of payment made to
4providers of Medi-Cal services and shall be as follows:
5(1) Copayment of up to fifty dollars ($50) shall be made for
6nonemergency services received in an emergency department or
7emergency room when the services do not result in the treatment
8of an emergency condition or inpatient admittance. For the
9purposes of this section, “nonemergency services” means services
10not required to, as appropriate, medically screen, examine, evaluate,
11or stabilize an emergency medical condition that manifests itself
12by acute symptoms of sufficient severity, including severe pain,
13such that the absence of immediate medical attention could
14reasonably be expected to result in any of the following:
15(A) Placing the individual’s health, or, with respect to a
pregnant
16woman, the health of the woman or her unborn child, in serious
17jeopardy.
18(B) Serious impairment to bodily functions.
19(C) Serious dysfunction of any bodily organ or part.
20(2) Copayment of up to fifty dollars ($50) shall be made for
21emergency services received in an emergency department or
22emergency room when the services result in the treatment of an
23emergency medical condition or inpatient admittance. For purposes
24of this section, “emergency services” means services required to,
25as appropriate, medically screen, examine, evaluate, or stabilize
26an emergency medical condition that manifests itself by acute
27symptoms of sufficient severity, including severe pain, such that
28the absence of immediate medical attention could reasonably be
29expected 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(3) Copayment of up to one hundred dollars ($100) shall be
36made for each hospital inpatient day, up to a maximum of two
37hundred dollars ($200) per admission.
38(4) Copayment of up to three dollars ($3) shall be made for each
39preferred drug prescription or refill. A copayment of up to five
40dollars ($5) shall be made for each nonpreferred drug prescription
P79 1or refill. Except as provided in subdivision (g), “preferred drug”
2shall have the same meaning as in Section
1916A of the Social
3Security Act (42 U.S.C. Sec. 1396o-1).
4(5) Copayment of up to five dollars ($5) shall be made for each
5visit for services under subdivision (a) of Section 14132 and for
6dental services received on an outpatient basis provided as a
7Medi-Cal benefit pursuant to this chapter or Chapter 8
8(commencing with Section 14200), as applicable.
9(6) This section does not apply to services provided pursuant
10to subdivision (aa) of Section 14132.
11(d) The copayments established pursuant to subdivision (c) shall
12be set by the department, at the maximum amount provided for in
13the applicable paragraph, except that each copayment amount shall
14not exceed the maximum amount allowable pursuant to the state
15plan amendments or other federal approvals.
16(e) The
copayment amounts set forth in subdivision (c) may be
17collected and retained or waived by the provider. The department
18shall deduct the amount of the copayment from the payment the
19department makes to the provider whether retained, waived, or not
20collected by the provider.
21(f) Notwithstanding any other provision of law, and only to the
22extent allowed pursuant to federal law, a provider of service has
23no obligation to provide services to a Medi-Cal beneficiary who
24does not, at the point of service, pay the copayment assessed
25pursuant to this section. If the provider provides services without
26collecting the copayment, and has not waived the copayment, the
27provider may hold the beneficiary liable for the copayment amount
28owed.
29(g) (1) Notwithstanding any other provision of law, except as
30described in paragraph (2), this section shall apply to Medi-Cal
31
beneficiaries enrolled in a health plan contracting with the
32department pursuant to this chapter or Chapter 8 (commencing
33with Section 14200), except for the Senior Care Action Network
34or AIDS Healthcare Foundation. To the extent permitted by federal
35law and pursuant to any federal waivers or state plan adjustments
36obtained, a managed care health plan may establish a lower
37copayment or no copayment.
38(2) For the purpose of paragraph (4) of subdivision (c),
39copayments assessed against a beneficiary who receives Medi-Cal
40services through a health plan described in paragraph (1) shall be
P80 1based on the plan’s designation of a drug as preferred or
2nonpreferred.
3(3) To the extent provided by federal law, capitation payments
4shall be calculated on an actuarial basis as if copayments described
5in this section were collected.
6(h) This section shall not apply to any preventive services that
7are assigned a grade of A or B by the United States Preventive
8Services Task Force provided by a physician or other licensed
9practitioner of the healing arts, or any approved adult vaccines and
10their administration recommended by the Advisory Committee on
11Immunization Practices. Pursuant to Section 1905(b) of the federal
12Social Security Act (42 U.S.C. Sec. 1396d(b)), these services shall
13be provided without any cost sharing by the beneficiary in order
14for the state to receive an increased federal medical assistance
15percentage for these services.
16(i) This section shall be implemented only to the extent that
17federal financial participation is available. The department shall
18seek and obtain any federal waivers or state plan amendments
19necessary to implement this section. The provisions for which
20appropriate federal waivers or state plan amendments cannot be
21obtained
shall not be implemented, but provisions for which
22waivers or state plan amendments are either obtained or found to
23be unnecessary shall be unaffected by the inability to obtain federal
24waivers or state plan amendments for the other provisions.
25(j) Notwithstanding Chapter 3.5 (commencing with Section
2611340) of Part 1 of Division 3 of Title 2 of the Government Code,
27the department may implement, interpret, or make specific this
28section by means of all-county letters, all-plan letters, provider
29bulletins, or similar instructions, without taking further regulatory
30actions.
31(k) (1) This section shall become operative on the date that the
32act adding this section is effective, but shall not be implemented
33until the date in the declaration executed by the director pursuant
34to paragraph (2). In no event shall the director set an
35implementation date prior to the date
federal approval is received.
36(2) The director shall execute a declaration that states the date
37that implementation of the copayments described in this section
38or subdivisions thereof, if applicable, will commence and shall
39post the declaration on the department’s Internet Web site and
40provide a copy of the declaration to the Chair of the Joint
P81 1Legislative Budget Committee, the Chief Clerk of the Assembly,
2the Secretary of the Senate, the Office of the Legislative Counsel,
3and the Secretary of State.
begin insertSection 14154 of the end insertbegin insertWelfare and Institutions Codeend insert
5begin insert is amended to read:end insert
(a) (1) The department shall establish and maintain a
7plan whereby costs for county administration of the determination
8of eligibility for benefits under this chapter will be effectively
9controlled within the amounts annually appropriated for that
10administration. The plan, to be known as the County Administrative
11Cost Control Plan, shall establish standards and performance
12criteria, including workload, productivity, and support services
13standards, to which counties shall adhere. The plan shall include
14standards for controlling eligibility determination costs that are
15incurred by performing eligibility determinations at county
16hospitals, or that are incurred due to the outstationing of any other
17eligibility function. Except as provided in Section 14154.15,
18reimbursement to a county for outstationed
eligibility functions
19shall be based solely on productivity standards applied to that
20county’s welfare department office.
21(2) (A) The plan shall delineate both of the following:
22(i) The process for determining county administration base costs,
23which include salaries and benefits, support costs, and staff
24development.
25(ii) The process for determining funding for caseload changes,
26cost-of-living adjustments, and program and other changes.
27(B) The annual county budget survey document utilized under
28the plan shall be constructed to enable the counties to provide
29sufficient detail to the department to support their budget requests.
30(3) The plan shall be part of a single
state plan, jointly developed
31by the department and the State Department of Social Services, in
32conjunction with the counties, for administrative cost control for
33the California Work Opportunity and Responsibility to Kids
34(CalWORKs), CalFresh, and Medical Assistance (Medi-Cal)
35programs. Allocations shall be made to each county and shall be
36limited by and determined based upon the County Administrative
37Cost Control Plan. In administering the plan to control county
38administrative costs, the department shall not allocate state funds
39to cover county cost overruns that result from county failure to
40meet requirements of the plan. The department and the State
P82 1Department of Social Services shall budget, administer, and
2allocate state funds for county administration in a uniform and
3consistent manner.
4(4) The department and county welfare departments shall
5develop procedures to ensure the data clarity, consistency, and
6reliability of information
contained in the county budget survey
7document submitted by counties to the department. These
8procedures shall include the format of the county budget survey
9document and process, data submittal and its documentation, and
10the use of the county budget survey documents for the development
11of determining county administration costs. Communication
12between the department and the county welfare departments shall
13be ongoing as needed regarding the content of the county budget
14surveys and any potential issues to ensure the information is
15complete and well understood by involved parties. Any changes
16developed pursuant to this section shall be incorporated within the
17state’s annual budget process by no later than the 2011-12 fiscal
18year.
19(5) The department shall provide a clear narrative description
20along with fiscal detail in the Medi-Cal estimate package, submitted
21to the Legislature in January and May of each year, of each
22component of the county
administrative funding for the Medi-Cal
23program. This shall describe how the information obtained from
24the county budget survey documents was utilized and, if applicable,
25modified and the rationale for the changes.
26(6) Notwithstanding any other law, the department shall develop
27and implement, in consultation with county program and fiscal
28representatives, a new budgeting methodology for Medi-Cal county
29administrative costs that reflects the impact of PPACA
30implementation on county administrative work. The new budgeting
31methodology shall be used to reimburse counties for eligibility
32processing and case maintenance for applicants and beneficiaries.
33(A) The budgeting methodology may include, but is not limited
34to, identification of the costs of eligibility determinations for
35applicants, and the costs of eligibility redeterminations and case
36maintenance activities for recipients, for
different groupings of
37cases, based on variations in time and resources needed to conduct
38eligibility determinations. The calculation of time and resources
39shall be based on the following factors: complexity of eligibility
40rules, ongoing eligibility requirements, and other factors as
P83 1determined appropriate by the department. The development of
2the new budgeting methodology may include, but is not limited
3to, county survey of costs, time and motion studies, in-person
4observations by department staff, data reporting, and other factors
5deemed appropriate by the department.
