Amended in Assembly April 15, 2015

California Legislature—2015–16 Regular Session

Assembly BillNo. 741


Introduced by Assembly Member Williams

February 25, 2015


An act tobegin insert amend Section 1502 of the Health and Safety Code, and toend insert amend Section 14132 of the Welfare and Institutions Code, relating tobegin delete Medi-Cal.end deletebegin insert mental health.end insert

LEGISLATIVE COUNSEL’S DIGEST

AB 741, as amended, Williams. begin deleteMedi-Cal: comprehensive end deletebegin insertComprehensive end insertmental health crisis services.

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. Existing law provides for a schedule of benefits under the Medi-Cal program, which includes early and periodic screening, diagnosis, and treatment for any individual under 21 years of age.

This bill would add to the schedule of benefits comprehensive mental health crisis services, including crisis intervention, crisis stabilization, crisis residential treatment, rehabilitative mental health services, and mobile crisis support teams, to the extent that federal financial participation is available and any necessary federal approvals have been obtained.

begin insert

Existing law, the California Community Care Facilities Act, provides for the licensing and regulation of community care facilities, as defined, by the State Department of Social Services. Existing law includes within the definition of community care facility, a social rehabilitation facility, which is a residential facility that provides social rehabilitation services in a group setting to adults recovering from mental illness. A violation of the act is a misdemeanor.

end insert
begin insert

This bill would expand the definition of a social rehabilitation facility to include a residential facility that provides social rehabilitation services in a group setting to children, adolescents, or adults recovering from mental illness or in a mental health crisis. By expanding the types of facilities that are regulated as a community care facility, this bill would expand the scope of an existing crime, thus creating a state-mandated local program.

end insert
begin insert

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 insert
begin insert

This bill would provide that no reimbursement is required by this act for a specified reason.

end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: begin deleteno end deletebegin insertyesend insert.

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

P2    1

SECTION 1.  

The Legislature finds and declares all of the
2following:

3(a) There is an urgent need to provide more crisis care
4alternatives to hospitals forbegin delete individualsend deletebegin insert children and youthend insert
5 experiencing mental health crises.

6(b) The problems are especially acute for childrenbegin insert and youthend insert
7 who may have to wait for days for a hospital bed and who may be
8transported, without a parent, to the nearest facility hundreds of
9miles away.

10(c) In 2012, the California Hospital Association reported that
11two-thirds of the people taken to a hospital for a psychiatric
12emergency did not meet the criteria for that level of care but the
13care they needed was not available.

14(d) The type of care that is needed includes crisisbegin delete stabilization,end delete
15begin insert stabilization andend insert crisis residentialbegin delete treatment, mobile crisis support
16teams, and in-home crisis careend delete
begin insert treatmentend insert for children.

17(e) This level of care is part of the full continuum of care
18considered medically necessary for many children with serious
P3    1emotionalbegin delete disturbances and adults with severe mental illnesses.end delete
2begin insert disturbances.end insert

3(f) In 2013, the Legislature enactedbegin delete Senate Bill 82 (Chapterend deletebegin insert the
4Investment in Mental Health Wellness Act (Senate Bill 82, Chapterend insert

5 34 of the Statutes of 2013) to provide one-time funding to counties
6to expand the availability ofbegin delete theseend delete mental health crisis care
7begin delete facilities. However, very few of these facilities can accommodate
8children.end delete
begin insert services, including short-term crisis residential treatment
9services. However, there is currently no state licensing category
10for short-term crisis residential programs for children. As a result,
11counties wanting to expand local capacity to meet the needs of
12children and youth for crisis residential treatment services were
13ineligible for this competitive grant program.end insert

begin delete

14(g) There is currently no state licensing category for crisis
15residential programs for children. Federal Medicaid provisions
16require, however, that services be equal in amount, duration, and
17scope for all individuals within each eligibility category. It is
18essential that children receive the same range of services as adults
19with mental health conditions.

end delete
begin insert

20(g) Federal Medicaid provisions allow for federal matching
21funds for mental health services delivered to Medi-Cal beneficiaries
22under 21 years of age in psychiatric residential treatment facilities,
23including short-term crisis residential treatment programs.
24However, because there is currently no state licensing category
25for crisis residential treatment programs for children, California
26is unable to benefit from these otherwise available federal financial
27resources.

end insert

28(h) In mostbegin delete private health plans this level of careend deletebegin insert communities,
29inpatient crisis treatmentend insert
is completely unavailable for children
30andbegin delete adultsend deletebegin insert youthend insert even though it may be medically necessary.

31(i) Crisisbegin insert residentialend insert care is an essential level of care for the
32begin delete rehabilitation of individuals with serious emotional disturbances
33and severe mental illnesses,end delete
begin insert treatment of children and youth with
34serious emotional disturbances in a mental health crisis,end insert
and it
35often serves as an alternative to hospitalization.

36(j) It is imperative that publicbegin delete and privateend delete health care coverage
37include these services as a covered benefit.

38begin insert

begin insertSEC. 2.end insert  

end insert

begin insertSection 1502 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is amended
39to read:end insert

40

1502.  

