Amended in Senate August 15, 2016

Amended in Senate June 16, 2016

Amended in Senate June 13, 2016

Amended in Assembly May 31, 2016

Amended in Assembly April 26, 2016

Amended in Assembly March 29, 2016

Amended in Assembly March 18, 2016

California Legislature—2015–16 Regular Session

Assembly Bill No. 2821

Introduced by Assembly Members Chiu and Santiago

(Principal coauthor: Assembly Member Atkins)

February 19, 2016

An act to add begin delete Chapter 6.9 (commencing with Section 50678) to Part 2 of end delete begin insert Part 14 (commencing with Section 53570) to end insert Division 31 of the Health and Safety Code, relating to housing.

LEGISLATIVE COUNSEL’S DIGEST

AB 2821, as amended, Chiu. Medi-Cal Housing Program.

Existing law establishes various housing programs directed by the Department of Housing and Community Development (HCD), including special housing programs to provide housing assistance for persons with developmental and physical disabilities and persons with mental health disorders. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services (DHCS), 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.

This bill would require HCD, in coordination with DHCS, to, on or before July 1, 2017, establish the Medi-Cal Housing Program and on or before December 1, 2017, and every year thereafter, subject to appropriation by the Legislature, award grants on a competitive basis to eligible grant applicants participating in a Whole Person Care pilot program, a program under the Medi-Cal program that provides specified entities with the option to receive support to integrate care for a particularly vulnerable group of Medi-Cal beneficiaries, including individuals who are experiencing or are at risk of homelessness, that includes eligibility based on homelessness, or with Medi-Cal managed care plans administering the Health Home Program. The bill would provide that an applicant is eligible for a grant under the program if the applicant meets specified requirements, including that the applicant is a lead agency participating in a Whole Person Care pilot or has previously participated in a Whole Person Care pilot designed to provide services to people experiencing homelessness or is located in a county with Medi-Cal managed care plan or plans participating in the Health Home Program.

The bill would require an applicant awarded a grant to use the funds for specified purposes, including long-term rental assistance and interim housing. The bill would provide that a county resident is eligible to receive assistance pursuant to a grant awarded under the Medi-Cal Housing Program if he or she meets specified requirements, including that the person is homeless, is a Medi-Cal beneficiary, is eligible for Supplemental Security Income, and is eligible to receive services under the Whole Person Care pilot or the Health Home Program. The bill would provide that the program shall be begin delete funded, end delete begin insert funded end insert upon appropriation by the begin delete Legislature, and that thereafter grants under the program are subject to annual appropriations by the Legislature, as specified. end delete begin insert Legislature. end insert The bill would also authorize HCD and DHCS, for purposes of implementing these provisions, to enter into exclusive or nonexclusive contracts on a bid or negotiated basis, exempt from specified small business procurement, personal service, and public contracting provisions, and exempt from the review or approval of any division of the Department of General Services. The bill would also prohibit HCD and DHCS from implementing provisions developed pursuant to these provisions until necessary federal approvals have been obtained and to the extent that other federal financial participation is not jeopardized. begin insert The bill would condition implementation of these provisions upon an appropriation provided for this purpose. end insert

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

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

SECTION 1.  

The Legislature finds and declares all of the
following:

(a) Homeless beneficiaries incur disproportionate Medi-Cal
costs, particularly people experiencing chronic homelessness and
people who cycle between homelessness, emergency departments,
inpatient care, and nursing home stays. Supportive housing, which
is affordable housing with intensive services, allows people
experiencing significant barriers to housing stability to improve
their health and decrease their Medicaid costs. National studies
comparing formerly homeless Medicaid beneficiaries living in
supportive housing with homeless beneficiaries receiving usual
care demonstrate Medicaid cost savings of almost $9,000 per year
after the costs of services.

(b) In the proposal to renew California’s Section 1115 Medicaid
Waiver, “Medi-Cal 2020: Key Concepts for Renewal,” the State
Department of Health Care Services (DHCS) stated, “Research
suggests that individuals experiencing homelessness, particularly
those individuals with multiple chronic conditions, often struggle
to receive appropriate health care services and are
disproportionately likely to be high utilizers of the health care
safety net.” DHCS proposed using Medi-Cal to fund the tools
communities need to help homeless beneficiaries gain access to
and maintain housing stability, including the costs of interim
housing, recuperative/respite care, and long-term rental subsidies.

