BILL NUMBER: SB 586 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 2, 2016
AMENDED IN ASSEMBLY JUNE 30, 2016
AMENDED IN ASSEMBLY JUNE 8, 2016
AMENDED IN ASSEMBLY MAY 4, 2016
AMENDED IN SENATE APRIL 28, 2015
INTRODUCED BY Senator Hernandez
(Coauthors: Assembly Members Alejo, Bonta, Chávez, and Wood)
FEBRUARY 26, 2015
An act to amend Section 123850 of the Health and Safety Code,
and to amend Sections 14093.06, 14094.2, and 14094.3 of, and
to add Article 2.985 (commencing with Section 14094.4) to Chapter 7
of Part 3 of Division 9 of, the Welfare and Institutions Code,
relating to children's services.
LEGISLATIVE COUNSEL'S DIGEST
SB 586, as amended, Hernandez. Children's services.
The California Children's Services (CCS) program is a statewide
program providing medically necessary services required by physically
handicapped children whose parents are unable to pay for those
services. The State Department of Health Care Services administers
the CCS program. Counties, based on population size, are also charged
with administering the program, either independently or jointly with
the department. The services covered by the CCS program include
expert diagnosis, medical treatment, surgical treatment, hospital
care, physical therapy, occupational therapy, special treatment,
materials, and the supply of appliances and their upkeep,
maintenance, and transportation. Funding for the program comes from
county, state, and federal sources. In order to be eligible for the
CCS program, an applicant must be under 21 years of age, have or be
suspected of having a condition covered by the program, and meet
certain financial eligibility standards established by the
department.
Existing law prohibits services covered by the CCS program from
being incorporated into a Medi-Cal managed care contract entered into
after August 1, 1994, until January 1, 2017, except with respect to
contracts entered into for county organized health systems or
Regional Health Authority in specified counties.
This bill would exempt contracts entered into under the Whole
Child Model program, described below, from that prohibition and would
extend to January 1, 2022, and until the evaluation required under
the Whole Child Model program has been completed, the termination of
the prohibition against CCS covered services being incorporated in a
Medi-Cal managed care contract entered into after August 1, 1994.
The bill would authorize the department, no sooner than July 1,
2017, to establish a Whole Child Model program, under which managed
care plans served by a county organized health system or Regional
Health Authority in designated counties would provide CCS services
under a capitated payment model to Medi-Cal eligible CCS children and
youth. The bill would limit the number of managed care plans under a
county organized health system or Regional Health Authority that are
eligible to participate in the program. The bill would require the
department to establish an application process
implement the program, as specified, and would require a
managed care plan to provide the department with a written
obtain from the department written approval
of its application of interest that contains
specified information, including evidence that the managed care plan
received written support from specified individuals and entities,
including CCS providers, as defined, that serve a preponderance of
CCS children and youth in the county. and establish a
local stakeholder process, as prescribed. The bill would
prohibit the department from approving the application of a managed
care plan until the Director of Health Care Services has verified the
readiness of the managed care plan to address the unique needs of
CCS-eligible beneficiaries, including, among other things, that the
managed care contractor demonstrates the availability of an
appropriate provider network to serve the needs of children and youth
with CCS conditions and complies with all CCS program guidelines.
The bill would prohibit the department from implementing the
program in any county until it has developed specific CCS monitoring
and oversight standards for managed care plans. The bill would
require the department to establish
establish, through December 31, 2021, a statewide Whole Child
Model stakeholder advisory group comprised of specified stakeholders,
including representatives from health plans and family resource
centers, or modify an existing stakeholder advisory group
and would require the department to consult with the Whole Child
Model stakeholder advisory group on the implementation of the
program, as specified. The bill would impose various requirements on
a Medi-Cal managed care plan serving children and youth with
CCS-eligible conditions under the CCS program, including, but not
limited to, coordinating services, as specified, providing
appropriate access to care, services, and information, providing
for case management, care coordination, provider referral, and
service authorization services, and providing a timely process
for accepting and acting upon complaints and grievances of
CCS-eligible children and youth. The bill would require the
department to contract with an independent entity to conduct an
evaluation to assess health plan performance and the outcomes and the
experience of CCS-eligible children and youth participating in the
program, and would require the department to provide a report on the
results of this evaluation to the Legislature no later than January
1, 2023. 2021. This bill would provide
that its provisions are not intended to permit any reduction in
benefits or eligibility levels under the existing CCS program. The
bill would require the department, by July 1, 2021, to adopt
regulations and, commencing July 1, 2017, would require the
department to provide a status report to the Legislature until
regulations have been adopted. The bill would authorize the Director
of Health Care Services to enter into exclusive or nonexclusive
contracts on a bid, nonbid, or negotiated basis and amend existing
managed care contracts to provide or arrange for services provided
under the bill.
By imposing new duties on counties with respect to the transaction
of CCS program services, this bill would impose 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, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) The California Children's Services (CCS) program is the nation'
s oldest Title V Maternal and Child Health Services Block Grant
program.
(b) The CCS program has provided critical access to specialized
medical care for California's most complex and fragile pediatric
patients since 1927.
(c) The strong standards and credentialing created under the CCS
program ensure that eligible children obtain care from experienced
providers with appropriate pediatric-specific expertise.
(d) CCS providers form a regional backbone for all specialty
pediatric care in California, benefiting children of every income
level and insurance status.
(e) Over the past 20 years, coordinated and integrated health care
delivery models have been shown to improve delivery of health care,
reduce costs, and improve outcomes.
(f) As California expanded the reach of integrated delivery
systems in Medi-Cal, CCS services were often excluded from managed
care arrangements in recognition of the specialty nature of CCS
services and the complicated health status of enrolled children.
(g) Accordingly, it is the intent of the Legislature to modernize
the CCS program, through development of specialized
integrated delivery systems the Whole Child Model,
focused on the unique needs of CCS-eligible children,
children in counties served by County Organized Health
Systems to accomplish the following:
(1) Improve coordination and integration of services to meet the
needs of the whole child, not just address the CCS-eligible
condition.
(2) Retain CCS program standards to maintain access to
high-quality specialty care for eligible children.
(3) Support active participation by parents and families, who are
frequently the primary caregivers for CCS-eligible children.
(4) Establish specialized programs to manage and coordinate the
care of CCS-enrolled children.
(5) Ensure that children with CCS-eligible conditions receive care
in the most appropriate, least restrictive setting.
(6) Maintain existing patient-provider relationships, whenever
possible.
