BILL NUMBER: AB 816 CHAPTERED 07/12/94 BILL TEXT CHAPTER 195 FILED WITH SECRETARY OF STATE JULY 12, 1994 APPROVED BY GOVERNOR JULY 11, 1994 PASSED THE SENATE JULY 7, 1994 PASSED THE ASSEMBLY JULY 7, 1994 CONFERENCE REPORT NO. 1 PROPOSED IN CONFERENCE JULY 6, 1994 AMENDED IN SENATE JANUARY 27, 1994 AMENDED IN SENATE JANUARY 18, 1994 AMENDED IN ASSEMBLY JUNE 8, 1993 AMENDED IN ASSEMBLY MAY 5, 1993 INTRODUCED BY Assembly Member Isenberg FEBRUARY 25, 1993 An act to amend Sections 49460, 49461, 49463, and 49465 of, and to add Section 49466 to, the Education Code, to amend Sections 1189.101, 1189.103, 1189.109, 1189.113, 24162, 24163, 24164, 24167, 24168.6, 24168.7, 24168.8, and 24169.8 of, to add Section 1189.107 to, to repeal and add Section 1189.105 of, and to add and repeal Article 8.7 (commencing with Section 424.10) of Chapter 2 of Part 1 of Division 1 of, the Health and Safety Code, to amend Sections 12696.05, 12698, 12699, 12699.50, and 12733 of the Insurance Code, to amend Sections 14148.5, 14148.99, 16809.5, 16909, 16918, 16930, 16931, 16934.5, 16935, 16936, 16937, 16938, 16941.1, 16942, 16945, 16948, 16952, 16970, 16980, 16981, and 16997.1 of, to add Section 16935.5 to, and to repeal Section 16954 of, the Welfare and Institutions Code, and to amend Section 43 of Chapter 278 of the Statutes of 1991, relating to public social services, making an appropriation therefor, and declaring the urgency thereof, to take effect immediately. LEGISLATIVE COUNSEL'S DIGEST AB 816, Isenberg. Health care. Existing law requires the State Department of Education, the State Department of Health Services, and the State Department of Social Services to jointly enter into a collaborative agreement with the California State University, the University of California, and the California medical schools, to establish a standardized health assessment of the children within public schools. The California State University is the agency responsible for coordinating that effort. This bill, instead, would designate the University of California as the agency responsible for coordinating that effort and would make changes to related provisions of law. Existing law provides that the State Department of Education, the State Department of Health Services, and the State Department of Social Services are only required to implement that health assessment upon the availability of sufficient private sector funding to cover all costs relating to the health assessment. This bill would instead make implementation of the health assessment contingent upon the availability of sufficient private sector and public funding. The bill would declare the intent of the Legislature that each fiscal year funds be appropriated to the University of California for the purposes of the health assessment in an amount equal to the private sector funds received for the relevant fiscal year. Existing law, until December 31, 1993, provides for awards and grants, through the University of California, for projects directed at the prevention of tobacco-related diseases. This bill would reenact those provisions for implementation until July 1, 1996. Existing law authorizes the State Department of Health Services to establish a reimbursement program for referral case management services provided to children for the 1993-94 fiscal year. This bill would extend that authorization to the 1994-95 and 1995-96 fiscal years. Existing law establishes the Expanded Access to Primary Care Program, operative until July 1, 1994, under which the State Department of Health Services would reimburse the costs incurred by selected health clinics in providing medical services and preventive health care to persons who meet specified income eligibility standards. This bill would extend the operative period of that program to July 1, 1996. It would also make various changes in methods of implementing this program. Existing law, until July 1, 1994, provides for the Tobacco Education Oversight Committee and establishes certain duties for that committee relating to tobacco education programs. This bill would continue the committee, rename it the Tobacco Education and Research Oversight Committee, and would revise the membership of the committee and its responsibilities, until July 1, 1996. Existing law, until July 1, 1994, requires the Major Risk Medical Insurance Board to implement a program to provide coverage for certain low-income women through participating health plans. Existing law specifies that the provisions requiring the implementation of the Access for Infants and Mothers (AIM) Program and establishment of the Perinatal Insurance Fund shall become inoperative July 1, 1994, and shall be repealed on January 1, 1995, unless a later enacted statute revises or repeals that date. This bill would extend that limitation to provide that those provisions shall become inoperative July 1, 1996, and shall be repealed January 1, 1997, unless a later enacted statute changes or repeals that date. Existing law authorizes the Major Risk Medical Insurance Board, charged with the implementation of the AIM Program, to issue rules and regulations and specifies that until December 31, 1992, any rules and regulations issued for those purposes may be adopted as emergency regulations. This bill would specifically authorize the issuance of emergency regulations by the board until January 1, 1997. Existing law limits the amount of household income that may not be exceeded in order to meet eligibility requirements for the AIM Program. This bill would revise those eligibility standards. Existing law establishes the continuously appropriated Perinatal Insurance Fund for implementation of the AIM Program. Existing law specifies that only funds appropriated from the Cigarette and Tobacco Products Surtax Fund shall be deposited in the Perinatal Insurance Fund. This bill would repeal that limitation and would, instead, specify that amounts deposited in the Perinatal Insurance Fund shall only be used for the purposes of the provisions requiring the establishment and implementation of the AIM Program. This bill would also revise procedures for the allocation and use of funds for school antitobacco education programs. The bill would revise the duties of the State Department of Health Services regarding tobacco interventions and require it to conduct a survey of specified factors with respect to tobacco use. Existing law also requires the Major Risk Medical Insurance Board to administer the California Major Risk Medical Insurance