6(B) The new budgeting methodology shall be clearly described,
7state the necessary data elements to be collected from the counties,
8and establish the timeframes for counties to provide the data to
9the state.
10(C) The new budgeting methodology developed pursuant to this
11paragraph shall be implemented no sooner than
the 2015-16 fiscal
12year. The department may develop a process for counties to phase
13in the requirements of the new budgeting methodology.
14(D) The department shall provide the new budgeting
15methodology to the legislative fiscal committees by March 1 of
16the fiscal year immediately preceding the first fiscal year of
17implementation of the new budgeting methodology.
18(E) To the extent that the funding for the county budgets
19developed pursuant to the new budget methodology is not fully
20appropriated in any given fiscal year, the department, with input
21from the counties, shall identify and consider options to align
22funding and workload responsibilities.
23(F) For purposes of this paragraph, “PPACA” means the federal
24Patient Protection and Affordable Care Act (Public Law 111-148),
25as amended by the federal Health Care and
Education
26Reconciliation Act of 2010 (Public Law 111-152) and any
27subsequent amendments.
28(G) Notwithstanding Chapter 3.5 (commencing with Section
2911340) of Part 1 of Division 3 of Title 2 of the Government Code,
30the department may implement, interpret, or make specific this
31paragraph by means of all-county letters, plan letters, plan or
32provider bulletins, or similar instructions until the time any
33necessary regulations are adopted. The department shall adopt
34regulations by July 1, 2017, in accordance with the requirements
35of Chapter 3.5 (commencing with Section 11340) of Part 1 of
36Division 3 of Title 2 of the Government Code. Beginning six
37months after the implementation of the new budgeting methodology
38pursuant to this paragraph, and notwithstanding Section 10231.5
39of the Government Code, the department shall provide a status
40report to the Legislature on a semiannual basis, in compliance with
P84 1Section 9795 of the Government Code, until
regulations have been
2adopted.
3(b) Nothing in this section, Section 15204.5, or Section 18906
4shall be construed to limit the administrative or budgetary
5responsibilities of the department in a manner that would violate
6Section 14100.1, and thereby jeopardize federal financial
7participation under the Medi-Cal program.
8(c) (1) The Legislature finds and declares that in order for
9counties to do the work that is expected of them, it is necessary
10that they receive adequate funding, including adjustments for
11reasonable annual cost-of-doing-business increases. The Legislature
12further finds and declares that linking appropriate funding for
13county Medi-Cal administrative operations, including annual
14cost-of-doing-business adjustments, with performance standards
15will give counties the incentive to meet the performance standards
16and enable them to continue to do the
work they do on behalf of
17the state. It is therefore the Legislature’s intent to provide
18appropriate funding to the counties for the effective administration
19of the Medi-Cal program at the local level to ensure that counties
20can reasonably meet the purposes of the performance measures as
21contained in this section.
22(2) It is the intent of the Legislature to not appropriate funds for
23the cost-of-doing-business adjustment for the 2008-09, 2009-10,
242010-11, 2011-12, 2012-13,begin insert 2014-15,end insert andbegin delete 2014-15end deletebegin insert 2015-16end insert
25 fiscal years.
26(d) The department is responsible for the Medi-Cal program in
27accordance with state and federal law. A county shall determine
28Medi-Cal eligibility in accordance with state and federal law. If
29in the course of its duties the department becomes aware of
30accuracy problems in any county, the department shall, within
31available resources, provide training and technical assistance as
32appropriate. Nothing in this section shall be interpreted to eliminate
33any remedy otherwise available to the department to enforce
34accurate county administration of the program. In administering
35the Medi-Cal eligibility process, each county shall meet the
36following performance standards each fiscal year:
37(1) Complete eligibility determinations as follows:
38(A) Ninety percent of the general applications without applicant
39errors and are complete shall be completed within 45 days.
P85 1(B) Ninety percent of the applications for Medi-Cal based on
2disability shall be completed within 90 days, excluding delays by
3the state.
4(2) (A) The department shall establish best-practice guidelines
5for expedited enrollment of newborns into the Medi-Cal program,
6preferably with the goal of enrolling newborns within 10 days after
7the county is informed of the birth. The department, in consultation
8with counties and other stakeholders, shall work to develop a
9process for expediting enrollment for all newborns, including those
10born to mothers receiving CalWORKs assistance.
11(B) Upon the development and implementation of the
12best-practice guidelines and expedited processes, the department
13and the counties may develop an expedited enrollment timeframe
14for newborns that is separate from the standards for all other
15applications, to the extent that the timeframe is consistent with
16these guidelines and processes.
17(3) Perform timely annual redeterminations, as follows:
18(A) Ninety percent of the annual redetermination forms shall
19be mailed to the recipient by the anniversary date.
20(B) Ninety percent of the annual redeterminations shall be
21completed within 60 days of the recipient’s annual redetermination
22date for those redeterminations based on forms that are complete
23and have been returned to the county by the recipient in a timely
24manner.
25(C) Ninety percent of those annual redeterminations where the
26redetermination form has not been returned to the county by the
27recipient shall be completed by sending a notice of action to the
28recipient within 45 days after the date the form was due to the
29county.
30(D) If a child is determined by the county to change from no
31share of cost to a share of cost and the child meets the eligibility
32criteria for the Healthy Families Program established under Section
3312693.98 of the Insurance Code, the child shall be placed in the
34Medi-Cal-to-Healthy Families Bridge Benefits Program, and these
35cases shall be processed as follows:
36(i) Ninety percent of the families of these children shall be sent
37a notice informing them of the Healthy Families Program within
38five working days from the determination of a share of cost.
39(ii) Ninety percent of all annual redetermination forms for these
40children shall be sent to the Healthy Families Program within five
P86 1working days from the determination of a share of cost if the parent
2has given consent to send this information to the Healthy Families
3Program.
4(iii) Ninety percent of the families of these children placed in
5the Medi-Cal-to-Healthy Families Bridge Benefits Program who
6have not consented to sending the child’s annual redetermination
7form to the Healthy Families Program shall be sent a request,
8within five working days of the determination of a share of cost,
9to consent to send the information to the Healthy Families Program.
10(E) Subparagraph (D) shall not be implemented until 60 days
11after the Medi-Cal and Joint Medi-Cal and Healthy Families
12applications and the Medi-Cal redetermination
forms are revised
13to allow the parent of a child to consent to forward the child’s
14information to the Healthy Families Program.
15(e) The department shall develop procedures in collaboration
16with the counties and stakeholder groups for determining county
17review cycles, sampling methodology and procedures, and data
18reporting.
19(f) On January 1 of each year, each applicable county, as
20determined by the department, shall report to the department on
21the county’s results in meeting the performance standards specified
22in this section. The report shall be subject to verification by the
23department. County reports shall be provided to the public upon
24written request.
25(g) If the department finds that a county is not in compliance
26with one or more of the standards set forth in this section, the
27county shall, within 60 days, submit
a corrective action plan to the
28department for approval. The corrective action plan shall, at a
29minimum, include steps that the county shall take to improve its
30performance on the standard or standards with which the county
31is out of compliance. The plan shall establish interim benchmarks
32for improvement that shall be expected to be met by the county in
33order to avoid a sanction.
34(h) (1) If a county does not meet the performance standards for
35completing eligibility determinations and redeterminations as
36specified in this section, the department may, at its sole discretion,
37reduce the allocation of funds to that county in the following year
38by 2 percent. Any funds so reduced may be restored by the
39department if, in the determination of the department, sufficient
40improvement has been made by the county in meeting the
P87 1performance standards during the year for which the funds were
2reduced. If the county continues not to meet
the performance
3standards, the department may reduce the allocation by an
4additional 2 percent for each year thereafter in which sufficient
5improvement has not been made to meet the performance standards.
6(2) No reduction of the allocation of funds to a county shall be
7imposed pursuant to this subdivision for failure to meet
8performance standards during any period of time in which the
9cost-of-doing-business increase is suspended.
10(i) The department shall develop procedures, in collaboration
11with the counties and stakeholders, for developing instructions for
12the performance standards established under subparagraph (D) of
13paragraph (3) of subdivision (d), no later than September 1, 2005.
14(j) No later than September 1, 2005, the department shall issue
15a revised annual redetermination form to allow a parent to indicate
16
parental consent to forward the annual redetermination form to
17the Healthy Families Program if the child is determined to have a
18share of cost.
19(k) The department, in coordination with the Managed Risk
20Medical Insurance Board, shall streamline the method of providing
21the Healthy Families Program with information necessary to
22determine Healthy Families eligibility for a child who is receiving
23services under the Medi-Cal-to-Healthy Families Bridge Benefits
24Program.
25(l) Notwithstanding Chapter 3.5 (commencing with Section
2611340) of Part 1 of Division 3 of Title 2 of the Government Code,
27and except as provided in subparagraph (G) of paragraph (6) of
28subdivision (a), the department shall, without taking any further
29regulatory action, implement, interpret, or make specific this
30section and any applicable federal waivers and state plan
31amendments by means of all-county letters or
similar instructions.
begin insertSection 14186 of the end insertbegin insertWelfare and Institutions Codeend insert
33begin insert is amended to read:end insert
(a) It is the intent of the Legislature that long-term
35services and supports (LTSS) be covered through managed care
36health plans in Coordinated Care Initiative counties.