(h) It is further the intent of the Legislature to protect the
unique access to pediatric specialty services provided by CCS while
promoting modern organized delivery systems to meet the medical care
needs of eligible children.
(i) It is further the intent of the Legislature to continue the
pediatric specialty expertise and statewide network of CCS providers
by promoting contractual relationships between those providers and
managed care plans. Accordingly, it is the intent of the Legislature
that reimbursement under the Whole Child Model program be sufficient
to attract and retain these specialists in the CCS program.
SEC. 2. Section 123850 of the Health
and Safety Code is amended to read:
123850. (a) The board of supervisors of
each county shall designate the county department of public health or
the county department of social welfare as the designated agency to
administer the California Children's Services Program.
(CCS) program. Counties with total population
under 200,000 persons may administer the county program independently
or jointly with the department. Counties with a total population in
excess of 200,000 persons shall administer the county program
independently. Except as otherwise provided in this article, the
director shall establish standards relating to the local
administration and minimum services to be offered by counties in the
conduct of the California Children's Services Program.
CCS program.
(b) (1) Upon determination of readiness by the director, the
designated county agency and a Medi-Cal managed care health plan or
plans serving the county, as determined by the director, shall
provide for the transition of CCS program services, except for
services provided pursuant to subdivision (c), into the Medi-Cal
managed care health plan contract in Whole Child Model counties
pursuant to Article 2.985 (commencing with Section 14094.4) for
children who are enrolled in the Medi-Cal managed care plan and CCS.
For children enrolled in a Medi-Cal managed care plan and CCS in
Whole Child Model counties pursuant to Article 2.985 (commencing with
Section 14094.4), the case management, care coordination, provider
referral, and service authorization administrative functions of the
CCS program shall then be the responsibility of the Medi-Cal managed
care health plan in accordance with Section 14094.13 and a written
transition plan prepared by the designated county agency and the
Medi-Cal managed care health plan. The director's written
determination shall provide an implementation date for the
transition, at which point the Medi-Cal managed care health plan is
also responsible for fulfillment of the requirements set forth in
Sections 123855, 123925, and 123960. CCS program eligibility
determination shall remain the responsibility of the designated
county agency in accordance with the provisions of this article.
(2) The case management, care coordination, provider referral, and
service authorization functions of the CCS program shall remain the
responsibility of the county for CCS beneficiaries exempt from
mandatory enrollment in the Medi-Cal managed care plan.
(c) The CCS Medical Therapy Unit shall remain responsible for the
provision of medically necessary occupational and physical therapy
services prescribed by the CCS Medical Therapy Unit Conference Team
Physician.
(d) 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, interpret, or make specific this article,
Article 2.97 (commencing with Section 14093) and Article 2.985
(commencing with Section 14094.4) of Chapter 7 of Part 3 of Division
9 of the Welfare and Institutions Code, and any applicable federal
waivers and state plan amendments by means of all-county letters,
plan letters, CCS numbered letters, plan or provider bulletins, or
similar instructions, without taking regulatory action in order to
implement the Whole Child Model established pursuant to Article 2.985
(commencing with Section 14094.4). By July 1, 2020, the department
shall adopt regulations 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. Commencing January 1, 2018, the
department shall provide a status report to the Legislature on a
semiannual basis, in compliance with Section 9795 of the Government
Code, until regulations have been adopted.
SEC. 3. Section 14093.06 of the Welfare
and Institutions Code is amended to read:
14093.06. (a) When a managed care contractor authorized to
provide California Children's Services (CCS) covered services
pursuant to subdivision (a) of Section 14094.3 expands to other
counties, the contractor shall comply with CCS program standards
including, but not limited to, referral of newborns to the
appropriate neonatal intensive care level, referral of children
requiring pediatric intensive care to CCS-approved pediatric
intensive care units, and referral of children with CCS eligible
conditions to CCS-approved inpatient facilities and special care
centers in accordance with subdivision (c) of Section 14093.05.
(b) The (1) In Whole
Child Model program counties authorized pursuant to Article 2.985
(commencing with Section 14094.4), the managed care contractor
shall comply with CCS program medical eligibility regulations.
Questions regarding interpretation of state CCS
CCS program medical eligibility regulations, or
disagreements between the county CCS program,
CCS program and the managed care contractor regarding
interpretation of those regulations, shall be resolved by the
local CCS program, in consultation with the state CCS
program. department. The resolution determined
by the CCS program department shall be
communicated in writing to the managed care contractor.
(2) Managed care contractors in counties not listed in Section
14094.5 shall comply with CCS program medical eligibility
regulations. Questions regarding interpretation of CCS program
medical eligibility regulations, or disagreements between the CCS
program medical eligibility regulations, or disagreements between the
county CCS program and the managed care contractor regarding
interpretation of those regulations, shall be resolved by the local
CCS program, in consultation with the department. The resolution
determined by the department shall be communicated in writing to the
managed care contractor.
(c) In following the treatment plan approved by the CCS
program, developed in accordance with CCS program
requirements, the managed care contractor shall ensure the
timely referral of children with special health care needs to
CCS-paneled providers who are board-certified in both pediatrics and
in the appropriate pediatric subspecialty.
(d) The managed care contractor shall report expenditures and
savings separately for CCS covered services and CCS eligible
children, in accordance with paragraph (1) of subdivision (d) of
Section 14093.05.
(e) All children who are enrolled with a managed care contractor
who are seeking CCS program benefits shall retain all rights to CCS
program appeals and fair hearings of denials of medical eligibility
or of service authorizations. Information regarding the number,
nature, and disposition of appeals and fair hearings shall be part of
an annual report to the Legislature on managed care contractor
compliance with CCS standards, regulations, and procedures. This
report shall be made available to the public.
(f) The state, department, in
consultation with stakeholder groups, shall develop unique pediatric
plan performance standards and measurements, including, but not
limited to, the health outcomes of children with special health care
needs.
SEC. 4. Section 14094.2 of the Welfare
and Institutions Code is amended to read:
14094.2. (a) This article is not intended, and shall not be
interpreted, to permit any reduction in benefits or eligibility
levels under the CCS program. Any medically necessary service not
available under the managed care contracts authorized under this
article shall remain the responsibility of the state and county.
(b) In order to ensure that CCS benefits are provided to enrollees
with a CCS eligible condition according to CCS program standards,
there shall be oversight by the state and local CCS program agencies
for both services covered and not covered by the managed care
contract.