As used in this chapter:

P4    1(a) “Community care facility” means any facility, place, or
2building that is maintained and operated to provide nonmedical
3residential care, day treatment, adult day care, or foster family
4agency services for children, adults, or children and adults,
5including, but not limited to, the physically handicapped, mentally
6impaired, incompetent persons, and abused or neglected children,
7and includes the following:

8(1) “Residential facility” means any family home, group care
9facility, or similar facility determined by the director, for 24-hour
10nonmedical care of persons in need of personal services,
11supervision, or assistance essential for sustaining the activities of
12daily living or for the protection of the individual.

13(2) “Adult day program” means any community-based facility
14or program that provides care to persons 18 years of age or older
15in need of personal services, supervision, or assistance essential
16for sustaining the activities of daily living or for the protection of
17these individuals on less than a 24-hour basis.

18(3) “Therapeutic day services facility” means any facility that
19provides nonmedical care, counseling, educational or vocational
20support, or social rehabilitation services on less than a 24-hour
21basis to persons under 18 years of age who would otherwise be
22placed in foster care or who are returning to families from foster
23care. Program standards for these facilities shall be developed by
24the department, pursuant to Section 1530, in consultation with
25therapeutic day services and foster care providers.

26(4) “Foster family agency” means any organization engaged in
27the recruiting, certifying, and training of, and providing
28professional support to, foster parents, or in finding homes or other
29places for placement of children for temporary or permanent care
30who require that level of care as an alternative to a group home.
31Private foster family agencies shall be organized and operated on
32a nonprofit basis.

33(5) “Foster family home” means any residential facility
34providing 24-hour care for six or fewer foster children that is
35owned, leased, or rented and is the residence of the foster parent
36or parents, including their family, in whose care the foster children
37have been placed. The placement may be by a public or private
38child placement agency or by a court order, or by voluntary
39placement by a parent, parents, or guardian. It also means a foster
40family home described in Section 1505.2.

P5    1(6) “Small family home” means any residential facility, in the
2licensee’s family residence, that provides 24-hour care for six or
3fewer foster children who have mental disorders or developmental
4or physical disabilities and who require special care and supervision
5as a result of their disabilities. A small family home may accept
6children with special health care needs, pursuant to subdivision
7(a) of Section 17710 of the Welfare and Institutions Code. In
8addition to placing children with special health care needs, the
9department may approve placement of children without special
10health care needs, up to the licensed capacity.

11(7) “Social rehabilitation facility” means any residential facility
12that provides social rehabilitation services for no longer than 18
13months in a group setting tobegin delete adultsend deletebegin insert individuals, including children,
14adolescents, and adults,end insert
recovering from mental illnessbegin insert or in a
15mental health crisisend insert
who temporarily need assistance, guidance,
16or counseling. Program components shall be subject to program
17standards pursuant to Article 1 (commencing with Section 5670)
18of Chapter 2.5 of Part 2 of Division 5 of the Welfare and
19Institutions Code.

20(8) “Community treatment facility” means any residential
21facility that provides mental health treatment services to children
22in a group setting and that has the capacity to provide secure
23containment. Program components shall be subject to program
24standards developed and enforced by the State Department of
25Health Care Services pursuant to Section 4094 of the Welfare and
26Institutions Code.

27Nothing in this section shall be construed to prohibit or
28discourage placement of persons who have mental or physical
29disabilities into any category of community care facility that meets
30the needs of the individual placed, if the placement is consistent
31with the licensing regulations of the department.

32(9) “Full-service adoption agency” means any licensed entity
33engaged in the business of providing adoption services, that does
34all of the following:

35(A) Assumes care, custody, and control of a child through
36relinquishment of the child to the agency or involuntary termination
37of parental rights to the child.

38(B) Assesses the birth parents, prospective adoptive parents, or
39child.

40(C) Places children for adoption.

P6    1(D) Supervises adoptive placements.

2Private full-service adoption agencies shall be organized and
3operated on a nonprofit basis. As a condition of licensure to provide
4intercountry adoption services, a full-service adoption agency shall
5be accredited and in good standing according to Part 96 of Title
622 of the Code of Federal Regulations, or supervised by an
7accredited primary provider, or acting as an exempted provider,
8in compliance with Subpart F (commencing with Section 96.29)
9of Part 96 of Title 22 of the Code of Federal Regulations.

10(10) “Noncustodial adoption agency” means any licensed entity
11engaged in the business of providing adoption services, that does
12all of the following:

13(A) Assesses the prospective adoptive parents.

14(B) Cooperatively matches children freed for adoption, who are
15under the care, custody, and control of a licensed adoption agency,
16for adoption, with assessed and approved adoptive applicants.

17(C) Cooperatively supervises adoptive placements with a
18full-service adoptive agency, but does not disrupt a placement or
19remove a child from a placement.

20Private noncustodial adoption agencies shall be organized and
21operated on a nonprofit basis. As a condition of licensure to provide
22intercountry adoption services, a noncustodial adoption agency
23shall be accredited and in good standing according to Part 96 of
24Title 22 of the Code of Federal Regulations, or supervised by an
25accredited primary provider, or acting as an exempted provider,
26in compliance with Subpart F (commencing with Section 96.29)
27of Part 96 of Title 22 of the Code of Federal Regulations.