37(b) It is further the intent of the Legislature that all of the
38following occur:
39(1) Persons receiving health care services through Medi-Cal
40receive these services through a coordinated health care system
P88 1that reduces the unnecessary use of emergency and hospital
2services.
3(2) Coordinated health care services, including medical,
4long-term services and supports, and enhanced care management
5be covered through Medi-Cal managed care health plans in order
6to eliminate system
inefficiencies and align incentives with positive
7health care outcomes.
8(3) Managed care health plans shall, in coordination with LTSS
9care management providers, develop and expand care coordination
10practices in consultation with counties, nursing facilities, area
11agencies on aging, and other home- and community-based
12providers, and share best practices. Unless the consumer objects,
13managed care health plans may establish care coordination teams
14as needed. If the consumer is an IHSS recipient, his or her
15participation and the participation of his or her provider shall be
16subject to the consumer’s consent. These care coordination teams
17shall include the consumer, and his or her authorized representative,
18health plan, county social services agency, Community-Based
19Adult Services (CBAS) case manager for CBAS clients,
20Multipurpose Senior Services Program (MSSP) case manager for
21MSSP clients, and, if an IHSS recipient, may include others.
22(4) To the extent possible, for Medi-Cal beneficiaries also
23enrolled in the Medicare Program, that the department work with
24the federal government to coordinate financing and incentives and
25permit managed care health plans to coordinate health care
26provided under both health care systems.
27(5) The health care choices made by Medi-Cal beneficiaries be
28considered with regard to all of the following:
29(A) Receiving care in a home- and community-based setting to
30maintain independence and quality of life.
31(B) Selecting their health care providers in the managed care
32plan network.
33(C) Controlling care planning, decisionmaking, and coordination
34with their health care providers.
35(D) Gaining access to services that are culturally, linguistically,
36and operationally sensitive to meet their needs or limitations and
37that improve their health outcomes, enhance independence, and
38promote living in home- and community-based settings.
39(E) Self-directing their care by being able to hire, fire, and
40supervise their IHSS provider.
P89 1(F) Being assured by the department and coordinating
2departments of their oversight of the quality of these coordinated
3health care services.
4(6) (A) Counties continue to perform functions necessary for
5the administration of the IHSS program, including conducting
6assessments and determining authorized hours for recipients,
7pursuant to Article 7 (commencing with Section 12300) of Chapter
83. County
agency assessments shall be shared with care
9coordination teams, when applicable. The county agency thereafter
10may receive and consider additional input from the care
11coordination team.
12(B) Managed care health plans may authorize personal care
13services and related domestic services in addition to the hours
14authorized under Article 7 (commencing with Section 12300) of
15Chapter 3, which managed care health plans shall be responsible
16for paying at no share of cost to the county. The department, in
17consultation with the State Department of Social Services, shall
18develop policies and procedures for these additional benefits, which
19managed care health plans may authorize. The grievance process
20for these benefits shall be the same process as used for other
21benefits authorized by managed care health plans, and shall comply
22with Section 14450, and Sections 1368 and 1368.1 of the Health
23and Safety Code.
24(7) (A) begin deleteEffective January 1, 2015, end deletebegin insertNo later than December 31,
252017,end insertbegin insert end insertorbegin delete 19 months after commencement of beneficiary enrollment begin insert on the date the managed care health plans and
26into managed careend delete
27MSSP providers jointly satisfy the readiness criteria developedend insert
28 pursuant tobegin delete Sections 14182 and 14182.16,end deletebegin insert subparagraph (D) of
29paragraph (4) of subdivision (b) of Section 14186.3,end insert whichever is
30begin delete later,end deletebegin insert earlier,end insert MSSP services shall transition from a federal waiver
31pursuant to Section 1915(c) under the federal Social Security Act
32(42 U.S.C. Sec.begin delete 1396n et seq.)end deletebegin insert 1396n(c))end insert to a benefit administered
33and allocated by managed care health plans in Coordinated Care
34Initiative counties.
35(B) Notwithstanding Chapter 8 (commencing with Section 9560)
36of Division 8.5, it is also the intent of the Legislature that the
37provisions of this article shall apply to dual eligible and
38Medi-Cal-only beneficiaries enrolled in MSSP. It is the further
39intent of the Legislature that managed care health plans shall work
40in collaboration with MSSP providers to begin development of an
P90 1integrated, person-centered care management and care coordination
2model that works within the context of managed care, and explore
3which portions of the MSSP program model may be adapted to
4managed care while maintaining the integrity and efficacy of the
5MSSP model.
6(C) At least 30 days before the MSSP services transition to a
7benefit administered and allocated by managed care health plans
8in Coordinated Care Initiative counties, the department shall notify
9the appropriate policy and fiscal committees of the Legislature of
10its intent to transition the MSSP services to managed care health
11plans.
12(8) In lieu of providing nursing facility services, managed care
13health plans may authorize home- and community-based services
14plan benefits, as defined in subdivision (d) of Section 14186.1,
15which managed care health plans shall be responsible for paying
16at no share of cost to the county.
17(c) If the Coordinated Care Initiative becomes inoperative
18pursuant to Section 34 of Chapter 37
of the Statutes of 2013, MSSP
19services shall be governed by the provisions of Chapter 8
20(commencing with Section 9560) of Division 8.5.
begin insertSection 14186.1 of the end insertbegin insertWelfare and Institutions Codeend insert
22begin insert is amended to read:end insert
For purposes of this article, the following definitions
24shall apply unless otherwise specified:
25(a) “Coordinated Care Initiative counties” has the same meaning
26as that term is defined in paragraph (1) of subdivision (b) of Section
2714182.16.
28(b) “Home- and community-based services” means services
29provided pursuant to paragraphs (1), (2), and (3) of subdivision
30(c).
31(c) “Long-term services and supports” or “LTSS” means all of
32the following:
33(1) In-home supportive services (IHSS) provided pursuant to
34Article 7 (commencing with Section 12300) of Chapter 3, and
35Sections 14132.95, 14132.952, and
14132.956.
36(2) Community-Based Adult Services (CBAS).
37(3) Multipurpose Senior Services Program (MSSP) services,
38which include those services approved under a federal home- and
39community-based services waiver or, beginning January 1,begin delete 2015,end delete
40begin insert 2018,end insert orbegin delete after 19 months,end deletebegin insert on the date the managed care health
P91 1plans and MSSP providers jointly satisfy the readiness criteria
2developed pursuant to subparagraph (D) of paragraph (4) of
3subdivision (b) of Section 14186.3, whichever is earlier,end insert equivalent
4services.
5(4) Skilled nursing facility services and subacute care services
6established under subdivision (c) of Section 14132, including those
7services described in Sections 51511 and 51511.5 of Title 22 of
8the California Code of Regulations, regardless of whether the
9service is included in the basic daily rate or billed separately, and
10any leave of absence or bed hold provided consistent with Section
1172520 of Title 22 of the California Code of Regulations or the
12state plan. However, services provided by any category of
13intermediate care
facility for the developmentally disabled shall
14not be considered long-term services and supports.
15(d) “Home- and community-based services (HCBS) plan
16benefits” may include in-home and out-of-home respite, nutritional
17assessment, counseling, and supplements, minor home or
18environmental adaptations, habilitation, and other services that
19may be deemed necessary by the managed care health plan,
20including its care coordination team. The department, in
21consultation with stakeholders, may determine whether health
22plans shall be required to include these benefits in their scope of
23service, and may establish guidelines for the scope, duration, and
24intensity of these benefits. The grievance process for these benefits
25shall be the same process as used for other benefits authorized by
26managed care health plans, and shall comply with Section 14450,
27and Sections 1368 and 1368.1 of the Health and Safety Code.
28(e) “Managed care health plan” means an individual,
29organization, or entity that enters into a contract with the
30department pursuant to Article 2.7 (commencing with Section
3114087.3), Article 2.8 (commencing with Section 14087.5), Article
322.81 (commencing with Section 14087.96), or Article 2.91
33(commencing with Section 14089), of this chapter, or Chapter 8
34(commencing with Section 14200). For purposes of this article,
35“managed care health plan” shall not include an individual,
36organization, or entity that enters into a contract with the
37department to provide services pursuant to Chapter 8.75
38(commencing with Section 14591) or the Senior Care Action
39Network.
P92 1(f) “Other health coverage” means health coverage providing
2the same full or partial benefits as the Medi-Cal program, health
3coverage under another state or federal medical care program
4except for the Medicare Program (Title XVIII of
the federal Social
5Security Act (42 U.S.C. Sec. 1395 et seq.)), or health coverage
6under a contractual or legal entitlement, including, but not limited
7to, a private group or indemnification insurance program.
8(g) “Recipient” means a Medi-Cal beneficiary eligible for IHSS
9provided pursuant to Article 7 (commencing with Section 12300)
10of Chapter 3, and Sections 14132.95, 14132.952, and 14132.956.