(b) (1) In Whole Child Model counties authorized pursuant to
Article 2.985 (commencing with Section 14094.4), in order to ensure
that CCS benefits are provided to enrollees with a CCS-eligible
condition according to CCS program standards, there shall be
oversight by the department for both services covered and not covered
by the managed care contract.
(2) In counties not listed in Section 14094.5, in order to ensure
that CCS benefits are provided to enrollees with a CCS-eligible
condition according to CCS program standards, there shall be
oversight by the department and local CCS program agencies for both
services covered and not covered by the managed care contract.
(c) To the extent that any changes in CCS medical eligibility are
proposed by the department, there shall be a stakeholder process that
shall include both of the following:
(1) A draft of the proposed regulatory changes shall be shared
publicly at least 120 days prior to the filing of a regulatory
change. The proposed changes shall also be shared with the
appropriate policy and fiscal committees of the Legislature as well
as posted publicly on the department's Internet Web site.
(2) The department shall utilize existing stakeholder committees
to receive input and comments on any proposed changes and provide
written comments back after input is provided. This input may be
provided to all stakeholders, including, but not limited to,
advocates, clinical experts, associations, county CCS program
administrators, families, and CCS providers.
SEC. 2. SEC. 5. Section 14094.3 of
the Welfare and Institutions Code is amended to read:
14094.3. (a) Notwithstanding this article or Section 14093.05 or
14094.1, CCS covered services shall not be incorporated into any
Medi-Cal managed care contract entered into after August 1, 1994,
pursuant to Article 2.7 (commencing with Section 14087.3), Article
2.8 (commencing with Section 14087.5), Article 2.9 (commencing with
Section 14088), Article 2.91 (commencing with Section 14089), Article
2.95 (commencing with Section 14092); or either Article 1
(commencing with Section 14200), or Article 7 (commencing with
Section 14490) of Chapter 8, until January 1, 2022, and until the
evaluation required pursuant to Section 14094.18 has been completed,
except for contracts entered into pursuant to the Whole Child Model
program, as described in Article 2.985 (commencing with Section
14094.4), or for county organized health systems or Regional Health
Authority in the Counties of San Mateo, Santa Barbara, Solano, Yolo,
Marin, and Napa.
(b) Notwithstanding any other provision of this chapter, providers
serving children under the CCS program who are enrolled with a
Medi-Cal managed care contractor but who are not enrolled in a pilot
project pursuant to subdivision (c) shall continue to submit billing
for CCS covered services on a fee-for-service basis until CCS covered
services are incorporated into the Medi-Cal managed care contracts
described in subdivision (a).
(c) (1) The department may authorize a pilot project in Solano
County in which reimbursement for conditions eligible under the CCS
program may be reimbursed on a capitated basis pursuant to Section
14093.05, and provided all CCS program's guidelines, standards, and
regulations are adhered to, and CCS program's case management is
utilized.
(2) During the time period described in subdivision (a), the
department may approve, implement, and evaluate limited pilot
projects under the CCS program to test alternative managed care
models tailored to the special health care needs of children under
the CCS program. The pilot projects may include, but need not be
limited to, coverage of different geographic areas, focusing on
certain subpopulations, and the employment of different payment and
incentive models. Pilot project proposals from CCS program-approved
providers shall be given preference. All pilot projects shall utilize
CCS program-approved standards and providers pursuant to Section
14094.1.
(d) For purposes of this section, CCS covered services include all
program benefits administered by the program specified in Section
123840 of the Health and Safety Code regardless of the funding
source.
(e) This section shall not be construed to exclude or restrict
CCS-eligible children from enrollment with a managed care contractor,
or from receiving from the managed care contractor with which they
are enrolled primary and other health care unrelated to the treatment
of the CCS-eligible condition.
(f) This section shall not be construed to exclude or restrict the
specialty of neonatology from reimbursement under the CCS program,
subject to the program's existing or applicable prior authorization
requirements or utilization review. Neonatology shall be included in
the CCS program.
SEC. 3. SEC. 6. Article 2.985
(commencing with Section 14094.4) is added to Chapter 7 of Part 3 of
Division 9 of the Welfare and Institutions Code, to read:
Article 2.985. Whole Child Model Program
14094.4. For the purposes of this article, the following
definitions shall apply:
(a) "CCS Provider" means a medical provider that is
paneled by the CCS program to treat a CCS-eligible condition pursuant
to Article 5 (commencing with Section 123800) of Chapter 3 of Part 2
of Division 106 of the Health and Safety Code. all of
the following:
(1) A medical provider that is paneled by the CCS program to treat
a CCS-eligible condition pursuant to Article 5 (commencing with
Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health
and Safety Code.
(2) A licensed acute care hospital approved by the CCS program to
treat a CCS-eligible condition.
(3) A special care center approved by the CCS program to treat a
CCS-eligible condition.
(b) "County organized health system" or "COHS" means:
(1) A county organized health system contracting with the
department to provide Medi-Cal services to beneficiaries pursuant to
Article 2.8 (commencing with Section 14087.5).
(2) A regional health authority.
(c) "Whole Child Model site" means a managed care plan under a
county organized health system or Regional Health Authority that is
selected to participate in the Whole Child Model program under a
capitated payment model.
(d) "Medi-Cal managed care plan" means a COHS.
14094.5. No sooner than July 1, 2017, the department may
establish a Whole Child Model program for Medi-Cal eligible CCS
children and youth enrolled in a managed care plan served by a county
organized health system or Regional Health Authority in the
following counties: Del Norte, Humboldt, Lake, Lassen, Marin,
Mendocino, Merced, Modoc, Monterey, Napa, Orange, San Luis Obispo,
San Mateo, Santa Barbara, Santa Cruz, Shasta, Siskiyou, Solano,
Sonoma, Trinity, and Yolo.
14094.6. The goals for the Whole Child Model program for children
and youth under 21 years of age who meet the eligibility
requirements of Section 123805 of the Health and Safety Code and are
enrolled in a managed care plan under a county organized health
system or Regional Health Authority shall include all of the
following:
(a) Improving the coordination of primary and preventive services
with specialty care services, medical therapy units, Early and
Periodic Screening, Diagnosis, and Treatment (EPSDT), long-term
services and supports (LTSS), regional center services, and home- and
community-based services using a child and youth and family-centered
approach.
(b) Maintaining or exceeding CCS program standards and specialty
care access, including access to appropriate subspecialties.