28(11) “Transitional shelter care facility” means any group care
29facility that provides for 24-hour nonmedical care of persons in
30need of personal services, supervision, or assistance essential for
31sustaining the activities of daily living or for the protection of the
32 individual. Program components shall be subject to program
33standards developed by the State Department of Social Services
34pursuant to Section 1502.3.

35(12) “Transitional housing placement provider” means an
36organization licensed by the department pursuant to Section
371559.110 and Section 16522.1 of the Welfare and Institutions Code
38to provide transitional housing to foster children at least 16 years
39of age and not more than 18 years of age, and nonminor
40dependents, as defined in subdivision (v) of Section 11400 of the
P7    1Welfare and Institutions Code, to promote their transition to
2adulthood. A transitional housing placement provider shall be
3privately operated and organized on a nonprofit basis.

4(13) “Group home” means a residential facility that provides
524-hour care and supervision to children, delivered at least in part
6by staff employed by the licensee in a structured environment. The
7care and supervision provided by a group home shall be
8nonmedical, except as otherwise permitted by law.

9(14) “Runaway and homeless youth shelter” means a group
10home licensed by the department to operate a program pursuant
11to Section 1502.35 to provide voluntary, short-term, shelter and
12personal services to runaway youth or homeless youth, as defined
13in paragraph (2) of subdivision (a) of Section 1502.35.

14(15) “Enhanced behavioral supports home” means a facility
15certified by the State Department of Developmental Services
16pursuant to Article 3.6 (commencing with Section 4684.80) of
17Chapter 6 of Division 4.5 of the Welfare and Institutions Code,
18and licensed by the State Department of Social Services as an adult
19residential facility or a group home that provides 24-hour
20nonmedical care to individuals with developmental disabilities
21who require enhanced behavioral supports, staffing, and
22supervision in a homelike setting. An enhanced behavioral supports
23home shall have a maximum capacity of four consumers, shall
24conform to Section 441.530(a)(1) of Title 42 of the Code of Federal
25Regulations, and shall be eligible for federal Medicaid home- and
26community-based services funding.

27(16) “Community crisis home” means a facility certified by the
28State Department of Developmental Services pursuant to Article
298 (commencing with Section 4698) of Chapter 6 of Division 4.5
30of the Welfare and Institutions Code, and licensed by the State
31Department of Social Services pursuant to Article 9.7 (commencing
32with Section 1567.80), as an adult residential facility, providing
3324-hour nonmedical care to individuals with developmental
34disabilities receiving regional center service, in need of crisis
35intervention services, and who would otherwise be at risk of
36admission to the acute crisis center at Fairview Developmental
37Center, Sonoma Developmental Center, an acute general hospital,
38acute psychiatric hospital, an institution for mental disease, as
39described in Part 5 (commencing with Section 5900) of Division
405 of the Welfare and Institutions Code, or an out-of-state
P8    1placement. A community crisis home shall have a maximum
2capacity of eight consumers, as defined in subdivision (a) of
3Section 1567.80, shall conform to Section 441.530(a)(1) of Title
442 of the Code of Federal Regulations, and shall be eligible for
5federal Medicaid home- and community-based services funding.

6(17) “Crisis nursery” means a facility licensed by the department
7to operate a program pursuant to Section 1516 to provide short-term
8care and supervision for children under six years of age who are
9voluntarily placed for temporary care by a parent or legal guardian
10due to a family crisis or stressful situation.

11(b) “Department” or “state department” means the State
12Department of Social Services.

13(c) “Director” means the Director of Social Services.

14

begin deleteSEC. 2.end delete
15begin insertSEC. 3.end insert  

Section 14132 of the Welfare and Institutions Code is
16amended to read:

17

14132.  

The following is the schedule of benefits under this
18chapter:

19(a) Outpatient services are covered as follows:

20Physician, hospital or clinic outpatient, surgical center,
21respiratory care, optometric, chiropractic, psychology, podiatric,
22occupational therapy, physical therapy, speech therapy, audiology,
23acupuncture to the extent federal matching funds are provided for
24acupuncture, and services of persons rendering treatment by prayer
25or healing by spiritual means in the practice of any church or
26religious denomination insofar as these can be encompassed by
27federal participation under an approved plan, subject to utilization
28controls.

29(b) (1) Inpatient hospital services, including, but not limited
30to, physician and podiatric services, physicalbegin delete therapyend deletebegin insert therapy,end insert and
31occupational therapy, are covered subject to utilization controls.

32(2) For Medi-Cal fee-for-service beneficiaries, emergency
33services and care that are necessary for the treatment of an
34emergency medical condition and medical care directly related to
35the emergency medical condition. This paragraph shall not be
36construed to change the obligation of Medi-Cal managed care
37plans to provide emergency services and care. For the purposes of
38this paragraph, “emergency services and care” and “emergency
39medical condition” shall have the same meanings as those terms
40are defined in Section 1317.1 of the Health and Safety Code.