11(h) “Stakeholder” shall include, but not be limited to, area
12agencies on aging and independent living centers.
begin insertSection 14186.3 of the end insertbegin insertWelfare and Institutions Codeend insert
14begin insert is amended to read:end insert
(a) (1) No sooner than July 1, 2012,
16Community-Based Adult Services (CBAS) shall be a Medi-Cal
17benefit covered under every managed care health plan contract
18and available only through managed care health plans. Medi-Cal
19beneficiaries who are eligible for CBAS shall enroll in a managed
20care health plan in order to receive those services, except for
21beneficiaries exempt under subdivision (c) of Section 14186.2 or
22in counties or geographic regions where Medi-Cal benefits are not
23covered through managed care health plans. Notwithstanding
24subdivision (a) of Section 14186.2 and pursuant to the provisions
25of an approved federal waiver or plan amendment, the provision
26of CBAS as a Medi-Cal benefit through a managed care health
27plan shall not be limited to Coordinated Care Initiative counties.
28(2) Managed care health plans shall determine a member’s
29medical need for CBAS using the assessment tool and eligibility
30criteria established pursuant to the provisions of an approved
31federal waiver or amendments and shall approve the number of
32days of attendance and monitor treatment plans of their members.
33Managed care health plans shall reauthorize CBAS in compliance
34with criteria established pursuant to the provisions of the approved
35federal waiver or amendment requirements.
36(b) (1) Beginning in the 2012 calendar year, managed care
37health plans shall collaborate with MSSP providers to begin
38development of an integrated, person-centered care management
39and care coordination model and explore how the MSSP program
40model may be adapted to managed care while maintaining the
P93 1efficacy of the MSSP model. The California Department of Aging
2and the department shall
work with the MSSP site association and
3managed care health plans to develop a template contract to be
4used by managed care health plans contracting with MSSP sites
5in Coordinated Care Initiative counties.
6(2) Notwithstanding the implementation date authorized in
7paragraph (1) of subdivision (a) of Section 14186.2,begin delete beginningend delete no
8begin delete soonerend deletebegin insert laterend insert thanbegin delete June 1, 2013,end deletebegin insert December 31, 2017,end insert or on the date
9begin delete that any necessary federal approvals or waivers are obtained,
10whichever is later, and effective January 1, 2015, or 19 months
11after commencement of beneficiary enrollment into managed careend delete
12begin insert the managed care health plans and MSSP providers jointly satisfy
13the readiness criteria developedend insert pursuant tobegin delete Sections 14182 and begin insert subparagraph (D) of paragraph (4),end insert whichever is
1414182.16,end deletebegin delete later:end delete
15begin insert earlier:end insert
16(A) Multipurpose Senior Services Program (MSSP) services
17shall be a Medi-Cal benefit available only through managed care
18health plans, except for beneficiaries exempt under subdivision
19(c) of Section 14186.2 in Coordinated Care Initiative counties.
20(B) Managed care health plans shall contract with all county
21and nonprofit organizations that are designated providers of MSSP
22services for the provision of MSSP case management and waiver
23services. These contracts shall provide for all of the following:
24(i) Managed care health plans shall allocate to the MSSP
25providers the same level of funding they would have otherwise
26received under their MSSP
contract with the California Department
27of Aging.
28(ii) MSSP providers shall continue to meet all existing federal
29waiver standards and program requirements, which include
30maintaining the contracted service levels.
31(iii) Managed care plans and MSSP providers shall share
32confidential beneficiary data with one another, as necessary to
33implement the provisions of this section.
34(C) The California Department of Aging shall continue to
35contract with all designated MSSP sites, including those in the
36counties participating in the demonstration project, and perform
37MSSP waiver oversight and monitoring.
38(D) The California Department of Aging and the department,
39in consultation with MSSP providers, managed care health plans,
40and stakeholders, shall develop service
fee structures, services,
P94 1and person-centered care coordination models that shall be effective
2June 2013, for the provision of care coordination and home- and
3community-based services to beneficiaries who are enrolled in
4managed care health plans but not enrolled in MSSP, and who
5may have care coordination and service needs that are similar to
6MSSP participants. The service fees for MSSP providers and MSSP
7services for any additional beneficiaries and additional services
8for existing MSSP beneficiaries shall be based upon, and consistent
9with, the rates and services delivered in MSSP.
10(3) In the 2014 calendar year, the provisions of paragraph (2)
11shall continue. In addition, managed care health plans shall work
12in collaboration with MSSP providers to begin development of an
13integrated, person-centered care management and care coordination
14model that works within the context of managed care and explore
15which portions of the MSSP program model
may be adapted to
16managed care while maintaining the integrity and efficacy of the
17MSSP model.
18(4) (A) begin deleteEffective January 1, 2015, or 19 months after the begin insertNo later than
19commencement of beneficiary enrollment into managed care
20pursuant to Sections 14182 and 14182.16, or end delete
21December 31, 2017, orend insertbegin insert end inserton the datebegin delete that any necessary federal begin insert the managed care health plans
22approvals or waivers are obtained,end delete
23and MSSP providers jointly satisfy the readiness criteria developed
24pursuant to subparagraph (D) of this paragraph,end insert whichever is
25begin delete later,end deletebegin insert earlier,end insert MSSP services in Coordinated Care Initiative
26counties shall transition from a federal waiver pursuant to Section
271915(c) under the federal Social Security Act (42 U.S.C. Sec.
28begin delete 1396n et seq.)end deletebegin insert 1396n(c))end insert to a benefit administered and allocated
29by managed care health plans.
30(B) No later than January 1, 2014, the department, in
31consultation with the California Department of Aging and the
32Department of Managed Health Care, and with stakeholder input,
33shall submit a transition plan to the Legislature to describe how
34subparagraph (A) shall be implemented. The plan shall incorporate
35the principles of the MSSP in the managed care benefit, and shall
36include provisions to ensure seamless transitions and continuity
37of care. Managed care health plans shall, in partnership with local
38MSSP providers, conduct a local stakeholder process to develop
39recommendations that the department shall consider when
40developing the transition plan.
P95 1(C) No later than 90 days prior to implementation of
2subparagraph (A), the department, in consultation with the
3California Department of Aging and the Department of Managed
4Health Care, and with stakeholder input, shall submit a transition
5plan to the Legislature that includes steps to address concerns, if
6any, raised by stakeholders subsequent to the plan developed
7pursuant to subparagraph (B).
8(D) Before MSSP services transition to a benefit administered
9and allocated by managed care health plans pursuant to
10subparagraph (A) of paragraph (2), the California Department of
11Aging and the department, in consultation with MSSP providers,
12managed care health plans, and stakeholders, shall develop
13readiness criteria for the transition. The readiness criteria shall
14include, but are not limited to, the mutual
agreement of the affected
15managed care health plans and MSSP providers to the transition
16date. The department shall evaluate the readiness of the managed
17care health plans and MSSP providers to commence the transition
18of MSSP services to managed care health plans.
19(E) At least 30 days before the MSSP services transition to a
20benefit administered and allocated by managed care health plans
21in Coordinated Care Initiative counties, the department shall notify
22the appropriate policy and fiscal committees of the Legislature of
23its intent to transition the MSSP services to managed care health
24plans.
25(c) (1) Not sooner than March 1, 2013, or on the date that any
26necessary federal approvals or waivers are obtained, whichever is
27later,
nursing facility services and subacute facility services shall
28be Medi-Cal benefits available only through managed care health
29plans.
30(2) Managed care health plans shall authorize utilization of
31nursing facility services or subacute facility services for their
32members when medically necessary. The managed care health
33plan shall maintain the standards for determining levels of care
34and authorization of services for both Medicare and Medi-Cal
35services that are consistent with policies established by the federal
36Centers for Medicare and Medicaid Services and consistent with
37the criteria for authorization of Medi-Cal services specified in
38Section 51003 of Title 22 of the California Code of Regulations,
39which includes utilization of the “Manual of Criteria for Medi-Cal
P96 1Authorization,” published by the department in January 1982, last
2revised April 11, 2011.
3(3) The managed care health
plan shall maintain continuity of
4care for beneficiaries by recognizing any prior treatment
5authorization made by the department for not less than six months
6following enrollment of a beneficiary into the health plan.
7(4) When a managed care health plan has authorized services
8in a facility and there is a change in the beneficiary’s condition
9under which the facility determines that the facility may no longer
10meet the needs of the beneficiary, the beneficiary’s health has
11improved sufficiently so the resident no longer needs the services
12provided by the facility, or the health or safety of individuals in
13the facility is endangered by the beneficiary, the managed care
14health plan shall arrange and coordinate a discharge of the
15beneficiary and continue to pay the facility the applicable rate until
16the beneficiary is successfully discharged and transitioned into an
17appropriate setting.
18(5) The managed care health plan shall pay providers, including
19institutional providers, in accordance with the prompt payment
20provisions contained in each health plan’s contracts with the
21department, including the ability to accept and pay electronic
22claims.
begin insertSection 15894 of the end insertbegin insertWelfare and Institutions Codeend insert
24begin insert is amended to read:end insert
begin insert(a)end insertbegin insert end insert Except as provided in Section 15894.5, the
26department shall authorize the expenditure of money in the fund
27to cover program expenses, including program expenses that exceed
28subscriber contributions, and to cover expenses relating to Section
2910127.16 of the Insurance Code, or to Section 1373.622 of the
30Health and Safety Code. The department shall determine the
31amount of funds expended for each of these purposes, taking into
32consideration the requirements of this chapter, Section 10127.16
33of the Insurance Code, and Section 1373.622 of the Health and
34Safety Code.