(c) Ensuring Providing for the
continuity of child and youth access to expert, CCS dedicated case
management and care coordination, provider referrals, and service
authorizations through contracting with or the employment of
county CCS staff to perform these functions. by
giving parents, guardians, or the youth the option to continue
receiving these services from his or her county public
health nurse.
(d) Improving the transition of youth from CCS to adult Medi-Cal
managed systems of care through better coordination of medical and
nonmedical services and supports and improved access to appropriate
adult providers for youth who age out of CCS.
(e) Identifying, tracking, and evaluating the transition of
children and youth from CCS to the Whole Child Model program to
inform future CCS program improvements.
14094.7. (a) No sooner than July 1, 2017, the department
shall establish an application process by which Medi-Cal managed
care plans under a county organized health system or Regional Health
Authority, including the county organized health systems and Regional
Health Authority that have incorporated CCS covered services into
their contracts pursuant to Section 14094.3, may participate in
may implement the Whole Child Model program
established under this section, pursuant to the criteria described in
this article. The director shall provide notice to the Legislature,
the federal Centers for Medicare and Medicaid Services, counties, CCS
providers, and CCS families when each managed care plan, including a
transition plan with the county CCS program, has been reviewed and
certified as ready to enroll children based on the criteria described
in this article.
(b) In order to apply to become a Whole Child Model site, a
managed care plan under a county organized health system or Regional
Health Authority shall provide a written application of interest that
provides the director with evidence of all of the following:
(1) Written approval by the county board of supervisors to partner
with the managed care plan for the integration of CCS medical and
case management and service authorizations for CCS Medi-Cal
beneficiaries into the managed care plan.
(2) Written support from the local bargaining units representing
affected CCS worker classifications.
(3) Written support from CCS providers that serve a preponderance
of the CCS children and youth in the county, home- and
community-based services networks, and the regional center or centers
that serve CCS children and youth in that county.
(4) Written support from the family resource center or family
empowerment center serving the affected county.
(c) The department shall post its written approval of an
application of interest on its Internet Web site at least 90 days
before CCS services are incorporated into the managed care plan under
the Whole Child Model program pursuant to this section.
(b) Prior to the implementation of the Whole Child Model, the
department shall do both of the following:
(1) Develop specific CCS program monitoring and oversight
standards for managed care plans that are subject to this article,
including access monitoring, quality measures, and ongoing public
data reporting.
(2) Establish a stakeholder process pursuant to Section 14094.17.
Consult with the statewide stakeholder advisory group established
pursuant to Section 14094.17 to develop and implement robust
monitoring processes to ensure that managed care plans are in
compliance with all of the provisions of this section. The department
shall monitor managed care plan compliance with the provisions of
this section on at least an annual basis and post CCS-specific
monitoring dashboards on its Internet Web site on at least an annual
basis.
(c) (1) In order to aid the transition of CCS services into
Medi-Cal managed care plans participating in the Whole Child Model
program, commencing January 1, 2017, and continuing through the
completion of the transition of CCS enrollees into the Whole Child
Model program, the department shall begin requesting and collecting
from Medi-Cal managed care information about each health plan's
provider network, including, but not limited to, the contracting
primary care, specialty care providers, and hospital facilities
contracting with the Medi-Cal managed care plan.
(2) The department shall analyze the existing Medi-Cal managed
care delivery system network and the CCS fee-for-service provider
networks to determine the overlap of the provider networks in each
county and shall furnish this information to the Medi-Cal managed
care plan.
(d) A managed care plan shall not be approved to participate in
the Whole Child Model program unless all of the following conditions
have been satisfied:
(1) The managed care plan has obtained written approval from the
director of its application of interest.
(2) The department has obtained any necessary federal approvals.
(3) The Medi-Cal managed care plan has established a local
stakeholder process with the meaningful engagement of a diverse group
of families that represent a range of conditions, disabilities, and
demographics, and local providers, including, but not limited to, the
parent centers, such as family resource centers, family empowerment
centers, and parent training and information centers, that support
families in the affected county.
(4) The director has verified the readiness of the managed care
plan to address the unique needs of CCS-eligible beneficiaries,
including, but not limited to, the requirements set forth in
subdivision (b) of Section 14087.48, subdivisions (b) to (f),
inclusive, of Section 14093.05, and all of the following:
(A) That the managed care contractor has demonstrated the
availability of an appropriate provider network to serve the needs of
children and youth with CCS conditions, including primary care
physicians, pediatric specialists and subspecialists, professional,
allied, and medical supportive personnel, and an adequate number of
licensed acute care hospitals and special care centers.
(B) That the Medi-Cal managed care plan has established and
maintains an updated and accessible listing of providers and their
specialties and subspecialties and makes it available to CCS-eligible
children and youth and their parents or guardians, at a minimum by
phone, written material, and Internet Web site.
(C) That the Medi-Cal managed care plan has entered into an
agreement with the county CCS program or the state, or both, for the
transition of CCS care coordination and service authorization and how
the plan will work with the CCS program
to ensure continuity and consistency of CCS
program expertise for that role, in accordance with this section and
subdivisions (e) and (f) of Section 14094.13.
(e) A Medi-Cal managed care plan, prior to implementation of the
Whole Child Model program, shall review historical CCS
fee-for-service utilization data for CCS-eligible children and youth
upon transition of CCS services to managed care plans so that the
managed care plans are better able to assist CCS-eligible children
and youth and prioritize assessment and care planning.
14094.8. (a) The department shall not implement the Whole Child
Model program in any county until it has developed specific CCS
program monitoring and oversight standards for managed care plans
that are subject to this article, including access monitoring,
quality measures, and ongoing public data reporting.
(b) The department shall consult with the statewide stakeholder
advisory group established pursuant to Section 14094.17 to develop
and implement robust monitoring processes to ensure that managed care
plans are in compliance with all of the provisions of this section.
The department shall monitor managed care plan compliance with the
provisions of this section on at least an annual basis and post
CCS-specific monitoring dashboards on its Internet Web site within 90
days.
(c) (1) In order to aid the transition of CCS services into
Medi-Cal managed care plans participating in the Whole Child Model
program, commencing January 1, 2017, and continuing through the
completion of the transition of CCS enrollees into the Whole Child
Model program, the department shall begin requesting and collecting
from Medi-Cal managed care information about each health plan's
provider network, including, but not limited to, the contracting
primary care, specialty care providers, and hospital facilities
contracting with the Medi-Cal managed care plan.