P9    1(c) Nursing facility services, subacute care services, and services
2provided by any category of intermediate care facility for the
3developmentally disabled, including podiatry, physician, nurse
4practitioner services, and prescribed drugs, as described in
5subdivision (d), are covered subject to utilization controls.
6Respiratory care, physical therapy, occupational therapy, speech
7therapy, and audiology services for patients in nursing facilities
8and any category of intermediate care facility for the
9developmentally disabled are covered subject to utilization controls.

10(d) (1) Purchase of prescribed drugs is covered subject to the
11Medi-Cal List of Contract Drugs and utilization controls.

12(2) Purchase of drugs used to treat erectile dysfunction or any
13off-label uses of those drugs are covered only to the extent that
14federal financial participation is available.

15(3) (A) To the extent required by federal law, the purchase of
16outpatient prescribed drugs, for which the prescription is executed
17by a prescriber in written, nonelectronic form on or after April 1,
182008, is covered only when executed on a tamper resistant
19prescription form. The implementation of this paragraph shall
20conform to the guidance issued by the federal Centers for Medicare
21and Medicaid Services but shall not conflict with state statutes on
22the characteristics of tamper resistant prescriptions for controlled
23substances, including Section 11162.1 of the Health and Safety
24Code. The department shall provide providers and beneficiaries
25with as much flexibility in implementing these rules as allowed
26by the federal government. The department shall notify and consult
27with appropriate stakeholders in implementing, interpreting, or
28making specific this paragraph.

29(B) Notwithstanding Chapter 3.5 (commencing with Section
3011340) of Part 1 of Division 3 of Title 2 of the Government Code,
31the department may take the actions specified in subparagraph (A)
32by means of a provider bulletin or notice, policy letter, or other
33similar instructions without taking regulatory action.

34(4) (A) (i) For the purposes of this paragraph, nonlegend has
35the same meaning as defined in subdivision (a) of Section
3614105.45.

37(ii) Nonlegend acetaminophen-containing products, with the
38exception of children’s acetaminophen-containing products,
39selected by the department are not covered benefits.

P10   1(iii) Nonlegend cough and cold products selected by the
2department are not covered benefits. This clause shall be
3implemented on the first day of the first calendar month following
490 days after the effective date of the act that added this clause,
5or on the first day of the first calendar month following 60 days
6after the date the department secures all necessary federal approvals
7to implement this section, whichever is later.

8(iv) Beneficiaries under the Early and Periodic Screening,
9Diagnosis, and Treatment Program shall be exempt from clauses
10(ii) and (iii).

11(B) Notwithstanding Chapter 3.5 (commencing with Section
1211340) of Part 1 of Division 3 of Title 2 of the Government Code,
13the department may take the actions specified in subparagraph (A)
14by means of a provider bulletin or notice, policy letter, or other
15similarbegin delete instructionend deletebegin insert instruction,end insert without taking regulatory action.

16(e) Outpatient dialysis services and home hemodialysis services,
17including physician services, medical supplies,begin delete drugsend deletebegin insert drugs,end insert and
18equipment required for dialysis, are covered, subject to utilization
19controls.

20(f) Anesthesiologist services when provided as part of an
21outpatient medical procedure, nurse anesthetist services when
22rendered in an inpatient or outpatient setting under conditions set
23forth by the director, outpatient laboratory services, and X-ray
24services are covered, subject to utilization controls. Nothing in
25this subdivision shall be construed to require prior authorization
26for anesthesiologist services provided as part of an outpatient
27medical procedure or for portable X-ray services in a nursing
28facility or any category of intermediate care facility for the
29developmentally disabled.

30(g) Blood and blood derivatives are covered.

31(h) (1) Emergency and essential diagnostic and restorative
32dental services, except for orthodontic, fixed bridgework, and
33partial dentures that are not necessary for balance of a complete
34artificial denture, are covered, subject to utilization controls. The
35utilization controls shall allow emergency and essential diagnostic
36and restorative dental services and prostheses that are necessary
37to prevent a significant disability or to replace previously furnished
38prostheses which are lost or destroyed due to circumstances beyond
39the beneficiary’s control. Notwithstanding the foregoing, the
40director may by regulation provide for certain fixed artificial
P11   1dentures necessary for obtaining employment or for medical
2conditions that preclude the use of removable dental prostheses,
3and for orthodontic services in cleft palate deformities administered
4by the department’s California Children Services Program.

5(2) For persons 21 years of age or older, the services specified
6in paragraph (1) shall be provided subject to the following
7conditions:

8(A) Periodontal treatment is not a benefit.

9(B) Endodontic therapy is not a benefit except for vital
10pulpotomy.

11(C) Laboratory processed crowns are not a benefit.

12(D) Removable prosthetics shall be a benefit only for patients
13as a requirement for employment.

14(E) The director may, by regulation, provide for the provision
15 of fixed artificial dentures that are necessary for medical conditions
16that preclude the use of removable dental prostheses.

17(F) Notwithstanding the conditions specified in subparagraphs
18(A) to (E), inclusive, the department may approve services for
19persons with special medical disorders subject to utilization review.

20(3) Paragraph (2) shall become inoperative July 1, 1995.

21(i) Medical transportation is covered, subject to utilization
22controls.

23(j) Home health care services are covered, subject to utilization
24controls.