35(b) Following consultation with a health care service plan or
36health insurer, if the department and the health care service plan
37or health insurer have not agreed to a final reconciliation of the
38amount to be expended from the fund or to be reimbursed to the
39fund, the department shall give written notice of its determination
40to the health care service plan or health insurer of the final
P97 1reconciliation amount, as determined by the department. The health
2care service plan or health insurer shall remit payment to the
3department within 60 days of the date of notice from the
4department. If payment is not received, interest shall accrue in the
5amount of 7 percent per annum. The department may offset the
6amount to be reimbursed to the fund against any other payments
7owed to the health care service plan or health insurer by the
8department, or may negotiate a payment plan with the health care
9service plan or health insurer for full payment, and in that
case
10may waive interest accrual as long as payment from the health
11care service plan or health insurer is made in accordance with
12the payment plan. This subdivision shall control over any conflict
13or ambiguity between this subdivision and the provisions of Section
141373.622 of the Health and Safety Code, Section 10127.16 of the
15Insurance Code, Part 6.5 (commencing with Section 12700) of
16Division 2 of the Insurance Code, or this chapter.
begin insertSection 24005 of the end insertbegin insertWelfare and Institutions Codeend insert
18begin insert is amended to read:end insert
(a) This section shall apply to the Family Planning,
20Access, Care, and Treatment Program identified in subdivision
21(aa) of Section 14132 and this program.
22(b) Only licensed medical personnel with family planning skills,
23knowledge, and competency may provide the full range of family
24planning medical services covered in this program.
25(c) Medi-Cal enrolled providers, as determined by the
26department, shall be eligible to provide family planning services
27under the program when these services are within their scope of
28practice and licensure. Those clinical providers electing to
29participate in the program and approved by the department shall
30provide the full scope of family planning education, counseling,
31and
medical services specified for the program, either directly or
32by referral, consistent with standards of care issued by the
33department.
34(d) The department shall require providers to enter into clinical
35agreements with the department to ensure compliance with
36standards and requirements to maintain the fiscal integrity of the
37program. Provider applicants, providers, and persons with an
38ownership or control interest, as defined in federal medicaid
39regulations, shall be required to submit to the department their
40social security numbers to the full extent allowed under federal
P98 1law. All state and federal statutes and regulations pertaining to the
2audit or examination of Medi-Cal providers shall apply to this
3program.
4(e) Clinical provider agreements shall be signed by the provider
5under penalty of perjury. The department may screen applicants
6at the initial application and at any
reapplication pursuant to
7requirements developed by the department to determine provider
8suitability for the program.
9(f) The department may complete a background check on clinical
10provider applicants for the purpose of verifying the accuracy of
11information provided to the department for purposes of enrolling
12in the program and in order to prevent fraud and abuse. The
13background check may include, but not be limited to, unannounced
14onsite inspection prior to enrollment, review of business records,
15and data searches. If discrepancies are found to exist during the
16preenrollment period, the department may conduct additional
17inspections prior to enrollment. Failure to remediate significant
18discrepancies as prescribed by the director may result in denial of
19the application for enrollment. Providers that do not provide
20services consistent with the standards of care or that do not comply
21with the department’s rules related to the fiscal integrity of
the
22program may be disenrolled as a provider from the program at the
23sole discretion of the department.
24(g) The department shall not enroll any applicant who, within
25the previous 10 years:
26(1) Has been convicted of any felony or misdemeanor that
27involves fraud or abuse in any government program, that relates
28to neglect or abuse of a patient in connection with the delivery of
29a health care item or service, or that is in connection with the
30interference with, or obstruction of, any investigation into health
31care related fraud or abuse.
32(2) Has been found liable for fraud or abuse in any civil
33proceeding, or that has entered into a settlement in lieu of
34conviction for fraud or abuse in any government program.
35(h) In addition, the department may deny
enrollment to any
36applicant that, at the time of application, is under investigation by
37the department or any local, state, or federal government law
38enforcement agency for fraud or abuse. The department shall not
39deny enrollment to an otherwise qualified applicant whose felony
40or misdemeanor charges did not result in a conviction solely on
P99 1the basis of the prior charges. If it is discovered that a provider is
2under investigation by the department or any local, state, or federal
3government law enforcement agency for fraud or abuse, that
4provider shall be subject to immediate disenrollment from the
5program.
6(i) (1) The program shall disenroll as a program provider any
7individual who, or any entity that, has a license, certificate, or other
8approval to provide health care, which is revoked or suspended
9by a federal, California, or other state’s licensing, certification, or
10other approval authority, has otherwise lost that
license, certificate,
11or approval, or has surrendered that license, certificate, or approval
12while a disciplinary hearing on the license, certificate, or approval
13was pending. The disenrollment shall be effective on the date the
14license, certificate, or approval is revoked, lost, or surrendered.
15(2) A provider shall be subject to disenrollment if the provider
16submits claims for payment for the services, goods, supplies, or
17merchandise provided, directly or indirectly, to a program
18beneficiary, by an individual or entity that has been previously
19suspended, excluded, or otherwise made ineligible to receive,
20directly or indirectly, reimbursement from the program or from
21the Medi-Cal program and the individual has previously been listed
22on either the Suspended and Ineligible Provider List, which is
23published by the department, to identify suspended and otherwise
24ineligible providers or any list published by the federal Office of
25the Inspector
General regarding the suspension or exclusion of
26individuals or entities from the federal Medicare and medicaid
27programs, to identify suspended, excluded, or otherwise ineligible
28providers.
29(3) The department shall deactivate, immediately and without
30prior notice, the provider numbers used by a provider to obtain
31reimbursement from the program when warrants or documents
32mailed to a provider’s mailing address, its pay to address, or its
33service address, if any, are returned by the United States Postal
34Service as not deliverable or when a provider has not submitted a
35claim for reimbursement from the program for one year. Prior to
36taking this action, the department shall use due diligence in
37attempting to contact the provider at its last known telephone
38number and to ascertain if the return by the United States Postal
39Service is by mistake and shall use due diligence in attempting to
40contact the provider by telephone or in writing to ascertain
whether
P100 1the provider wishes to continue to participate in the Medi-Cal
2program. If deactivation pursuant to this section occurs, the
3provider shall meet the requirements for reapplication as specified
4in regulation.
5(4) For purposes of this subdivision:
6(A) “Mailing address” means the address that the provider has
7identified to the department in its application for enrollment as the
8address at which it wishes to receive general program
9correspondence.
10(B) “Pay to address” means the address that the provider has
11identified to the department in its application for enrollment as the
12address at which it wishes to receive warrants.
13(C) “Service address” means the address that the provider has
14identified to the department in its application for enrollment as
the
15address at which the provider will provide services to program
16beneficiaries.
17(j) Subject to Article 4 (commencing with Section 19130) of
18Chapter 5 of Part 2 of Division 5 of Title 2 of the Government
19Code, the department may enter into contracts to secure consultant
20services or information technology including, but not limited to,
21software, data, or analytical techniques or methodologies for the
22purpose of fraud or abuse detection and prevention. Contracts
23under this section shall be exempt from the Public Contract Code.
24(k) Enrolled providers shall attend specific orientation approved
25by the department in comprehensive family planning services.
26Enrolled providers who insert IUDs or contraceptive implants shall
27have received prior clinical training specific to these procedures.
28(l) Upon receipt of
reliable evidence that would be admissible
29under the administrative adjudication provisions of Chapter 5
30(commencing with Section 11500) of Part 1 of Division 3 of Title
312 of the Government Code, of fraud or willful misrepresentation
32by a provider under the program or commencement of a suspension
33under Section 14123, the department may do any of the following:
34(1) Collect any State-Only Family Planning program or Family
35Planning, Access, Care, and Treatment Program overpayment
36identified through an audit or examination, or any portion thereof
37from any provider. Notwithstanding Section 100171 of the Health
38and Safety Code, a provider may appeal the collection of
39overpayments under this section pursuant to procedures established
40in Article 5.3 (commencing with Section 14170) of Chapter 7 of
P101 1Part 3 of Division 9. Overpayments collected under this section
2shall not be returned to the provider during the pendency of any
3appeal and may be offset to
satisfy audit or appeal findings, if the
4findings are against the provider. Overpayments shall be returned
5to a provider with interest if findings are in favor of the provider.
6(2) Withhold payment for any goods or services, or any portion
7thereof, from any State-Only Family Planning program or Family
8begin delete Planning Access Careend deletebegin insert Planning, Access, Care,end insert and Treatment
9Program provider. The department shall notify the provider within
10five days of any withholding of payment under this section. The
11notice shall do all of the following:
12(A) State that payments are being withheld in accordance with
13this paragraph and that the withholding is for a temporary period
14and will not continue after it is determined that the evidence of
15fraud or willful misrepresentation is insufficient or when legal
16proceedings relating to the alleged fraud or willful
17misrepresentation are completed.
18(B) Cite the circumstances under which the withholding of the
19payments will be terminated.
20(C) Specify, when appropriate, the type or types of claimed
21payments being withheld.
22(D) Inform the provider of the right to submit written evidence
23that is evidence that would be admissible under the administrative
24adjudication provisions of Chapter 5 (commencing with Section
2511500) of Part 1 of Division 3 of Title 2 of the Government Code,
26for consideration by the department.
27(3) Notwithstanding Section 100171 of the Health and Safety
28Code, a provider may appeal a withholding of payment under this
29section pursuant to Section 14043.65. Payments withheld under
30this section shall not be returned to the provider during the
31pendency of any appeal and may be offset to satisfy audit or appeal
32findings.
