Amended in Assembly May 4, 2015

Amended in Assembly April 15, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 741

Introduced by Assembly Member Williams

February 25, 2015

An act to amend Section 1502 of the Health and Safety Code, begin delete and to amend Section 14132 of the Welfare and Institutions Code, end delete relating to mental health.

LEGISLATIVE COUNSEL’S DIGEST

AB 741, as amended, Williams. begin delete Comprehensive mental health crisis services. end delete begin insert Mental health: community care facilities. end insert

begin delete

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.

end delete begin delete

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.

end delete

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.

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.

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.

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

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

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

SECTION 1.  

The Legislature finds and declares all of the
following:

(a) There is an urgent need to provide more crisis care
alternatives to hospitals for children and youth experiencing mental
health crises.

(b) The problems are especially acute for children and youth
who may have to wait for days for a hospital bed and who may be
transported, without a parent, to the nearest facility hundreds of
miles away.

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

(d) The type of care that is needed includes crisis begin delete stabilization
and crisis end delete residential treatment for children.

(e) This level of care is part of the full continuum of care
considered medically necessary for many children with serious
emotional disturbances.

(f) In 2013, the Legislature enacted the Investment in Mental
Health Wellness Act (Senate Bill 82, Chapter 34 of the Statutes
of 2013) to provide one-time funding to counties to expand the
availability of mental health crisis care services, including
short-term crisis residential treatment services. However, there is
currently no state licensing category for short-term crisis residential
programs for children. As a result, counties wanting to expand
local capacity to meet the needs of children and youth for crisis
residential treatment services were ineligible for this competitive
grant program.

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

(h) In most communities, inpatient crisis treatment is completely
unavailable for children and youth even though it may be medically
necessary.

(i) Crisis residential care is an essential level of care for the
treatment of children and youth with serious emotional disturbances
in a mental health crisis, and it often serves as an alternative to
hospitalization.

(j) It is imperative that public health care coverage include these
services as a covered benefit.

SEC. 2.  

Section 1502 of the Health and Safety Code is amended
to read:

1502.  

As used in this chapter:

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

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

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

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

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

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

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

(7) “Social rehabilitation facility” means any residential facility
that provides social rehabilitation services for no longer than 18
months in a group setting to individuals, including children,
adolescents, and adults, recovering from mental illness or in a
mental health crisis who temporarily need assistance, guidance,
or counseling. Program components shall be subject to program
standards pursuant to Article 1 (commencing with Section 5670)
of Chapter 2.5 of Part 2 of Division 5 of the Welfare and
Institutions Code.

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

begin delete

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

end delete

(9)  begin insert (A) end insert begin insert   end insert “Full-service adoption agency” means any licensed
entity engaged in the business of providing adoption services, that
does all of the following:

begin delete

(A)

end delete

begin insert (i) end insert  Assumes care, custody, and control of a child through
relinquishment of the child to the agency or involuntary termination
of parental rights to the child.

begin delete

(B)

end delete

begin insert (ii) end insert  Assesses the birth parents, prospective adoptive parents, or
child.

begin delete

(C)

end delete

begin insert (iii) end insert  Places children for adoption.

begin delete

(D)

end delete

begin insert (iv) end insert  Supervises adoptive placements.

begin delete

Private

end delete

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

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

begin delete

(A)

end delete

begin insert (i) end insert  Assesses the prospective adoptive parents.

begin delete

(B)

end delete

begin insert (ii) end insert  Cooperatively matches children freed for adoption, who are
under the care, custody, and control of a licensed adoption agency,
for adoption, with assessed and approved adoptive applicants.

begin delete

(C)

end delete

begin insert (iii) end insert  Cooperatively supervises adoptive placements with a
full-service adoptive agency, but does not disrupt a placement or
remove a child from a placement.

begin delete

Private

end delete

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

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

(12) “Transitional housing placement provider” means an
organization licensed by the department pursuant to Section
1559.110 and Section 16522.1 of the Welfare and Institutions Code
to provide transitional housing to foster children at least 16 years
of age and not more than 18 years of age, and nonminor
dependents, as defined in subdivision (v) of Section 11400 of the
Welfare and Institutions Code, to promote their transition to
adulthood. A transitional housing placement provider shall be
privately operated and organized on a nonprofit basis.

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

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

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

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

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

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

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

begin insert

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

end insert

begin delete

SEC. 3.  

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

14132.  

The following is the schedule of benefits under this
chapter:

(a) Outpatient services are covered as follows:

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

(b) (1) Inpatient hospital services, including, but not limited
to, physician and podiatric services, physical therapy, and
occupational therapy, are covered subject to utilization controls.