25(k) Prosthetic and orthotic devices and eyeglasses are covered,
26subject to utilization controls. Utilization controls shall allow
27replacement of prosthetic and orthotic devices and eyeglasses
28necessary because of loss or destruction due to circumstances
29beyond the beneficiary’s control. Frame styles for eyeglasses
30replaced pursuant to this subdivision shall not change more than
31once every two years, unless the department so directs.

32Orthopedic and conventional shoes are covered when provided
33by a prosthetic and orthotic supplier on the prescription of a
34physician and when at least one of the shoes will be attached to a
35prosthesis or brace, subject to utilization controls. Modification
36of stock conventional or orthopedic shoes when medically
37indicated, is covered subject to utilization controls. When there is
38a clearly established medical need that cannot be satisfied by the
39modification of stock conventional or orthopedic shoes,
P12   1custom-made orthopedic shoes are covered, subject to utilization
2controls.

3Therapeutic shoes and inserts are covered when provided to
4beneficiaries with a diagnosis of diabetes, subject to utilization
5controls, to the extent that federal financial participation is
6available.

7(l) Hearing aids are covered, subject to utilization controls.
8Utilization controls shall allow replacement of hearing aids
9necessary because of loss or destruction due to circumstances
10beyond the beneficiary’s control.

11(m) Durable medical equipment and medical supplies are
12covered, subject to utilization controls. The utilization controls
13shall allow the replacement of durable medical equipment and
14medical supplies when necessary because of loss or destruction
15due to circumstances beyond the beneficiary’s control. The
16utilization controls shall allow authorization of durable medical
17equipment needed to assist a disabled beneficiary in caring for a
18child for whom the disabled beneficiary is a parent, stepparent,
19foster parent, or legal guardian, subject to the availability of federal
20financial participation. The department shall adopt emergency
21regulations to define and establish criteria for assistive durable
22medical equipment in accordance with the rulemaking provisions
23of the Administrative Procedure Act (Chapter 3.5 (commencing
24with Section 11340) of Part 1 of Division 3 of Title 2 of the
25Government Code).

26(n) Family planning services are covered, subject to utilization
27 controls. However, for Medi-Cal managed care plans, any
28utilization controls shall be subject to Section 1367.25 of the Health
29and Safety Code.

30(o) Inpatient intensive rehabilitation hospital services, including
31respiratory rehabilitation services, in a general acute care hospital
32are covered, subject to utilization controls, when either of the
33following criteria are met:

34(1) A patient with a permanent disability or severe impairment
35requires an inpatient intensive rehabilitation hospital program as
36described in Section 14064 to develop function beyond the limited
37amount that would occur in the normal course of recovery.

38(2) A patient with a chronic or progressive disease requires an
39inpatient intensive rehabilitation hospital program as described in
P13   1Section 14064 to maintain the patient’s present functional level as
2 long as possible.

3(p) (1) Adult day health care is covered in accordance with
4Chapter 8.7 (commencing with Section 14520).

5(2) Commencing 30 days after the effective date of the act that
6added this paragraph, and notwithstanding the number of days
7previously approved through a treatment authorization request,
8adult day health care is covered for a maximum of three days per
9week.

10(3) As provided in accordance with paragraph (4), adult day
11health care is covered for a maximum of five days per week.

12(4) As of the date that the director makes the declaration
13described in subdivision (g) of Section 14525.1, paragraph (2)
14shall become inoperative and paragraph (3) shall become operative.

15(q) (1) Application of fluoride, or other appropriate fluoride
16treatment as defined by the department, and other prophylaxis
17treatment for children 17 years of age and under are covered.

18(2) All dental hygiene services provided by a registered dental
19hygienist, registered dental hygienist in extended functions, and
20registered dental hygienist in alternative practice licensed pursuant
21to Sections 1753, 1917, 1918, and 1922 of the Business and
22Professions Code may be covered as long as they are within the
23scope of Denti-Cal benefits and they are necessary services
24provided by a registered dental hygienist, registered dental
25hygienist in extended functions, or registered dental hygienist in
26alternative practice.

27(r) (1) Paramedic services performed by a city, county, or
28special district, or pursuant to a contract with a city, county, or
29special district, and pursuant to a program established underbegin insert formerend insert
30 Article 3 (commencing with Section 1480) of Chapter 2.5 of
31Division 2 of the Health and Safety Code by a paramedic certified
32pursuant to that article, and consisting of defibrillation and those
33services specified in subdivision (3) ofbegin insert formerend insert Section 1482 of the
34article.

35(2) All providers enrolled under this subdivision shall satisfy
36all applicable statutory and regulatory requirements for becoming
37a Medi-Cal provider.

38(3) This subdivision shall be implemented only to the extent
39funding is available under Section 14106.6.

P14   1(s) In-home medical care services are covered when medically
2appropriate and subject to utilization controls, for beneficiaries
3who would otherwise require care for an extended period of time
4in an acute care hospital at a cost higher than in-home medical
5care services. The director shall have the authority under this
6section to contract with organizations qualified to provide in-home
7medical care services to those persons. These services may be
8provided to patients placed in shared or congregate living
9arrangements, if a home setting is not medically appropriate or
10available to the beneficiary. As used in this section, “in-home
11medical care service” includes utility bills directly attributable to
12continuous, 24-hour operation of life-sustaining medical equipment,
13to the extent that federal financial participation is available.