33(m) As used in this section:
34(1) “Abuse” means either of the following:
35(A) Practices that are inconsistent with sound fiscal or business
36practices and result in unnecessary cost to the medicaid program,
37the Medicare program, the Medi-Cal program, including the Family
38Planning, Access, Care, and Treatment Program, identified in
39subdivision (aa) of Section 14132, another state’s medicaid
40program, or the State-Only Family Planning program, or other
P102 1health care programs operated, or financed in whole or in part, by
2the federal government or any state or local agency in this state or
3any other state.
4(B) Practices that are inconsistent with sound medical practices
5and result in reimbursement, by any of the programs referred to
6in subparagraph (A) or other health care programs operated, or
7financed in whole or in part, by the federal government or any
8state or local agency in this state or any other state, for services
9that
are unnecessary or for substandard items or services that fail
10to meet professionally recognized standards for health care.
11(2) “Fraud” means an intentional deception or misrepresentation
12made by a person with the knowledge that the deception could
13result in some unauthorized benefit to himself or herself or some
14other person. It includes any act that constitutes fraud under
15applicable federal or state law.
16(3) “Provider” means any individual, partnership, group,
17association, corporation, institution, or entity, and the officers,
18directors, owners, managing employees, or agents of any
19partnership, group, association, corporation, institution, or entity,
20that provides services, goods, supplies, or merchandise, directly
21or indirectly, to a beneficiary and that has been enrolled in the
22program.
23(4) “Convicted” means any of the following:
24(A) A judgment of conviction has been entered against an
25individual or entity by a federal, state, or local court, regardless
26of whether there is a post-trial motion or an appeal pending or the
27judgment of conviction or other record relating to the criminal
28conduct has been expunged or otherwise removed.
29(B) A federal, state, or local court has made a finding of guilt
30against an individual or entity.
31(C) A federal, state, or local court has accepted a plea of guilty
32or nolo contendere by an individual or entity.
33(D) An individual or entity has entered into participation in a
34first offender, deferred adjudication, or other program or
35arrangement where judgment of conviction has been withheld.
36(5) “Professionally recognized standards of health care” means
37statewide or national standards of care, whether in writing or not,
38that professional peers of the individual or entity whose provision
39of care is an issue, recognize as applying to those peers practicing
40or providing care within a state. When the United States
P103 1Department of Health and Human Services has declared a treatment
2modality not to be safe and effective, practitioners that employ
3that treatment modality shall be deemed not to meet professionally
4recognized standards of health care. This definition shall not be
5construed to mean that all other treatments meet professionally
6recognized standards of care.
7(6) “Unnecessary or substandard items or services” means those
8that are either of the following:
9(A) Substantially in excess of the provider’s usual
charges or
10costs for the items or services.
11(B) Furnished, or caused to be furnished, to patients, whether
12or not covered by Medicare, medicaid, or any of the state health
13care programs to which the definitions of applicant and provider
14apply, and which are substantially in excess of the patient’s needs,
15or of a quality that fails to meet professionally recognized standards
16of health care. The department’s determination that the items or
17services furnished were excessive or of unacceptable quality shall
18be made on the basis of information, including sanction reports,
19from the following sources:
20(i) The professional review organization for the area served by
21the individual or entity.
22(ii) State or local licensing or certification authorities.
23(iii) Fiscal agents or contractors, or private insurance companies.
24(iv) State or local professional societies.
25(v) Any other sources deemed appropriate by the department.
26(7) “Enrolled or enrollment in the program” means authorized
27under any and all processes by the department or its agents or
28contractors to receive, directly or indirectly, reimbursement for
29the provision of services, goods, supplies, or merchandise to a
30program beneficiary.
31(n) In lieu of, or in addition to, the imposition of any other
32sanctions available, including the imposition of a civil penalty
33under Sections 14123.2 or 14171.6, the program may impose on
34providers any or all of the penalties pursuant to Section 14123.25,
35in accordance with the provisions of that
section. In addition,
36program providers shall be subject to the penalties contained in
37Section 14107.
38(o) (1) Notwithstanding any other provision of law, every
39primary supplier of pharmaceuticals, medical equipment, or
40supplies shall maintain accounting records to demonstrate the
P104 1manufacture, assembly, purchase, or acquisition and subsequent
2sale, of any pharmaceuticals, medical equipment, or supplies, to
3providers. Accounting records shall include, but not be limited to,
4inventory records, general ledgers, financial statements, purchase
5and sales journals, and invoices, prescription records, bills of
6lading, and delivery records.
7(2) For purposes of this subdivision, the term “primary supplier”
8means any manufacturer, principal labeler, assembler, wholesaler,
9or retailer.
10(3) Accounting records
maintained pursuant to paragraph (1)
11shall be subject to audit or examination by the department or its
12agents. The audit or examination may include, but is not limited
13to, verification of what was claimed by the provider. These
14accounting records shall be maintained for three years from the
15date of sale or the date of service.
16(p) Each provider of health care services rendered to any
17program beneficiary shall keep and maintain records of each service
18rendered, the beneficiary to whom rendered, the date, and such
19additional information as the department may by regulation require.
20Records required to be kept and maintained pursuant to this
21subdivision shall be retained by the provider for a period of three
22years from the date the service was rendered.
23(q) A program provider applicant or a program provider shall
24furnish information or copies of records and documentation
25requested by
the department. Failure to comply with the
26department’s request shall be grounds for denial of the application
27or automatic disenrollment of the provider.
28(r) A program provider may assign signature authority for
29transmission of claims to a billing agent subject to Sections 14040,
3014040.1, and 14040.5.
31(s) Moneys payable or rights existing under this division shall
32be subject to any claim, lien, or offset of the State of California,
33and any claim of the United States of America made pursuant to
34federal statute, but shall not otherwise be subject to enforcement
35of a money judgment or other legal process, and no transfer or
36assignment, at law or in equity, of any right of a provider of health
37care to any payment shall be enforceable against the state, a fiscal
38intermediary, or carrier.
39(t) (1) Notwithstanding any other law, within 30 calendar days
40of receiving a complete application for enrollment into the Family
P105 1PACT Program from an affiliate primary care clinic licensed under
2Section 1218.1 of the Health and Safety Code, the department shall
3do one of the following:
4(A) Approve the provider’s Family PACT Program application,
5provided the applicant meets the Family PACT Program provider
6enrollment requirements set forth in this section.
7(B) If the provider is an enrolled Medi-Cal provider in good
8standing, notify the applicant in writing of any discrepancies in
9the Family PACT Program enrollment application. The applicant
10shall have 30 days from the date of written notice to correct any
11identified discrepancies. Upon receipt of all requested corrections,
12the department shall approve the application within 30 calendar
13days.
14(C) If the provider is not an enrolled Medi-Cal provider in good
15standing, the department shall not proceed with the actions
16described in this subdivision until the department receives
17confirmation of good standing and enrollment as a Medi-Cal
18provider.
19(2) The effective date of enrollment into the Family PACT
20Program shall be the later of the date the department receives
21confirmation of enrollment as a Medi-Cal provider, or the date the
22applicant meets all Family PACT Program provider enrollment
23requirements set forth in this section.
24(u) Providers, or the enrolling entity, shall make available to
25all applicants and beneficiaries prior to, or concurrent with,
26enrollment, information on the manner in which to apply for
27insurance
affordability programs, in a manner determined by the
28State Department of Health Care Services. The information
29provided shall include the manner in which applications can be
30submitted for insurance affordability programs, information about
31the open enrollment periods for the California Health Benefit
32Exchange, and the continuous enrollment aspect of the Medi-Cal
33program.
begin insertSection 70 of Chapter 23 of the Statutes of 2013 is
35amended to read:end insert
(a) The State Department of Health Care Services
37shall accept contributions by private foundations in the amount of
38at least fourteen million dollars ($14,000,000) for the purpose of
39this section and shall immediately seek an equal amount of federal
40matching funds.
P106 1(b) Entities and persons that are eligible for Medi-Cal in-person
2enrollment assistance payments of fifty-eight dollars ($58) per
3approved Medi-Cal application and payment processing costs shall
4be those trained and eligible for in-person enrollment assistance
5payments by the California Health Benefit Exchange. The
6payments may be made by the State Department of Health Care
7Services or through the California Health Benefit Exchange
8in-person assistance payment system.
9(c) Enrollment assistance payments shall be made only for
10Medi-Cal applicants newly eligible for coverage pursuant to the
11federal Patient Protection and Affordable Care Act (Public Law
12111-148), as amended by the Health Care and Education
13Reconciliation Act of 2010 (Public Law 111-152), or those who
14have not been enrolled in the Medi-Cal program during the
15previous 12 months prior to making the application.
16(d) The commencement of enrollment assistance payments shall
17be consistent with those of the California Health Benefit Exchange.
18(e) The State Department of Health Care Services or the
19California Health Benefit Exchange shall provide monthly and
20cumulative payment updates and number of persons enrolled
21through in-person assistance payments on its Internet Web site.