(2) The department shall analyze the existing Medi-Cal managed
care delivery system network and the CCS fee-for-service provider
networks to determine the overlap of the provider networks in each
county, and shall furnish this information to the Medi-Cal managed
care plan.
14094.9. (a) A managed care plan shall not be approved to
participate in the Whole Child Model program unless all of the
following conditions have been satisfied:
(1) The managed care plan has obtained written approval from the
director of its application of interest.
(2) The department has obtained any necessary federal approvals.
(3) At least three months prior to implementation of the Whole
Child Model program in the county or counties served by the plan, the
Medi-Cal managed care plan has established a local stakeholder
process with the meaningful engagement of a diverse group of families
that represent a range of conditions, disabilities, and
demographics, and local providers, including, but not limited to, the
parent centers, such as family resource centers, family empowerment
centers, and parent training and information centers, that support
families in the affected county.
(4) The director has verified the readiness of the managed care
plan to address the unique needs of CCS-eligible beneficiaries,
including, but not limited to, the requirements set forth in
subdivision (b) of Section 14087.48, subdivisions (b) to (f),
inclusive, of Section 14093.05, and all of the following:
(A) Timely and appropriate communication with affected
CCS-eligible children and youth and their parents or guardians.
Communication shall be tested for readability by a health literacy
and readability professional and targeted at a 6th grade reading
level. Plan communications to families and providers shall also be
shared with the plan's local family advisory group established
pursuant to this article for feedback.
(B) That the managed care contractor demonstrates the availability
of an appropriate provider network to serve the needs of children
and youth with CCS conditions, including primary care physicians,
pediatric specialists and subspecialists, professional, allied, and
medical supportive personnel, and an adequate number of accessible
facilities.
(C) That the Medi-Cal managed care plan has established and
maintains an updated and accessible listing of providers and their
specialties and subspecialties and makes it available to CCS-eligible
children and youth and their parents or guardians, at a minimum by
phone, written material, and Internet Web site.
(D) That the Medi-Cal managed care plan has entered into an
agreement with the county CCS program or the state, or both, for the
transition of CCS care coordination and service authorization and how
the plan will work with the CCS program to ensure continuity and
consistency of CCS program expertise for that role, in accordance
with this section.
(b) A Medi-Cal managed care plan, prior to implementation of the
Whole Child Model program, shall review historical CCS
fee-for-service utilization data for CCS-eligible children and youth
upon transition of CCS services to managed care plans so that the
managed care plans are better able to assist CCS-eligible children
and youth and prioritize assessment and care planning.
14094.9. (a) The department shall develop a memorandum of
understanding template, which shall be utilized by participating
counties and health plans, and which shall include, but not be
limited to, the standards relating to the local administration of,
and minimum services to be provided by, counties and Medi-Cal managed
care plans in the administration of the Whole Child Model program.
The department shall consult with counties and Medi-Cal managed care
plans in the development of the Whole Child Model memorandum of
understanding template.
(b) The department shall provide written notice to the county
agency, as designated in Section 123850 of the Health and Safety
Code, of the calculation for determining the administrative
allocation to the county CCS program by means of county information
notice. The department shall consult with the Whole Child Model
program counties in determining the calculation for determining the
administrative allocation.
14094.10. (a) Each Medi-Cal managed care plan participating in
the Whole Child Model program shall establish an assessment process
that, at a minimum, does all of the following:
(1) Assesses each CCS child's or youth's risk level and needs by
performing a risk assessment process using means such as telephonic
or in-person communication, review of utilization and claims
processing data, or by other means as determined by the department.
(2) Assesses, in accordance with the transition agreement with the
county CCS program, the health care needs of CCS-eligible
children and youth and coordinates their CCS specialty services,
Medi-Cal primary care services, mental health and behavioral
health benefits, services and mild to moderate mental
health services, specialty mental health as appropriate thr
ough the county specialty mental health plan, and Drug Medi-Cal
services as appropriate through county substance use disorder
program, and regional center services across all settings,
including coordination of necessary services within and, when
necessary, outside of the managed care plan's provider network.
(3) Follows timeframes for reassessment of risk and, if necessary,
circumstances or conditions that require redetermination of risk
level, which shall be set by the department.
(b) The risk assessment process shall be performed in accordance
with all applicable federal and state laws.
14094.11. A Medi-Cal managed care plan participating in the Whole
Child Model program shall meet all of the following requirements:
(a) Ensure that each CCS-eligible child or youth receives case
management, care coordination, provider referral, and service
authorization services from an employee of the plan who has knowledge
of and clinical experience with the CCS program pursuant to
subdivision (e) of Section 14094.13.
(a)
(b) Work with the state or county CCS program, as
appropriate, to ensure that, at a minimum, and in addition to other
statutory and contractual requirements, care coordination and care
management activities do all of the following:
(1) Reflect a CCS child or youth family-centered, outcome-based
approach to care planning.
(2) Ensure families have access to ongoing information, education,
and support so that they understand the care plan for their child or
youth and their role in the individual care process, the benefits of
mental health services, what self-determination means, and what
services might be available.
(3) Adhere to the CCS child's or youth's or the CCS child's or
youth's family's determination about the appropriate involvement of
his or her medical providers and caregivers, according to the federal
Health Insurance Portability and Accountability Act of 1996 (Public
Law 104-191).
(4) Are developed for the CCS child or youth across CCS specialty
services, Medi-Cal primary care services, mental health and
behavioral health benefits, regional center services, MTUs, and
in-home supportive services (IHSS), including transitions among
levels of care and between service locations.
(5)
(4) Include individual care plans for CCS-eligible
children and youth based on the results of the risk assessment
process with a particular focus on CCS specialty care.
(6)
(5) Consider behavioral health needs of CCS-eligible
children and youth and coordinate those services with the
county mental health department as part of the CCS child's
or youth's individual care plan, when appropriate, and facilitate a
CCS child's or youth's ability to access appropriate community
resources and other agencies, including referrals, as necessary and
appropriate, for behavioral services, such as specialty
mental health services and substance use disorder
services.
(7)
(6) Ensure that children and youth and their families
have appropriate access to transportation and other support services
necessary to receive treatment.
(b)
(c) Incorporate all of the following into the CCS child'
s or youth's plan of care patterns and processes:
(1) Access for families so that families know where to go for
ongoing information, education, and support in order that they
understand the goals, treatment plan, and course of care for their
child or youth and their role in the process, what it means to have
primary or specialty care for their child or youth, when it is time
to call a specialist, primary, urgent care, or emergency room, what
an interdisciplinary team is, and what the community resources are.