(c) The final Medi-Cal 2020 Waiver allows participating entities,
including counties, to create Whole Person Care pilots to address
the health, behavioral health, and social services needs of high
users of multiple systems. Participating entities will be able to use
Whole Person Care pilots to offer housing-related services to
homeless residents, form collaborations between local agencies
and health plans to address service needs of homeless beneficiaries,
pool waiver and other sources of financing to pay for services
promoting housing stability, and collect data on residents’
outcomes.

(d) Though the federal Centers for Medicare and Medicaid
Services disallowed federal financial participation in the costs of
housing interventions, the final Section 1115 Medicaid Waiver
special terms and conditions, referred to as the “Medi-Cal 2020
Waiver,” allow for state contributions to Whole Person Care
“county housing pools” to fund long-term costs of housing to
achieve the goals of the Waiver proposal. The final Waiver special
terms and conditions also permit leveraging local resources to
increase access to subsidized housing units. They may also
incorporate a financing component to reallocate or reinvest a
portion of the savings from the reduced utilization of health care
services into the housing pool.

(e) In most communities in California, a lack of housing
affordable to people experiencing homelessness is one of the
greatest barriers to exiting homelessness. Housing resources would
equip Whole Person Care counties choosing to target homeless
people with the resources to achieve the goals of the Whole Person
Care Waiver provisions, during the course of the pilot and after
the pilot ends.

begin delete

SEC. 2.  

Chapter 6.9 (commencing with Section 50678) is added
to Part 2 of Division 31 of the Health and Safety Code, to read:

 

Chapter  6.9. Medi-Cal Housing Program

 

50678.  

For purposes of this chapter, all of the following
definitions shall apply:

(a) “DHCS” means the State Department of Health Care
Services.

(b)

 
“HCD” means the Department of Housing and Community
Development.

(c)

 
“Homeless” has the same meaning as in Section 578.3 of Title
24 of the Code of Federal Regulations. “Homeless” also includes
a person who would become homeless upon exiting a
publicly-funded institution or system of care, including a hospital,
skilled nursing facility, mental health facility, or incarceration.
“Homeless” also includes Whole Person Care pilot program
homeless populations, as approved by DHCS in the Whole Person
Care pilot program application and Medi-Cal beneficiaries served
under California’s Health Home Program under Section 2703 of
the federal Patient Protection and Affordable Care Act (Public
Law 111-148).

(d)

 
“Interim housing” means a safe place for a participant to live
temporarily while the participant is waiting to move into a
permanent apartment affordable to the participant with rental
assistance, and where the participant is not required to pay more
than 30 percent of his or her income toward the cost of the interim
housing. “Interim housing” may include recuperative or respite
care and shall not be funded for longer than a period of nine
months.

(e)

 
“Long-term rental assistance” means a rental subsidy provided
to a housing provider, including a landlord renting in the private
market or a developer leasing affordable housing, to assist a tenant
to pay the difference between 30 percent of the tenant’s income
and the costs of operating the assisted housing unit.

(f)

 
“Permanent housing” means a housing unit where the landlord
does not limit length of stay in the housing unit, the landlord does
not restrict the movements of the tenant, and the tenant has a lease
and is subject to the rights and responsibilities of tenancy, pursuant
to Chapter 2 (commencing with Section 1940) of Title 5 of Part 4
of Division 3 of the Civil Code.

(g)

 
“Supportive housing” has the same meaning as in Section
50675.14.

(h)

 
“Whole Person Care pilot” has the same meaning as described
in the Medi-Cal 2020 Waiver Special Terms and Conditions
(STCs), Sections 110-126, as approved by the federal Centers for
Medicare and Medicaid Services, on December 30, 2015, or in
any subsequent amendment to the STCs.

50678.1.  

HCD in coordination with DHCS, shall do all of the
following:

(a) On or before July 1, 2017, establish the Medi-Cal Housing
Program.

(b) On or before July 1, 2017, draft guidelines for stakeholder
comment to fund competitive grants to pay for interim and
long-term rental assistance under the Medi-Cal Housing Program.
The guidelines shall detail competitive scoring criteria that
includes, but is not limited to, scoring that awards points based
upon all of the following:

(1) Need, which includes consideration of the number of
individuals experiencing homelessness and the impact of housing
costs in the applicant’s geographic area.