22(f) The State Department of Health Care Services shall make
23enrollment assistance payments pursuant to this section for
24submitted applications received through June 30, 2015, that result
25in approved applications. Once all of those payments have been
26made, any remaining funds described in subdivision (a) shall be
27allocated to the county outreach and enrollment grants under
28Section 71 of Chapter 23 of the Statutes of 2013. Any of those
29remaining funds that are allocated to those grants shall be
30distributed to community-based organizations providing enrollment
31assistance to prospective Medi-Cal enrollees pursuant to Section
3271 of Chapter 23 of the Statutes of 2013. The State Department of
33Health Care Services shall make authorized payments to counties
34for distribution to community-based organizations. Counties that
35receive money pursuant to this subdivision may retain an amount
36for administrative costs not to exceed 10 percent of grants
37approved by
the State Department of Health Care Services. The
38State Department of Health Care Services shall require progress
39reports, in a manner as determined by the department, from those
40receiving allocations under this subdivision. The State Department
P107 1of Health Care Services shall make an initial allocation to the
2counties for these funds no later than January 1, 2016, and the
3final allocation no later than June 30, 2016.
4(g) This section shall be inoperative and cease to be
5implemented on the date that all of the private contributions
6accepted pursuant to subdivision (a) and any federal matching
7funds have been exhausted.
begin insertSection 71 of Chapter 23 of the Statutes of 2013, as
9amended by Section 4 of Chapter 361 of the Statues of 2013, is
10amended to read:end insert
(a) (1) The State Department of Health Care Services
12shall accept funding from private foundations in the amount of at
13least $12.5 million to provide allocations for the management and
14funding of Medi-Cal outreach and enrollment plans specific to the
15provisions contained in this section.
16(2) The department shall seek necessary federal approval for
17purposes of obtaining federal funding for activities conducted
18under this section.
19(3) Notwithstanding any other law, and in a manner that the
20Director of Health Care Services shall provide, the department
21may make allocations to fund Medi-Cal outreach and enrollment
22activities as described in this section.
23(b) (1) Funds appropriated by the Legislature to the department
24for the purposes of this section shall be made available to selected
25counties, counties acting jointly, and the County Medical Services
26Program Governing Board pursuant to Section 16809 of the
27Welfare and Institutions Code.
28(2) Selected counties, counties acting jointly, and the County
29Medical Services Program Governing Board may partner with
30community-based organizations as applicable to conduct outreach
31and enrollment to the target population as contained in subdivision
32(d).
33(3) The director may, at his or her discretion, also give
34consideration to community-based organizations in an area or
35region of the state if a county, or counties acting jointly do not
36seek an allocation or funds are made available.
37(4) For purposes of this section only, “county” shall be defined
38as county, city and county, a consortium of counties serving a
39region consisting of more than one county, the County Medical
40Services Program Governing Board, or a health authority.
P108 1(c) (1) The allocations shall be apportioned geographically, by
2the entities identified in subdivision (b), according to the estimated
3number of persons who are eligible but not enrolled in Medi-Cal
4and who will be newly Medi-Cal eligible as of January 1, 2014.
5(2) The department may determine the number of allocations
6and the application process. The director may consult or obtain
7technical assistance from private foundations in implementation
8of the application and allocation process.
9(3) The department shall coordinate and partner with the
10California Health Benefit Exchange on certified application assister
11and outreach, enrollment, and marketing activities related to the
12federal Patient Protection and Affordable Care Act.
13(d) Notwithstanding any other law, the department shall develop
14selection criteria to allocate funds for the Medi-Cal outreach and
15enrollment activities with special emphasis targeting all of the
16following populations:
17(1) Persons with mental health disorder needs.
18(2) Persons with substance use disorder needs.
19(3) Persons who are homeless.
20(4) Young men of color.
21(5) Persons who are in county jail, in state prison, on state
22parole, on county probation, or under postrelease community
23supervision.
24(6) Families of mixed-immigration status.
25(7) Persons with limited English proficiency.
26(e) (1) The funds allocated under this section shall be used only
27for the Medi-Cal outreach and enrollment activities and may
28supplement, but shall not supplant, existing local, state, and
29foundation funding of county outreach and enrollment activities.
30(2) Notwithstanding Section 10744 of the Welfare and
31Institutions Code, the department may recoup or withhold all or
32part of an allocation for failure to comply with any requirements
33or standards set forth by the department for the purposes of this
34
section.
35(f) The department shall begin the payment for the outreach and
36enrollment allocation program no later than February 1, 2014.
37(g) Under the terms of the approved allocation for the outreach
38and enrollment program, funded entities under this section shall
39not receive payment for in-person assister payments for assisting
40potential Medi-Cal enrollees.
P109 1(h) The department shall require progress reports, in a manner
2as determined by the department, from those receiving allocations
3under this section.
4(i) To the extent federal funding is received for the services
5specified in this section, reimbursements for costs incurred under
6the approved allocations shall be made in compliance with federal
7law.
8(j) Notwithstanding Chapter 3.5 (commencing with Section
911340) of Part 1 of Division 3 of Title 2 of the Government Code,
10the department may implement, interpret, or make specific this
11section by means of all-county letters, provider bulletins, or similar
12instructions.
13(k) This section shall become inoperative on June 30, 2018.
end insert
begin insertSection 5 of Chapter 361 of the Statutes of 2013 is
15amended to read:end insert
(a) The Healthcare Outreach and Medi-Cal Enrollment
17Account is hereby created in the Special Deposit Fund within the
18State Treasury in order to collect and allocate non-General Fund
19public or private grant funds, to be expended upon appropriation
20by the Legislature, for the purposes of outreach to and enrollment
21of targeted Medi-Cal populations and to compensate Medi-Cal
22in-person assisters, as specified in Sections 70 and 71 of Chapter
2323 of the Statutes of 2013.
24(b) There is hereby appropriated to the State Department of
25Health Care Services the following sums to compensate eligible
26Medi-Cal in-person assisters as specified in Section 70 of Chapter
2723 of the Statues of 2013:
28(1) The sum of fourteen million
dollars ($14,000,000) from the
29Healthcare Outreach and Medi-Cal Enrollment Account, to be
30available for encumbrance or expenditure until June 30,begin delete 2016end deletebegin insert 2018end insert.
31(2) The sum of fourteen million dollars ($14,000,000) from the
32Federal Trust Fund, to be available for encumbrance or expenditure
33until June 30,begin delete 2016end deletebegin insert 2018end insert.
34(3) After June 30, 2015, the State Department of Health Care
35Services is authorized to expend all or any portion
of the remaining
36funds targeted for payment of enrollment assistance for Medi-Cal
37applications in the Healthcare Outreach and Medi-Cal Enrollment
38Account that has been created within the Special Deposit Fund
39within the State Treasury and any matching federal funds, as
40specified in paragraph (2), for the funding of allocations for
P110 1Medi-Cal Outreach And Enrollment plans, as specified in Section
271 of Chapter 23 of the Statutes of 2013, as amended by the act
3the added this paragraph.
4(c) There is hereby appropriated to the State Department of
5Health Care Services the following sums to provide allocations
6for outreach and enrollment grants to eligible entities as specified
7in Section 71 of Chapter 23 of the Statutes of 2013:
8(1) The sum of twelve million five hundred thousand dollars
9($12,500,000) from the Healthcare Outreach and Medi-Cal
10Enrollment Account,
to be available for encumbrance or
11expenditure until June 30,begin delete 2016end deletebegin insert 2018end insert.
12(2) The sum of twelve million five hundred thousand dollars
13($12,500,000) from the Federal Trust Fund, to be available for
14encumbrance or expenditure until June 30,begin delete 2016end deletebegin insert 2018end insert.
15(d) Of the amounts appropriated in subdivisions (b) and (c), the
16State Department of Health Care Services may expend in aggregate
17up to five hundred thousand dollars ($500,000) annually in fiscal
18years 2013-14, 2014-15, and 2015-16, inclusive, to administer
19
the activities described in Sections 70 and 71 of Chapter 23 of the
20Statutes of 2013, including funding for four three-year limited-term
21positions, which are hereby authorized to be established. Any
22private foundation funding expended by the department to
23administer the activities under Sections 70 and 71 of Chapter 23
24of the Statutes of 2013 shall be expended only for filled positions
25and administrative expenses directly related to these sections.
26(e) The State Department of Health Care Services may expend,
27in aggregate, up to five hundred thousand dollars ($500,000)
28annually for the 2016-17 and 2017-18 fiscal years, to administer
29the activities described in Sections 70 and 71 of Chapter 23 of the
30Statutes of 2013, and Section 1 of Chapter 551 of the Statutes of
312014, as amended by that act that added this subdivision. Any
32private foundation funding expended by
the department for
33administration shall be expended only for the administrative
34expenses directly related to Sections 70 and 71 of Chapter 23 of
35the Statutes of 2013, and Section 1 of Chapter 551 of the Statutes
36of 2014.
37(e)
end delete
38begin insert(f)end insert This section shall become inoperative on June 30,begin delete 2018,end delete
39begin insert 2020,end insert and, as of January 1,begin delete 2019,end deletebegin insert
2021,end insert is repealed, unless a later
40enacted statute, that becomes operative on or before January 1,
P111 1begin delete 2019,end deletebegin insert 2021,end insert deletes or extends the dates on which it becomes
2inoperative and is repealed.
begin insertSection 1 of Chapter 551 of the Statutes of 2014 is
4amended to read:end insert
(a) (1) The State Department of Health Care
6Services shall accept contributions by private foundations in the
7amount of at least six million dollars ($6,000,000) for the purpose
8of providing Medi-Cal renewal assistance payments starting
9January 1, 2015. These contributions shall be deposited in the
10Healthcare Outreach and Medi-Cal Enrollment Account that has
11been created in the Special Deposit Fund within the State Treasury
12for the purposes specified in this section.