(2) A primary or specialty care physician who is the primary
clinician for the CCS-eligible child or youth and who provides core
clinical management functions.
(3) Care management and care coordination for the CCS-eligible
child or youth across the health care system, including transitions
among levels of care and interdisciplinary care teams.
(4) Provision of information about qualified professionals,
community resources, or other agencies for services or items outside
the scope of responsibility of the managed care plan.
(5) Use of clinical data to identify CCS-eligible children or
youth at the care site with chronic illness or other significant
health issues.
(6) Timely preventive, acute, and chronic illness treatment of
CCS-eligible children or youth in the appropriate setting.
14094.12. A Medi-Cal managed care plan serving children and youth
with CCS-eligible conditions under the CCS program shall do all of
the following:
(a) Coordinate with each regional center operating within the plan'
s service area to assist CCS-eligible children and youth with
developmental disabilities and their families in understanding and
accessing services and act as a central point of contact for
questions, questions related to health care
access and care concerns, and problem resolution.
(b) Coordinate with the local CCS Medical Therapy Unit (MTU) to
ensure appropriate access to MTU services. The Medi-Cal managed care
plan shall enter into a memorandum of understanding or similar
agreement with the county regarding coordination of MTU services and
other non-MTU services provided by the plan.
(c) Ensure that families have access to ongoing information,
education, and support so they understand the care plan, course of
treatment, and expected outcomes for their child or youth, the
assessment process, what it means, their role in the process, and
what services their child or youth may be eligible for.
(d) Facilitate communication among a CCS child's or youth's health
care and personal care providers, including in-home supportive
services and behavioral health providers, when appropriate, with the
CCS-eligible child or youth, parent, or guardian.
(e) Facilitate timely access to primary care, specialty care,
pharmacy, and other health services provided by CCS providers
and facilities with clinical expertise in treating the enrollee's
specific CCS condition that are needed by the CCS child or
youth, including referrals to address any physical or cognitive
disabilities.
(f) Provide training information for
families about managed care processes and how to navigate a health
plan, including their rights to appeal any service denials.
The managed care plan shall partner with a family empowerment center
or family resource center in its service area to provide this
training. denials, and how to request continuity of
care for pharmacy, specialized durable medical equipment and health
care providers, and nurses pursuant to Section 14094.13.
(g) Establish a mechanism to provide information,
education, and peer support to parents of CCS-eligible children and
youth through parent-to-parent liaisons or relationships with
information on how to access local family
resource centers or family empowerment centers.
(h) Provide that communication to, and services for, the
CCS-eligible children or youth and their families are available in
alternative formats that are culturally, linguistically, and
physically appropriate through means, including, but not limited to,
assistive listening systems, sign language interpreters, captioning,
written communication, plain language, and written translations in
at least the the applicable Medi-Cal
threshold languages.
(i) Provide that materials are available and provided to inform
CCS children and youth and their families of procedures for obtaining
CCS specialty services and Medi-Cal primary care and mental health
benefits, including grievance and appeals procedures that are offered
by the managed care plan or are available through the Medi-Cal
program.
(j) Identify and track children and youth with CCS-eligible
conditions for the duration of the child's or youth's participation
in the Whole Child Model program and for children and youth who age
into adult Medi-Cal systems, for at least 10 years into
adulthood. systems and who continue to be enrolled in
the same Medi-Cal managed care plan for at least three years into
adulthood, to the extent feasible.
(k) (1) Provide Comply with
Medi-Cal due process and reauthorization requirements and provide
timely processes for accepting and acting upon complaints and
grievances, including procedures for appealing decisions regarding
coverage or benefits. The grievance process shall comply with Section
14450 of this code, and Sections 1368 and 1368.01 of the Health and
Safety Code.
(2) Upon denial, denial of reauthorization, or termination of
services, a notice of action shall be sent to the CCS-eligible child
or youth, or person legally authorized to act on behalf of the child
or youth. The notice of action shall include information about the
option to file a Medi-Cal appeal and Medi-Cal due process rights.
(3) If a child, youth, or his or her authorized person elects to
participate in the process described in this section and disagrees
with the decision of the designated CCS agency, the child, youth, or
authorized person may appeal that decision, except when the service
under dispute has been ordered or terminated by a CCS physician with
responsibility for the medical supervision of the child or youth. If
the child, youth, or authorized person disagrees with the CCS
physician, he or she shall be provided with names of three expert
physicians. The child, youth, or authorized person shall choose one
of the expert physicians, and the physician shall evaluate the child
or youth at CCS expense. The opinion of the expert physician shall be
final.
(l) Annually publicly report on the number of CCS-eligible
children and youth served in their county by type of condition and
services used and the number of youth who aged out of the CCS program
by type of condition, provided the required report does not contain
individually identifiable information. If the required report would
result in the publication of individually identifiable information,
the plan shall not include that information in the required report.
14094.13. (a) Each Medi-Cal managed care plan shall establish and
maintain a process by which families a CCS-
eligible child or youth may maintain access to
any CCS providers CCS providers that the
child or youth has an existing relationship with for treatment
of the child's CCS condition, up to the length of
the child's or youth's CCS qualifying condition
or 12 months, whichever is longer, for three
years, under the following conditions:
(1) The CCS-eligible child or youth has an ongoing
relationship with a provider who is a CCS-approved provider.
seen the out-of-network CCS provider for a
nonemergency visit at least once during the 12 months immediately
preceding the date the Medi-Cal managed care plan assumed
responsibility for the child's or youth's CCS care under
the Whole Child Model program.
(2) The CCS provider will shall
accept the health plan's rate for the service offered or the
applicable Medi-Cal or CCS fee-for-service rate, whichever is higher,
unless the physician and surgeon enter CCS
provider enters into an agreement on an alternative payment
methodology mutually agreed to by the physician and surgeon
CCS provider and the Medi-Cal managed care plan.
(3) The managed care plan determines
confirms that the provider meets applicable CCS standards and
has no disqualifying quality of care issues, in accordance
with guidance from the department, including all-plan letters and CCS
numbered letters or other administrative communication.
issues.
(4) The CCS provider provides treatment information to
the Medi-Cal managed care plan, to the extent authorized by the state
and federal patient privacy provisions.
(5) This section shall apply to out-of-network and out-of-county
primary care and specialist providers.