(2) Ability of the applicant to administer a program offering
interim and long-term rental assistance to people experiencing
homelessness.

(3) The applicant’s documented partnerships with affordable
and supportive housing providers in the applicant’s geographic
area.

(4) The applicant’s partnerships with Medi-Cal managed care
plans in the applicant’s geographic area and the percentage of
Medi-Cal beneficiaries assigned to those partnering Medi-Cal
managed health plans.

(5) A comprehensive plan to connect interim housing, long-term
rental assistance, and project-based supportive housing resources
made available under the Medi-Cal Housing Program with services
made available through the Whole Person Care pilot and the Health
Home Program.

(6) Coordination with (A) community-based housing and
homeless service providers, (B) behavioral health providers, (C)
and safety net providers, including community health centers.

(c) On or before December 1, 2017, and every year thereafter,
subject to appropriation by the Legislature, award grants on a
competitive basis to eligible grant applicants participating in a
Whole Person Care pilot that includes eligibility based on
homelessness or a partnership with Medi-Cal managed care plans
administering the Health Home Program. If appropriations are
made available in future years, counties shall compete for each
round of five-year grants.

(d) Midyear and annually, collect data from the Medi-Cal
Housing Program grantees or from the Medi-Cal managed care
plan partnering with applicants, as well as other Medi-Cal data
available from DHCS, as appropriate.

(e) No later than January 1, 2018, contract with an independent
evaluator to analyze data collected pursuant to Section 50678.3 to
determine changes in health care costs associated with services
provided under the Medi-Cal Housing Program. HCD shall provide,
on a regular basis as needed, collected data to the evaluator.

(f) (1) By March 31, 2019, for grants awarded in 2017, and in
subsequent years thereafter in which the Medi-Cal Housing
Program is allocated additional funds, report data collected to the
Assembly Committee on Budget, the Senate Committee on Budget
and Fiscal Review, the Assembly and Senate committees on health,
the Assembly Committee on Housing and Community
Development, and the Senate Committee on Transportation and
Housing.

(2) A report to be submitted pursuant to paragraph (1) shall be
submitted in compliance with Section 9795 of the Government
Code.

50678.2.  

An applicant shall be eligible for a Medi-Cal Housing
Program grant if the applicant meets the requirements of this
section. Eligibility does not create an entitlement to grant funds
and is subject to availability of funds. The applicant shall meet all
of the following requirements:

(a) Satisfies one or more the following:

(1) Is a lead agency participating in a Whole Person Care pilot
designed to provide services to people experiencing homelessness.

(2) Is a lead agency that previously participated in a Whole
Person Care pilot that has expired and the applicant has decided
to continue to provide services to homeless people under the
structures developed in the Whole Person Care pilot.

(3) Is located in a county with a Medi-Cal managed care plan
or plans participating in the Health Home Program.

(b) Has identified a source of funding for Housing Transition
Services and Tenancy Sustaining Services, as defined in the Centers
for Medicare and Medicaid Services’ Informational Bulletin
regarding Housing-Related Activities and Services for People with
Disabilities, issued June 26, 2015. Funding for these services shall
include one or more of the following:

(1) County general funds.

(2) Whole Person Care pilot program funds.

(3) The Health Home Program.

(c) Agrees to contribute funding for interim and long-term rental
assistance through one or more of the following sources:

(1) County general funds.

(2) Flexible housing pools created through a Whole Person Care
pilot.

(3) A county or partnering housing authority’s set-aside of at
least 15 percent turn-over federal Housing Choice Vouchers to
residents experiencing homelessness and who are eligible to receive
Whole Person Care pilot or Health Home Program services.

(d) Has designated a process for administering grant funds
through agencies administering housing programs.

(e) Agrees to collect and report data, as described in Section
50678.3, to HCD and DHCS.

50678.3.  

(a) HCD shall coordinate with DHCS to identify a
process for collecting and providing Medi-Cal data regarding
changes in health care costs associated with services provided
under the Medi-Cal Housing Program to the extent that information
is available, up to 12 months prior to each participant’s move into
permanent housing, as well as changes in costs after each
participant’s move into permanent housing.

(b) An applicant awarded grant funds shall, at annual and
midyear intervals, report all of the following data to HCD and
DHCS:

(1) Data specified by HCD necessary to measure the costs
described in subdivision (a).