14As used in this subdivision, in-home medical care services
15include, but are not limited to:

16(1) Level-of-care and cost-of-care evaluations.

17(2) Expenses, directly attributable to home care activities, for
18materials.

19(3) Physician fees for home visits.

20(4) Expenses directly attributable to home care activities for
21shelter and modification to shelter.

22(5) Expenses directly attributable to additional costs of special
23diets, including tube feeding.

24(6) Medically related personal services.

25(7) Home nursing education.

26(8) Emergency maintenance repair.

27(9) Home health agency personnel benefitsbegin delete whichend deletebegin insert thatend insert permit
28coverage of care during periods when regular personnel are on
29vacation or using sick leave.

30(10) All services needed to maintain antiseptic conditions at
31stoma or shunt sites on the body.

32(11) Emergency and nonemergency medical transportation.

33(12) Medical supplies.

34(13) Medical equipment, including, but not limited to, scales,
35gurneys, and equipment racks suitable for paralyzed patients.

36(14) Utility use directly attributable to the requirements of home
37care activitiesbegin delete whichend deletebegin insert thatend insert are in addition to normal utility use.

38(15) Special drugs and medications.

P15   1(16) Home health agency supervision of visiting staffbegin delete whichend delete
2begin insert thatend insert is medically necessary, but not included in the home health
3agency rate.

4(17) Therapy services.

5(18) Household appliances and household utensil costs directly
6attributable to home care activities.

7(19) Modification of medical equipment for home use.

8(20) Training and orientation for use of life-support systems,
9including, but not limited to, support of respiratory functions.

10(21) Respiratory care practitioner services as defined in Sections
113702 and 3703 of the Business and Professions Code, subject to
12prescription by a physician and surgeon.

13Beneficiaries receiving in-home medical care services are entitled
14to the full range of services within the Medi-Cal scope of benefits
15as defined by this section, subject to medical necessity and
16applicable utilization control. Services provided pursuant to this
17subdivision, which are not otherwise included in the Medi-Cal
18schedule of benefits, shall be available only to the extent that
19federal financial participation for these services is available in
20accordance with a home- and community-based services waiver.

21(t) Home- and community-based services approved by the
22United States Department of Health and Human Services are
23covered to the extent that federal financial participation is available
24for those services under the state plan or waivers granted in
25accordance with Section 1315 or 1396n of Title 42 of the United
26States Code. The director may seek waivers for any or all home-
27and community-based services approvable under Section 1315 or
281396n of Title 42 of the United States Code. Coverage for those
29services shall be limited by the terms, conditions, and duration of
30the federal waivers.

31(u) Comprehensive perinatal services, as provided through an
32agreement with a health care provider designated in Section
3314134.5 and meeting the standards developed by the department
34pursuant to Section 14134.5, subject to utilization controls.

35The department shall seek any federal waivers necessary to
36implement the provisions of this subdivision. The provisions for
37which appropriate federal waivers cannot be obtained shall not be
38implemented. Provisions for which waivers are obtained or for
39which waivers are not required shall be implemented
40notwithstanding any inability to obtain federal waivers for the
P16   1other provisions. No provision of this subdivision shall be
2implemented unless matching funds from Subchapter XIX
3(commencing with Section 1396) of Chapter 7 of Title 42 of the
4United States Code are available.

5(v) Early and periodic screening, diagnosis, and treatment for
6any individual under 21 years of age is covered, consistent with
7the requirements of Subchapter XIX (commencing with Section
81396) of Chapter 7 of Title 42 of the United States Code.

9(w) Hospice servicebegin delete whichend deletebegin insert thatend insert is Medicare-certified hospice
10service is covered, subject to utilization controls. Coverage shall
11be available only to the extent that no additional net program costs
12are incurred.

13(x) When a claim for treatment provided to a beneficiary
14includes both servicesbegin delete whichend deletebegin insert thatend insert are authorized and reimbursable
15under this chapter, and servicesbegin delete whichend deletebegin insert thatend insert are not reimbursable
16under this chapter, that portion of the claim for the treatment and
17services authorized and reimbursable under this chapter shall be
18payable.

19(y) Home- and community-based services approved by the
20United States Department of Health and Human Services for
21beneficiaries with a diagnosis of AIDS or ARC, who require
22intermediate care or a higher level of care.

23Services provided pursuant to a waiver obtained from the
24Secretary of the United States Department of Health and Human
25Services pursuant to this subdivision, and which are not otherwise
26included in the Medi-Cal schedule of benefits, shall be available
27only to the extent that federal financial participation for these
28services is available in accordance with the waiver, and subject to
29the terms, conditions, and duration of the waiver. These services
30shall be provided to individual beneficiaries in accordance with
31the client’s needs as identified in the plan of care, and subject to
32medical necessity and applicable utilization control.