(b) Each Medi-Cal managed care plan shall establish and maintain a
process by which a CCS-eligible child or youth may maintain access
to specialized or customized durable medical equipment providers for
up to 12 months under the conditions in paragraph (2):
(1) For the purposes of this subdivision, "specialized or
customized durable medical equipment" means durable medical equipment
that meets all of the following criteria:
(A) Is uniquely constructed from raw materials or substantially
modified from the base material solely for the full-time use of the
specific beneficiary according to a physician's description and
orders.
(B) Is made to order or adapted to meet the specific needs of the
beneficiary.
(C) Is uniquely constructed, adapted, or modified to permanently
preclude the use of the equipment by another individual, and is so
different from another item used for the same purpose that the two
items cannot be grouped together for pricing purposes.
(2) (A) The CCS-eligible child or youth has an ongoing
relationship with a durable medical equipment provider who has
previously provided specialized or customized equipment, such as
power wheelchairs, repairs, and replacement parts; prosthetic limbs;
customized orthotic devices; and individualized assistive technology.
This does not include generally available or noncustomized durable
medical equipment.
(B) The durable medical equipment provider shall accept the health
plan's rate for the service offered or the applicable Medi-Cal or
CCS fee-for-service rate, whichever is higher, unless the durable
medical equipment provider enters into an agreement on an alternative
payment methodology mutually agreed upon by the durable medical
equipment provider and the Medi-Cal managed care plan.
(C) The durable medical equipment provider provides information to
the Medi-Cal managed care plan as requested by the plan, to the
extent authorized by state and federal patient privacy provisions.
(3) The department may extend the continuity of care duration
period described in this subdivision for highly specialized or
customized durable medical equipment that is under warranty as
specified by the department.
(b)
(c) A managed care plan, at its discretion, may extend
the continuity of care period beyond the length of time specified in
subdivision (a). subdivisions (a) and (b).
(c)
(d) (1) Each Medi-Cal managed
care plan participating in the Whole Child Model program shall comply
with continuity of care requirements in Section 1373.96 of the
Health and Safety Code and Section 14185 of this code.
Code.
(2) Each Medi-Cal managed care plan shall permit a CCS-eligible
child or youth enrolled as part of the Whole Child Program to
continue use of any prescription drug that is part of a prescribed
therapy for the enrollee's CCS-eligible condition or conditions
immediately prior to the date of enrollment, whether or not the
prescription drug is covered by the plan, until the prescription drug
is no longer prescribed by the enrollee's plan-contracting CCS
provider.
(e) Each Medi-Cal managed care plan participating in the Whole
Child Model program shall ensure that children and youth are provided
expert case management, care coordination, service authorization,
and provider referral. Each plan shall meet this requirement by, at
the request of the child, youth, or his or her parent or guardian,
allowing the child or youth to continue to receive case management,
care coordination, provider referrals and service authorizations from
his or her public health nurse. This election shall be made within
90 days of the transition of CCS services into the Medi-Cal managed
care plan. A plan shall meet this requirement by either or both of
the following:
(1) By entering into a memorandum of understanding with the county
for case management, care coordination, provider referral, and
service authorization services to the child.
(2) By collocating county public health nurses who provide case
management and coordination within the Medi-Cal managed care plan.
(f) In the event the county public health nurse leaves the CCS
program, the Medi-Cal managed care plan may transition the care
coordination and case management of a child or youth to an employee
of the plan who has education, knowledge, and experience with the CCS
program and pediatric patients or who has knowledge and experience
treating CCS-eligible conditions in pediatric patients.
(g) A family or caregiver of a child or youth may appeal the
three-year continuity of care limitation in subdivision (a) to a
panel of three CCS providers with relevant clinical experience and
expertise who do not contract with the plan in order to continue to
receive services from a noncontracting CCS provider who meets the
criteria in subdivision (a). The family or caregiver shall choose
one, who shall evaluate the child at CCS expense and make a decision
on whether the child or youth can continue to receive continuity of
care from the CCS-paneled provider, subject to the conditions in
paragraphs (1) to (3), inclusive. The opinion of the expert physician
shall be final and binding upon the plan.
14094.14. (a) Each Medi-Cal managed care plan participating in
the Whole Child Model program shall provide a mechanism for a
CCS-eligible child's and youth's parent or caregiver to request a
specialist or clinic as a primary care provider.
(b) A CCS specialist or clinic may serve as a primary care
provider if the specialist or clinic agrees to serve in a primary
care provider role and is qualified to treat the required range of
CCS-eligible conditions of the CCS child or youth.
14094.15. A
Medi-Cal managed care plan shall meet all of the following
requirements:
(a) Comply with all Use all current and
applicable CCS program guidelines, including CCS program
regulations, CCS numbered letters, and CCS program information
notices. notices in developing criteria for
use by the plan's chief medical officer or the equivalent and other
care management staff.
(b) Base treatment decisions for CCS-related conditions on CCS
program guidelines or, if those guidelines do not exist, on treatment
protocols or recommendations of a national pediatric specialty
society with expertise in the condition.
(c) Use clinical guidelines or other evidence-based medicine when
applicable for treatment of the CCS-eligible child's or youth's
health care issues or timing of clinical preventive services.
(b) In cases in which CCS program guidelines do not exist, use
evidence-based guidelines or treatment protocols that are medically
appropriate given the child's CCS-eligible condition.
(d)
(c) Utilize only appropriately credentialed
CCS-paneled CCS providers to treat CCS
conditions.
(e)
(d) Utilize a provider dispute resolution process that
meets the standards established under Section 1371.38 of the Health
and Safety Code.
14094.16. (a) The department shall pay any managed care plan
participating in the Whole Child Model program a separate,
actuarially sound rate specifically for CCS children and
youth. youth, as long as an actuarially sound rate can
be developed for the managed care plan's CCS population. When
contracting with managed care plans, the department may allow the use
of risk corridors or other methods to appropriately mitigate a plan'
s risk for this population.
(b) A Medi-Cal managed care plan shall reimburse providers at
rates sufficient to recruit and retain qualified providers with
appropriate CCS expertise.