(2) The number of participants and the type of interventions
offered through grant funds.

(3) The number of participants living in supportive housing or
other permanent housing.

(c) HCD shall collaborate with DHCS to provide available
fee-for-service data to the evaluator.

50678.4.  

An applicant shall use grants awarded pursuant to
this chapter for one or more of the following, which may be
administered through a housing pool, as defined in the Whole
Person Care pilot:

(a) Long-term rental assistance for periods up to five years.

(b) A capitalized operating reserve for up to 15 years to pay for
operating costs of an apartment or apartments within a development
receiving public funding to provide supportive housing to people
experiencing homelessness.

(c) Interim housing.

(d) A county’s administrative costs for up to 3 percent of the
total grant awarded.

50678.5.  

A county resident is eligible to receive assistance
pursuant to a grant awarded under the Medi-Cal Housing Program
if he or she meets all of the following requirements:

(a) Is homeless upon initial eligibility.

(b) Is a Medi-Cal beneficiary.

(c) Is eligible for Supplemental Security Income.

(d) Is eligible to receive services under either the Whole Person
Care pilot or the Health Home Program, whichever is operative
in the participating county or region.

(e) Is likely to improve his or her health conditions with
supportive housing.

50678.6.  

The Medi-Cal Housing Program shall be funded,
upon appropriation by the Legislature. The funding of grants under
the program is subject to annual appropriations by the Legislature.
The Legislature shall consider the impact that housing and
supportive services have had in changing utilization and health
care costs, as identified in the evaluation described in Section
50678.1, of moving eligible participants into supportive housing.

50678.7.  

HCD shall reimburse DHCS for the costs of
collaborating in the design and implementation of the program.
HDC shall use no more than 5 percent of the funds appropriated
for the Medi-Cal Housing Program for purposes of administering
the program.

50678.8.  

(a) For purposes of implementing this chapter, HCD
or DHCS may enter into exclusive or nonexclusive contracts on a
bid or negotiated basis. Contracts entered into or amended pursuant
to this subdivision shall be exempt from Chapter 6 (commencing
with Section 14825) of Part 5.5 of Division 3 of Title 2 of the
Government Code, Section 19130 of the Government Code, and
Part 2 (commencing with Section 10100) of Division 2 of the
Public Contract Code and shall be exempt from the review or
approval of any division of the Department of General Services.

(b) HCD and DHCS shall implement the provisions developed
pursuant to this chapter only after all necessary federal approvals
have been obtained for the Health Home Program and to the extent
that other federal financial participation is not jeopardized.

end delete

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Part 14 (commencing with Section 53570) is added to
Division 31 of the end insert begin insert Health and Safety Code end insert begin insert , to read: end insert

begin insert

 

PART  begin insert 14. end insert   Medi-Cal Housing Program

 

begin insert 53570. end insert   

For purposes of this part, all of the following definitions
shall apply:

(a) “DHCS” means the State Department of Health Care
Services.

(b) “Fair market rent” means the rent, including the cost of
utilities, as established by the United States Department of Housing
and Urban Development pursuant to Parts 888 and 982 of Title
24 of the Code of Federal Regulations, as those parts read on
January 1, 2017, for units by number of bedrooms, that must be
paid in the market area to rent privately owned, existing, decent,
safe, and sanitary rental housing of nonluxury nature with suitable
amenities.

(c) “HCD” means the Department of Housing and Community
Development.

(d) “Homeless” has the same meaning as in Section 578.3 of
Title 24 of the Code of Federal Regulations, as that section read
on January 1, 2017. “Homeless” also includes a person who would
become homeless upon exiting a publicly funded institution or
system of care, including a hospital, skilled nursing facility, mental
health facility, or incarceration. “Homeless” also includes Whole
Person Care pilot program homeless populations, as approved by
DHCS in the Whole Person Care pilot program application and
Medi-Cal beneficiaries served under California’s Health Home
Program under Section 2703 of the federal Patient Protection and
Affordable Care Act (Public Law 111-148).

(e) “Interim housing” means a safe place for a participant to
live temporarily while the participant is waiting to move into a
permanent apartment affordable to the participant with rental
assistance, and where the participant is not required to pay more
than 30 percent of his or her income toward the cost of the interim
housing. “Interim housing” may include recuperative or respite
care and shall not be funded for longer than a period of nine
months.