13(2) There is hereby appropriated to the State Department of
14Health Care Services the following sums for the purposes specified
15in this section:
16(A) The sum of six million dollars ($6,000,000) from the
17Healthcare Outreach
and Medi-Cal Enrollment Account, to be
18available for encumbrance or expenditure untilbegin delete December 31, 2016end delete
19begin insert
June 30, 2018end insert.
20(B) The sum of six million dollars ($6,000,000) from the Federal
21Trust Fund, to be available for encumbrance or expenditure until
22begin delete December 31, 2016end deletebegin insert June 30, 2018end insert.
23(3) The department may expend a portion of the five hundred
24thousand dollars ($500,000) authorized for expenditure in
25subdivision (d) of Section 5 of Chapter 361 of the Statutes of 2013
26to administer the activities described in this section. Private
27foundation funding expended by the department to administer the
28activities described in this section shall be expended only for filled
29positions and administrative expenses directly related to this
30section.
31(b) (1) Notwithstanding any other law, and in a manner that
32the Director of the State Department of Health Care Services shall
33provide, the department may make allocations to fund Medi-Cal
34renewal assistance activities as described in this section.
35(2) The department may determine the number of allocations
36and the application process. The director may consult or obtain
37technical assistance from private foundations in implementation
38of the application and allocation process.
39(3) The director may, at his or her discretion, give consideration
40to distributing funds to community-based organizations in an area
P112 1or region of the state if a county or counties, acting jointly, do not
2seek an allocation or if funds are made available.
3(c) Renewal assistance payments shall be distributed to
4community-based organizations providing renewal assistance to
5Medi-Cal beneficiaries. Authorized payments shall be made to
6counties by the department for distribution of funds to
7community-based organizations. Counties may retain an amount
8for administrative costs that have been approved by the department.
9(d) The department, in collaboration with the County Welfare
10Directors Association and legal services organizations, shall
11develop renewal assistance training for employees of
12community-based organizations that shall be consistent with the
13counties’ human services agencies Medi-Cal redetermination
14timeframes and process. In order to be eligible for renewal
15assistance payments under this section, the community-based
16organization’s employees providing the assistance shall have
17completed the renewal assistance training developed under this
18subdivision.
19(e) (1) The funds allocated under this section shall be used only
20for the Medi-Cal renewal assistance activities and may supplement,
21but shall not supplant, existing local, state, and foundation funding
22of county renewal assistance activities.
23(2) Notwithstanding Section 10744 of the Welfare and
24Institutions Code, the department may recoup or withhold all or
25part of an allocation for failure to comply with any requirements
26or standards set forth by the department for the purposes of this
27section.
28(f) The department shall require progress reports, in a manner
29as determined by the department, from those receiving allocations
30under this section.
31(g) The department shall seek federal matching funds for the
32contributions to the extent
permissible for training, testing,
33certifying, supporting, and compensating persons and entities
34providing renewal assistance and for any other permissible renewal
35assistance related activities and shall seek all necessary federal
36approvals for purposes of obtaining federal funding for activities
37conducted under this section.
38(h) To the extent federal funding is received for the services
39specified in this section, reimbursements for costs incurred under
P113 1the approved allocations shall be made in compliance with federal
2law.
3(i) 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, interpret, or make specific this
6section by means of all-county letters, provider bulletins, or similar
7instructions.
8(j) This section shall cease
to be implemented when all of the
9private contributions and any federal matching funds have been
10exhausted.
The sum of fifty million dollars ($50,000,000) is
12hereby appropriated from the Health Home Program Account to
13the State Department of Health Care Services for the purposes of
14implementing the Health Home Program established pursuant to
15Article 3.9 (commencing with Section 14127) of Chapter 7 of Part
163 of Division 9 of the Welfare and Institutions Code.
17Notwithstanding Section 16304 of the Government Code, this
18appropriation shall be available for encumbrance or expenditure
19until June 30, 2020.
(a) For the 2015-16 fiscal year, and upon an
21appropriation of funds by the Legislature for this purpose, the
22State Department of Health Care Services shall provide a grant
23to health benefit plans that meet all of the following requirements:
24(1) The health benefit plan has a valid exemption letter from
25the Internal Revenue Service pursuant to Section 501(c)(9) of the
26Internal Revenue Code.
27(2) The health benefit plan is a multiemployer plan, as defined
28in Section
3(37) of the federal Employee Retirement Income
29Security Act of 1974 (29 U.S.C. Sec. 1002(37)(A)).
30(3) The health benefit plan is funded by contributions made by
31agricultural employers, as defined in subdivision (c) of the Section
321140.4 of the Labor Code, where 85 percent or more of the plan’s
33eligible participants are agricultural employees, as defined in
34subdivision (b) of Section 1140.4 of the Labor Code, for work
35performed and covered under a collective bargaining agreement.
36(b) On or before September 1, 2015, the State Department of
37Health Care Services shall pay the funds allocated pursuant to
38this section to the health plan that meets the criteria set forth in
39this section. The funds shall be used to provide health care
40coverage for agricultural employees and dependents.
P114 1(c) The payment set forth in
subdivision (b) shall not require
2the State Department of Health Care Services to contract with the
3recipient of the funds nor shall the payment of funds be subject to
4the requirements of Part 2 (commencing with Section 10100) of
5Division 2 of the Public Contract Code.
(a) For the 2015-16 fiscal year, and upon an
7appropriation of funds by the Legislature for this purpose, the
8State Department of Health Care Services shall provide a grant
9to LifeLong Medical Care, a federally qualified health center in
10Contra Costa County.
11(b) On or before September 1, 2015, the State Department of
12Health Care Services shall pay the funds allocated pursuant to
13this section to LifeLong Medical Care. The funds shall be
14considered a grant to be used to support LifeLong Medical Care
15and are not a payment for
services.
16(c) To the extent allowable by federal law, the grant received
17pursuant to subdivision (b) is not income for the purposes of the
18prospective payment system rate setting or rate reconciliations
19that are conducted by the State Department of Health Care Services
20for LifeLong Medical Care.
21(d) The grant made pursuant to subdivision (b) does not require
22the State Department of Health Care Services to contract with the
23recipient of the funds, nor is the grant subject to the requirements
24of Part 2 (commencing with Section 10100) of Division 2 of the
25Public Contract Code.
(a) For the 2015-16 fiscal year, the California Health
27Facilities Financing Authority (CHFFA) may authorize up to three
28million dollars ($3,000,000) in unencumbered funds, as
29appropriated in Item 0977-101-0001 for Mental Health Wellness
30Grants, of Section 2.00 of the Budget Act of 2013, to develop peer
31respite sites.
32(b) Any grant awards authorized by CHFFA for peer respite
33sites shall be used to expand local resources for the development,
34capital, equipment acquisition, and applicable program startup
35or expansion costs to
increase bed capacity for peer respite support
36services. This may include, but not be limited to, the purchase of
37property, purchase of equipment, and the remodeling or
38construction of housing for the purposes of operating a peer respite
39site.
P115 1(c) Any recipient of a grant to develop peer respite sites shall
2adhere to all applicable laws relating to scope of practice,
3licensure, certification, staffing, and building codes.
4(d) CHFFA may adopt emergency regulations relating to grants
5for peer respite sites, including emergency regulations that define
6eligible costs, and determine minimum and maximum grant
7amounts. The adoption, amendments, or repeal of these regulations
8shall be in accordance with the Administrative Procedure Act
9(Chapter 3.5 (commencing with Section 11340) of Part 1 of
10Division 3 of Title 2 of the Government Code) and shall be deemed
11to be an emergency and
necessary for the immediate preservation
12of the public peace, health, safety, or general welfare.
The Office of System Integration shall report to the
14Legislature by April 1, 2017, on the feasibility, benefits, costs, and
15risks of installing the Modified Adjusted Gross Income (MAGI)
16Eligibility Decision Engine in one, two, or all of the Statewide
17Automated Welfare System consortia systems.
The Legislature finds and declares that the sections
19of this act that amend Section 120962 of the Health and Safety
20Code and Section 19548.2 of the Revenue and Taxation Code
21impose a limitation on the public’s right of access to the meetings
22of public bodies or the writings of public officials and agencies
23within the meaning of Section 3 of Article I of the California
24Constitution. Pursuant to that constitutional provision, the
25Legislature makes the following findings to demonstrate the interest
26protected by this limitation and the need for protecting that
27interest:
28In order to continue to protect the confidentiality of public health
29records under specified provisions of this act, the limitations on
30the public’s right of access imposed under this act are necessary.
The Legislature finds and declares that a special law
32is necessary and that a general law cannot be made applicable
33within the meaning of Section 16 of Article IV of the California
34Constitution because of the unique circumstances regarding
35providing urgent care to the citizens of Contra Costa County.
No reimbursement is required by this act pursuant
37to Section 6 of Article XIII B of the California Constitution for
38certain costs that may be incurred by a local agency or school
39district because, in that regard, this act creates a new crime or
40infraction, eliminates a crime or infraction, or changes the penalty
P116 1for a crime or infraction, within the meaning of Section 17556 of
2the Government Code, or changes the definition of a crime within
3the meaning of Section 6 of Article XIII B of the California
4Constitution.
5However, if the Commission on State Mandates determines that
6this act contains other costs mandated by the state, reimbursement
7to local agencies and school districts for those costs shall be made
8pursuant to Part 7 (commencing with Section 17500) of Division
94 of Title 2 of the Government Code.
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.
It is the intent of the Legislature to enact statutory
16changes relating to the Budget Act of 2015.
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