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

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

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

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

(3) (A) To the extent required by federal law, the purchase of
outpatient prescribed drugs, for which the prescription is executed
by a prescriber in written, nonelectronic form on or after April 1,
2008, is covered only when executed on a tamper resistant
prescription form. The implementation of this paragraph shall
conform to the guidance issued by the federal Centers for Medicare
and Medicaid Services but shall not conflict with state statutes on
the characteristics of tamper resistant prescriptions for controlled
substances, including Section 11162.1 of the Health and Safety
Code. The department shall provide providers and beneficiaries
with as much flexibility in implementing these rules as allowed
by the federal government. The department shall notify and consult
with appropriate stakeholders in implementing, interpreting, or
making specific this paragraph.

(B) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department may take the actions specified in subparagraph (A)
by means of a provider bulletin or notice, policy letter, or other
similar instructions without taking regulatory action.

(4) (A) (i) For the purposes of this paragraph, nonlegend has
the same meaning as defined in subdivision (a) of Section
14105.45.

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

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

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

(B) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department may take the actions specified in subparagraph (A)
by means of a provider bulletin or notice, policy letter, or other
similar instruction, without taking regulatory action.

(e) Outpatient dialysis services and home hemodialysis services,
including physician services, medical supplies, drugs, and
equipment required for dialysis, are covered, subject to utilization
controls.

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

(g) Blood and blood derivatives are covered.

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

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

(A) Periodontal treatment is not a benefit.

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

(C) Laboratory processed crowns are not a benefit.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(r) (1) Paramedic services performed by a city, county, or
special district, or pursuant to a contract with a city, county, or
special district, and pursuant to a program established under former
Article 3 (commencing with Section 1480) of Chapter 2.5 of
Division 2 of the Health and Safety Code by a paramedic certified
pursuant to that article, and consisting of defibrillation and those
services specified in subdivision (3) of former Section 1482 of the
article.

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

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

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

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

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

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

(3) Physician fees for home visits.

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

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

(6) Medically related personal services.

(7) Home nursing education.

(8) Emergency maintenance repair.

(9) Home health agency personnel benefits that permit coverage
of care during periods when regular personnel are on vacation or
using sick leave.

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

(11) Emergency and nonemergency medical transportation.

(12) Medical supplies.

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

(14) Utility use directly attributable to the requirements of home
care activities that are in addition to normal utility use.

(15) Special drugs and medications.

(16) Home health agency supervision of visiting staff that is
medically necessary, but not included in the home health agency
rate.

(17) Therapy services.

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

(19) Modification of medical equipment for home use.

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

(21) Respiratory care practitioner services as defined in Sections
3702 and 3703 of the Business and Professions Code, subject to
prescription by a physician and surgeon.

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

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

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

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

(v) Early and periodic screening, diagnosis, and treatment for
any individual under 21 years of age is covered, consistent with
the requirements of Subchapter XIX (commencing with Section
1396) of Chapter 7 of Title 42 of the United States Code.

(w) Hospice service that is Medicare-certified hospice service
is covered, subject to utilization controls. Coverage shall be
available only to the extent that no additional net program costs
are incurred.

(x) When a claim for treatment provided to a beneficiary
includes both services that are authorized and reimbursable under
this chapter, and services that are not reimbursable under this
chapter, that portion of the claim for the treatment and services
authorized and reimbursable under this chapter shall be payable.

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

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

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

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

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

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

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

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

(5) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department may implement, without taking regulatory action,
the provisions of the waiver after its approval by the federal Centers
for Medicare and Medicaid Services and the provisions of this
section by means of an all-county letter or similar instruction to
providers. Thereafter, the department shall adopt regulations to
implement this section and the approved waiver in accordance
with the requirements of Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code.
Beginning six months after the effective date of the act adding this
subdivision, the department shall provide a status report to the
Legislature on a semiannual basis until regulations have been
adopted.

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

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

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

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

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

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

(i) Psychosocial and medical aspects of contraception.

(ii) Sexuality.

(iii) Fertility.

(iv) Pregnancy.

(v) Parenthood.

(vi) Infertility.

(vii) Reproductive health care.

(viii) Preconception and nutrition counseling.

(ix) Prevention and treatment of sexually transmitted infection.

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

(xi) Possible contraceptive consequences and followup.

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

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

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

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

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

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

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

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

(4) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code,
the department may implement the amendments to this subdivision
made by the act that added this paragraph by means of all-county
letters, provider bulletins, or similar instructions, without taking
regulatory action.

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

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

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

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

end delete

begin delete SEC. 4. end delete
begin insert SEC. 3. end insert   

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