(f) “Long-term rental assistance” means a rental subsidy
provided to a housing provider, including a landlord renting in
the private market or a developer leasing affordable housing, to
assist a tenant to pay the difference between 30 percent of the
tenant’s income and fair market rent.

(g) “Permanent housing” means a housing unit where the
landlord does not limit length of stay in the housing unit, the
landlord does not restrict the movements of the tenant, and the
tenant has a lease and is subject to the rights and responsibilities
of tenancy, pursuant to Chapter 2 (commencing with Section 1940)
of Title 5 of Part 4 of Division 3 of the Civil Code.

(h) “Supportive housing” has the same meaning as in Section
50675.14.

(i) “Whole Person Care pilot” has the same meaning as
described in the Medi-Cal 2020 Waiver Special Terms and
Conditions (STCs), Sections 110-126, as approved by the federal
Centers for Medicare and Medicaid Services, on December 30,
2015, or in any subsequent amendment to the STCs.

begin insert 53571. end insert   

HCD, in coordination with DHCS, shall do all of the
following:

(a) On or before July 1, 2017, establish the Medi-Cal Housing
Program.

(b) On or before July 1, 2017, draft guidelines for stakeholder
comment to fund competitive grants to pay for interim and
long-term rental assistance under the Medi-Cal Housing Program.
The guidelines shall detail competitive scoring criteria that
includes, but is not limited to, scoring that awards points based
upon all of the following:

(1) Need, which includes consideration of the number of
individuals experiencing homelessness and the impact of housing
costs in the applicant’s geographic area.

(2) Ability of the applicant to administer a program offering
interim and long-term rental assistance to people experiencing
homelessness.

(3) The applicant’s documented partnerships with affordable
and supportive housing providers in the applicant’s geographic
area.

(4) The applicant’s partnerships with Medi-Cal managed care
plans in the applicant’s geographic area and the percentage of
Medi-Cal beneficiaries assigned to those partnering Medi-Cal
managed health plans.

(5) A comprehensive plan to connect interim housing, long-term
rental assistance, and project-based supportive housing resources
made available under the Medi-Cal Housing Program with services
made available through the Whole Person Care pilot and the
Health Home Program.

(6) Coordination with (A) community-based housing and
homeless service providers, (B) behavioral health providers, and
(C), safety net providers, including community health centers.

(c) On or before December 1, 2017, and every year thereafter,
subject to appropriation by the Legislature, award grants on a
competitive basis to eligible grant applicants participating in a
Whole Person Care pilot that includes eligibility based on
homelessness or a partnership with Medi-Cal managed care plans
administering the Health Home Program. If appropriations are
made available in future years, applicants shall compete for each
round of five-year grants.

(d) Midyear and annually, collect data from the Medi-Cal
Housing Program grantees or from the Medi-Cal managed care
plan partnering with applicants, as well as other Medi-Cal data
available from DHCS, as appropriate.

(e) No later than January 1, 2018, contract with an independent
evaluator to analyze data collected pursuant to Section 53573 to
determine changes in health care costs associated with services
provided under the Medi-Cal Housing Program. HCD shall
provide, on a regular basis as needed, collected data to the
evaluator.

(f) (1) By March 31, 2019, for grants awarded in 2017, and in
subsequent years thereafter in which the Medi-Cal Housing
Program is allocated additional funds, report data collected to
the Assembly Committee on Budget, the Senate Committee on
Budget and Fiscal Review, the Assembly and Senate committees
on health, the Assembly Committee on Housing and Community
Development, and the Senate Committee on Transportation and
Housing.

(2) A report to be submitted pursuant to paragraph (1) shall be
submitted in compliance with Section 9795 of the Government
Code.

begin insert 53572. end insert   

An applicant shall be eligible for a Medi-Cal Housing
Program grant if the applicant meets the requirements of this
section. Eligibility does not create an entitlement to grant funds
and is subject to availability of funds. The applicant shall meet all
of the following requirements:

(a) Satisfies one or more the following:

(1) Is a lead agency participating in a Whole Person Care pilot
designed to provide services to people experiencing homelessness.

(2) Is a lead agency that previously participated in a Whole
Person Care pilot that has expired and the applicant has decided
to continue to provide services to homeless people under the
structures developed in the Whole Person Care pilot.