(c)
(b) Medi-Cal managed care plans shall pay physician and
surgeon provider services at rates that are equal to or exceed the
applicable CCS fee-for-service rates, unless the physician and
surgeon enters into an agreement on an alternative payment
methodology mutually agreed to by the physician and surgeon and the
Medi-Cal managed care plan
14094.17. (a) A Medi-Cal managed care plan participating in the
Whole Child Model program shall create and maintain a clinical
advisory committee composed of the managed care contractor's
Chief Medical Officer, chief medical officer or the
equivalent, the county CCS medical director, and at least four
CCS-paneled providers to review treatment authorizations and
other clinical issues relating to CCS conditions.
advise on clinical issues relating to CCS conditions, including
treatment authorization guidelines, and serve as clinical advisers on
other clinical issues relating to CCS conditions.
(b) (1) Each Medi-Cal managed care plan participating in the Whole
Child Model program shall establish a family advisory group for CCS
families.
(2) Family representatives who serve on this advisory group shall
receive ongoing information and training, travel
reimbursement, child care, and other financial assistance as
appropriate to enable participation in the advisory group.
a reasonable per diem payment to enable in-person
participation in the advisory group. A plan may conduct fa
mily advisory group meetings by teleconference or through other
similar electronic means to facilitate family participation in the
advisory group.
(3) A representative of this local group shall be invited to
serve on the department's statewide stakeholder advisory group
established pursuant to subdivision (c).
(c) (1) The department shall establish a statewide Whole Child
Model program stakeholder advisory group, or modify an existing
Whole Child Model program stakeholder advisory group, comprised
of representatives of CCS providers, county CCS program
administrators, health plans, family resource centers,
family empowerment centers, regional centers, labor
organizations, CCS case managers, CCS MTUs, and a
representative from each of the local representatives
from family advisory groups established pursuant to subdivision
(b).
(2) The department shall consult with the stakeholder advisory
group on the implementation of the Whole Child Model program and
shall incorporate consider the
recommendations of the stakeholder advisory group in developing the
monitoring processes and outcome measures by which the plans
participating in the Whole Child Model program shall be monitored and
evaluated.
(3) The statewide Whole Child Model program stakeholder advisory
group established under this section shall terminate December 31,
2021.
14094.18. (a) (1) The department shall contract with an
independent entity that has experience in performing robust program
evaluations to conduct an evaluation to assess Medi-Cal managed care
plan performance and the outcomes and the experience of CCS-eligible
children and youth participating in the Whole Child Model program,
including access to primary and specialty care, and youth transitions
from Whole Child Model program to adult Medi-Cal coverage.
(2) The department shall provide a report on the results of this
evaluation required pursuant to this section to the Legislature by no
later than January 1, 2023. 2021. A
report submitted to the Legislature pursuant to this subdivision
shall be submitted in compliance with Section 9795 of the Government
Code.
(b) The evaluation required by this section, at a minimum, shall
compare evaluate the performance of the
plans participating in the Whole Child Model program as
compared to the performance of the CCS program in
counties where CCS is not incorporated into managed care and collect
appropriate data to prior to the implementation of the
Whole Child Model in those same counties. The evaluation shall
evaluate whether the inclusion of CCS services in a managed care
delivery system improves access to care, quality of care, and the
patient experience by analyzing all of the following by the child's
or youth's race, ethnicity, and primary language spoken at home:
(1) Access to specialty and primary care, and in particular,
utilization of CCS-paneled providers.
(2) The level of compliance with CCS clinical guidelines and the
recommended guidelines of the American Academy of Pediatrics.
(3)
(2) The type and location of CCS services and,
with respect to health plans that have CCS services incorporated in
their contracts, and the extent to which CCS
services are provided in-network compared to out of network.
(4)
(3) Utilization rates of inpatient admissions,
outpatient services, durable medical equipment, behavioral health
services, home health, pharmacy, and other ancillary services.
(5)
(4) Patient and family satisfaction.
(6)
(5) Appeals, grievances, and complaints.
(7)
(6) Authorization of CCS-eligible services.
(8)
(7) Access to adult providers, support, and ancillary
services for youth who have aged into adult Medi-Cal coverage from
the Whole Child Model program.
(9)
(8) For health plans with CCS incorporated into their
contracts, network and provider participation, including
participation of pediatricians, pediatric specialists, and pediatric
subspecialists, by specialty and subspecialty.
(9) The ability of a child or youth who ages out of CCS and
remains in the same Medi-Cal managed care plan to retain his or her
existing providers.
(c) The evaluation required by this section shall also evaluate
the performance of managed care plans participating in the Whole
Child Model program as compared to the performance of the CCS program
in counties where CCS services are not incorporated into managed
care, and collect appropriate data to evaluate whether inclusion of
CCS services in a managed care delivery system improves access to
care, quality of care, and the patient experience, by analyzing all
of the following:
(1) The rate of new CCS enrollment in each county.
(2) The percentage of CCS-eligible children and youth with a
diagnosis requiring a referral to a CCS special care center who have
been at a CCS special care center.
(3) The percentage of CCS children and youth discharged from a
hospital who had at least one followup contact or visit within 20
days after discharge.
(c)
(d) The department shall consult with stakeholders,
including, but not limited to, the Whole Child Model stakeholder
advisory group, regarding the scope and structure of the review.
14094.19. This article is not intended, and shall not be
interpreted, to permit any reduction in benefits or eligibility
levels under the CCS program.
14094.20. (a) Notwithstanding Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code, the department, without taking regulatory action, shall
implement, interpret, or make specific this article, Article 2.97
(commencing with Section 14093), Article 2.98 (commencing with
Section 14094), and any applicable federal waivers and state plan
amendments by means of all-county letters, plan letters, CCS numbered
letters, plan or provider bulletins, or similar instructions until
the time regulations are adopted. By July 1, 2021, the department
shall adopt regulations 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. Commencing July 1, 2017, the
department shall provide a status report to the Legislature on a
semiannual basis, in compliance with Section 9795 of the Government
Code, until regulations have been adopted.
(b) The director may enter into exclusive or nonexclusive
contracts on a bid, nonbid, or negotiated basis and may amend
existing managed care contracts to provide or arrange for services
provided under this article. Contracts entered into or amended
pursuant to this section shall be exempt from the provisions of
Chapter 2 (commencing with Section 10290) of Part 2 of Division 2 of
the Public Contract Code and Chapter 6 (commencing with Section
14825) of Part 5.5 of Division 3 of Title 2 of the Government Code,
and shall be exempt from the review and approval of any division of
the Department of General Services.
SEC. 7. If the Commission on State Mandates
determines that this act contains costs mandated by the state,
reimbursement to local agencies and school districts for those costs
shall be made pursuant to Part 7 (commencing with Section 17500) of
Division 4 of Title 2 of the Government Code.