33The director may under this section contract with organizations
34qualified to provide, directly or by subcontract, services provided
35for in this subdivision to eligible beneficiaries. Contracts or
36agreements entered into pursuant to this division shall not be
37subject to the Public Contract Code.

38(z) Respiratory care when provided in organized health care
39systems as defined in Section 3701 of the Business and Professions
P17   1Code, and as an in-home medical service as outlined in subdivision
2(s).

3(aa) (1) There is hereby established in the department, a
4program to provide comprehensive clinical family planning
5services to any person who has a family income at or below 200
6percent of the federal poverty level, as revised annually, and who
7is eligible to receive these services pursuant to the waiver identified
8in paragraph (2). This program shall be known as the Family
9Planning, Access, Care, and Treatment (Family PACT) Program.

10(2) The department shall seek a waiver in accordance with
11Section 1315 of Title 42 of the United States Code, or a state plan
12amendment adopted in accordance with Section
131396a(a)(10)(A)(ii)(XXI) of Title 42 of the United States Code,
14which was added to Section 1396a of Title 42 of the United States
15Code by Section 2303(a)(2) of the federal Patient Protection and
16Affordable Care Act (PPACA) (Public Law 111-148), for a
17program to provide comprehensive clinical family planning
18services as described in paragraph (8). Under the waiver, the
19program shall be operated only in accordance with the waiver and
20the statutes and regulations in paragraph (4) and subject to the
21terms, conditions, and duration of the waiver. Under the state plan
22amendment, which shall replace the waiver and shall be known as
23the Family PACT successor state plan amendment, the program
24shall be operated only in accordance with this subdivision and the
25statutes and regulations in paragraph (4). The state shall use the
26standards and processes imposed by the state on January 1, 2007,
27including the application of an eligibility discount factor to the
28extent required by the federal Centers for Medicare and Medicaid
29Services, for purposes of determining eligibility as permitted under
30Section 1396a(a)(10)(A)(ii)(XXI) of Title 42 of the United States
31Code. To the extent that federal financial participation is available,
32the program shall continue to conduct education, outreach,
33enrollment, service delivery, and evaluation services as specified
34under the waiver. The services shall be provided under the program
35only if the waiver and, when applicable, the successor state plan
36amendment are approved by the federal Centers for Medicare and
37Medicaid Services and only to the extent that federal financial
38participation is available for the services. Nothing in this section
39shall prohibit the department from seeking the Family PACT
40successor state plan amendment during the operation of the waiver.

P18   1(3) Solely for the purposes of the waiver or Family PACT
2successor state plan amendment and notwithstanding any other
3begin delete provision ofend delete law, the collection and use of an individual’s social
4security number shall be necessary only to the extent required by
5federal law.

6(4) Sections 14105.3 to 14105.39, inclusive, 14107.11, 24005,
7and 24013, and any regulations adopted under these statutes shall
8apply to the program provided for under this subdivision. No other
9provision of law under the Medi-Cal program or the State-Only
10Family Planning Program shall apply to the program provided for
11under this subdivision.

12(5) Notwithstanding Chapter 3.5 (commencing with Section
1311340) of Part 1 of Division 3 of Title 2 of the Government Code,
14the department may implement, without taking regulatory action,
15the provisions of the waiver after its approval by the federalbegin delete Health
16Care Financing Administrationend delete
begin insert Centers for Medicare and Medicaid
17Servicesend insert
and the provisions of this section by means of an
18all-county letter or similar instruction to providers. Thereafter, the
19department shall adopt regulations to implement this section and
20the approved waiver in accordance with the requirements of
21Chapter 3.5 (commencing with Section 11340) of Part 1 of Division
223 of Title 2 of the Government Code. Beginning six months after
23the effective date of the act adding this subdivision, the department
24shall provide a status report to the Legislature on a semiannual
25basis until regulations have been adopted.

26(6) In the event that the Department of Finance determines that
27the program operated under the authority of the waiver described
28in paragraph (2) or the Family PACT successor state plan
29amendment is no longer cost effective, this subdivision shall
30become inoperative on the first day of the first month following
31the issuance of a 30-day notification of that determination in
32writing by the Department of Finance to the chairperson in each
33house that considers appropriations, the chairpersons of the
34committees, and the appropriate subcommittees in each house that
35considers the State Budget, and the Chairperson of the Joint
36Legislative Budget Committee.

37(7) If this subdivision ceases to be operative, all persons who
38have received or are eligible to receive comprehensive clinical
39family planning services pursuant to the waiver described in
40paragraph (2) shall receive family planning services under the
P19   1Medi-Cal program pursuant to subdivision (n) if they are otherwise
2eligible for Medi-Cal with no share of cost, or shall receive
3comprehensive clinical family planning services under the program
4established in Division 24 (commencing with Section 24000) either
5if they are eligible for Medi-Cal with a share of cost or if they are
6otherwise eligible under Section 24003.