(3) Is located in a county with a Medi-Cal managed care plan
or plans participating in the Health Home Program.

(b) Has identified a source of funding for Housing Transition
Services and Tenancy Sustaining Services, as defined in the Centers
for Medicare and Medicaid Services’ Informational Bulletin
regarding Housing-Related Activities and Services for People with
Disabilities, issued June 26, 2015. Funding for these services shall
include one or more of the following:

(1) County general funds.

(2) Whole Person Care pilot program funds.

(3) The Health Home Program.

(c) Agrees to contribute funding for interim and long-term rental
assistance through one or more of the following sources:

(1) County general funds.

(2) Flexible housing pools created through a Whole Person
Care pilot.

(3) A county or partnering housing authority’s set-aside of at
least 15 percent Housing Choice Vouchers to residents
experiencing homelessness and who are eligible to receive Whole
Person Care pilot or Health Home Program services.

(d) Has designated a process for administering grant funds
through agencies administering housing programs.

(e) Agrees to collect and report data, as described in Section
53573, to HCD and DHCS.

begin insert 53573. end insert   

(a) HCD shall coordinate with DHCS to identify a
process for collecting and providing Medi-Cal data regarding
changes in health care costs associated with services provided
under the Medi-Cal Housing Program to the extent that
information is available, up to 12 months prior to each
participant’s move into permanent housing, as well as changes in
costs after each participant’s move into permanent housing.

(b) An applicant awarded grant funds shall, at annual and
midyear intervals, report all of the following data to HCD and
DHCS:

(1) Data specified by HCD necessary to measure the costs
described in subdivision (a).

(2) The number of participants and the type of interventions
offered through grant funds.

(3) The number of participants living in supportive housing or
other permanent housing.

(c) HCD shall collaborate with DHCS to provide available
fee-for-service data to the evaluator.

begin insert 53574. end insert   

An applicant shall use grants awarded pursuant to this
part for one or more of the following, which may be administered
through a housing pool, as defined in the Whole Person Care pilot:

(a) Long-term rental assistance for periods of up to five years.

(b) A capitalized operating reserve for up to 15 years to pay for
operating costs of an apartment or apartments within a
development receiving public funding to provide supportive
housing to people experiencing homelessness.

(c) Interim housing.

(d) A county’s administrative costs for up to 3 percent of the
total grant awarded.

begin insert 53575. end insert   

A county resident is eligible to receive assistance
pursuant to a grant awarded under the Medi-Cal Housing Program
if he or she meets all of the following requirements:

(a) Is homeless upon initial eligibility.

(b) Is a Medi-Cal beneficiary.

(c) Is eligible for Supplemental Security Income.

(d) Is eligible to receive services under either the Whole Person
Care pilot or the Health Home Program, whichever is operative
in the participating county or region.

(e) Is likely to improve his or her health conditions with
supportive housing.

begin insert 53576. end insert   

The Medi-Cal Housing Program shall be funded upon
appropriation by the Legislature. The Legislature shall consider
the impact that housing and supportive services have had in
changing utilization and health care costs, as identified in the
evaluation described in Section 53571, of moving eligible
participants into supportive housing.

begin insert 53577. end insert   

HCD shall reimburse DHCS for the costs of
collaborating in the design and implementation of the program.
HCD shall use no more than 5 percent of the funds appropriated
for the Medi-Cal Housing Program for purposes of administering
the program.

begin insert 53578. end insert   

(a) For purposes of implementing this part, HCD or
DHCS may enter into exclusive or nonexclusive contracts on a bid
or negotiated basis. Contracts entered into or amended pursuant
to this subdivision shall be exempt from Chapter 6 (commencing
with Section 14825) of Part 5.5 of Division 3 of Title 2 of the
Government Code, Section 19130 of the Government Code, and
Part 2 (commencing with Section 10100) of Division 2 of the Public
Contract Code and shall be exempt from the review or approval
of any division of the Department of General Services.

(b) HCD and DHCS shall implement the provisions developed
pursuant to this part only after all necessary federal approvals
have been obtained for the Health Home Program and to the extent
that other federal financial participation is not jeopardized.

begin insert 53579. end insert   

Implementation of this part shall be contingent on an
appropriation provided for this purpose in the annual Budget Act
or other measure.

end insert