7(8) For purposes of this subdivision, “comprehensive clinical
8family planning services” means the process of establishing
9objectives for the number and spacing of children, and selecting
10the means by which those objectives may be achieved. These
11means include a broad range of acceptable and effective methods
12and services to limit or enhance fertility, including contraceptive
13methods, federal Food and Drug Administration approved
14contraceptive drugs, devices, and supplies, natural family planning,
15abstinence methods, and basic, limited fertility management.
16Comprehensive clinical family planning services include, but are
17not limited to, preconception counseling, maternal and fetal health
18counseling, general reproductive health care, including diagnosis
19and treatment of infections and conditions, including cancer, that
20threaten reproductive capability, medical family planning treatment
21and procedures, including supplies and followup, and
22informational, counseling, and educational services.
23 Comprehensive clinical family planning services shall not include
24abortion, pregnancy testing solely for the purposes of referral for
25abortion or services ancillary to abortions, or pregnancy care that
26is not incident to the diagnosis of pregnancy. Comprehensive
27clinical family planning services shall be subject to utilization
28control and include all of the following:

29(A) Family planning related services and male and female
30sterilization. Family planning services for men and women shall
31include emergency services and services for complications directly
32related to the contraceptive method, federal Food and Drug
33Administration approved contraceptive drugs, devices, and
34supplies, and followup, consultation, and referral services, as
35indicated, which may require treatment authorization requests.

36(B) All United States Department of Agriculture, federal Food
37and Drug Administration approved contraceptive drugs, devices,
38and supplies that are in keeping with current standards of practice
39and from which the individual may choose.

P20   1(C) Culturally and linguistically appropriate health education
2and counseling services, including informed consent, that include
3all of the following:

4(i) Psychosocial and medical aspects of contraception.

5(ii) Sexuality.

6(iii) Fertility.

7(iv) Pregnancy.

8(v) Parenthood.

9(vi) Infertility.

10(vii) Reproductive health care.

11(viii) Preconception and nutrition counseling.

12(ix) Prevention and treatment of sexually transmitted infection.

13(x) Use of contraceptive methods, federal Food and Drug
14Administration approved contraceptive drugs, devices, and
15supplies.

16(xi) Possible contraceptive consequences and followup.

17(xii) Interpersonal communication and negotiation of
18relationships to assist individuals and couples in effective
19contraceptive method use and planning families.

20(D) A comprehensive health history, updated at the next periodic
21visit (between 11 and 24 months after initial examination) that
22includes a complete obstetrical history, gynecological history,
23contraceptive history, personal medical history, health risk factors,
24and family health history, including genetic or hereditary
25conditions.

26(E) A complete physical examination on initial and subsequent
27periodic visits.

28(F) Services, drugs, devices, and supplies deemed by the federal
29Centers for Medicare and Medicaid Services to be appropriate for
30inclusion in the program.

31(9) In order to maximize the availability of federal financial
32participation under this subdivision, the director shall have the
33discretion to implement the Family PACT successor state plan
34amendment retroactively to July 1, 2010.

35(ab) (1) Purchase of prescribed enteral nutrition products is
36covered, subject to the Medi-Cal list of enteral nutrition products
37and utilization controls.

38(2) Purchase of enteral nutrition products is limited to those
39products to be administered through a feeding tube, including, but
40not limited to, a gastric, nasogastric, or jejunostomy tube.
P21   1Beneficiaries under the Early and Periodic Screening, Diagnosis,
2and Treatment Program shall be exempt from this paragraph.

3(3) Notwithstanding paragraph (2), the department may deem
4an enteral nutrition product, not administered through a feeding
5tube, including, but not limited to, a gastric, nasogastric, or
6jejunostomy tube, a benefit for patients with diagnoses, including,
7but not limited to, malabsorption and inborn errors of metabolism,
8if the product has been shown to be neither investigational nor
9experimental when used as part of a therapeutic regimen to prevent
10serious disability or death.

11(4) Notwithstanding Chapter 3.5 (commencing with Section
1211340) of Part 1 of Division 3 of Title 2 of the Government Code,
13the department may implement the amendments to this subdivision
14made by the act that added this paragraph by means of all-county
15letters, provider bulletins, or similar instructions, without taking
16regulatory action.

17(5) The amendments made to this subdivision by the act that
18added this paragraph shall be implemented June 1, 2011, or on the
19first day of the first calendar month following 60 days after the
20date the department secures all necessary federal approvals to
21implement this section, whichever is later.

22(ac) Diabetic testing supplies are covered when provided by a
23pharmacy, subject to utilization controls.

24(ad) (1) Comprehensive mental health crisis services, including
25crisis intervention, crisis stabilization, crisis residential treatment,
26rehabilitative mental health services, and mobile crisis support
27teams, are covered.

28(2) The department shall seek approval of any necessary state
29plan amendments to implement this subdivision. This subdivision
30shall be implemented only to the extent that federal financial
31participation is available and any necessary federal approvals have
32been obtained.

33begin insert

begin insertSEC. 4.end insert  

end insert
begin insert

No reimbursement is required by this act pursuant to
34Section 6 of Article XIII B of the California Constitution because
35the only costs that may be incurred by a local agency or school
36district will be incurred because this act creates a new crime or
37infraction, eliminates a crime or infraction, or changes the penalty
38for a crime or infraction, within the meaning of Section 17556 of
39the Government Code, or changes the definition of a crime within
P22   1the meaning of Section 6 of Article XIII B of the California
2Constitution.

end insert


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