Program, in order to provide health coverage to certain persons. Existing law provides that subscribers to this program and their dependents who become eligible for Medicare benefits shall not be enrolled or continue to be enrolled in the program. This bill would exempt from this provision persons qualifying for Medicare benefits solely because of end-stage renal disease. Under existing law, until July 1, 1994, perinatal services are provided under the Medi-Cal program to eligible pregnant women and infants, as defined, and requires the department to provide for outreach activities. This bill would extend those requirements until July 1, 1996. Existing law contained in the California Health Care for the Indigent Program (CHIP) provides for the allocation of money from the Cigarette and Tobacco Products Surtax Fund to the counties to provide health care benefits. The CHIP will become inoperative July 1, 1994, and be repealed on January 1, 1995. This bill would extend until July 1, 1996, the operative date of provisions for the implementation of the CHIP. The bill would also revise procedures for the implementation of, and allocation of funds allocated under, the CHIP. This bill would appropriate funds from the Cigarette and Tobacco Products Surtax Fund to be allocated from the various accounts in the fund according to a specified schedule. The bill would state the intent of the Legislature regarding the University of California contracting for an evaluation of various programs funded by the Tobacco Tax and Health Protection Act of 1988. The bill would declare that it is to take effect immediately as an urgency statute. Appropriation: yes. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 49460 of the Education Code is amended to read: 49460. The State Department of Education, the State Department of Health Services, and the State Department of Social Services shall jointly enter into a collaborative agreement with the California State University, the University of California, and California medical schools, to establish a standardized health assessment of the children within public schools, and develop a data base on the health of children who are representative of the state's population. The University of California is responsible for coordinating this effort. The agreement shall address all of the following: (a) Conducting the health assessment which may include the following: (1) Anthropometric measures. (2) Testing for physical fitness. (3) Testing for chronic disease indicators by using the following methods: (A) A survey of family health and medical history. (B) Blood pressure measurement. (C) A blood panel by participating pupils, on a voluntary basis, and with the written consent of the pupil's parent or guardian. (4) Assessment of the nutritional status of participating pupils. (5) Conducting a voluntary and anonymous survey relating to alcohol, drug, and tobacco use, and related diseases. (b) Establishing a coordinating center at the University of California, in collaboration with the California State University and California medical schools, with pupil assessment sites at public schools. (c) Summarizing the assessment findings that shall be made available to the public. (d) Providing the assessment results to the State Department of Health Services, other state agencies, and to medical and education groups. SEC. 2. Section 49461 of the Education Code is amended to read: 49461. The coordinating center at the University of California shall select a sample of schools that is demographically and ethnically representative of the state's population to participate in the health assessment. SEC. 3. Section 49463 of the Education Code is amended to read: 49463. The University of California shall notify each school selected to participate in the assessment about any pupils at that school for whom the assessment has detected any health problems and shall notify the parent or guardian of each pupil for whom the assessment has detected health problems and shall recommend further consultation with a physician. If there is no physician available, the coordinating center shall direct the parent or guardian to an appropriate medical referral. Under no circumstances shall a school or the University of California be held liable for the parent or guardian's action, or failure to take action on seeking medical care for the identified health problem. This section is not applicable to alcohol, drug, and tobacco use. SEC. 4. Section 49465 of the Education Code is amended to read: 49465. (a) The agencies enumerated in Section 49460 shall only be required to implement this article upon the availability of funds received from the private sector and state funds appropriated for the purposes of this article in a total amount sufficient to cover all costs relating to the implementation and continuing administration of this article. (b) The University of California shall notify all participating entities, including school districts, the State Department of Education, the State Department of Health Services, the State Department of Social Services, and the California State University when sufficient funds are available to meet the requirements specified in subdivision (a). (c) Any funds received from the private sector under this article shall be deposited in the State Treasury and are continuously appropriated to the University of California, which shall allocate those funds to participating agencies to reimburse those agencies for costs incurred in carrying out this article. The amounts allocated to the State Department of Education shall include amounts sufficient to reimburse participating school districts for any costs incurred pursuant to this article. No school district shall be required to participate in the assessments unless it is reimbursed from those funds for all costs incurred pursuant to this article. (d) Reimbursements pursuant to this section shall be limited to the amounts and purposes specified in the collaborative agreement described in Section 49460. SEC. 5. Section 49466 is added to the Education Code, to read: 49466. No provision of this chapter shall apply to the University of California unless the Regents of the University of California, by resolution, make that provision applicable. SEC. 6. Article 8.7 (commencing with Section 424.10) is added to Chapter 2 of Part 1 of Division 1 of the Health and Safety Code, to read: Article 8.7. Cigarette and Tobacco Products Surtax Research Program 424.10. (a) (1) The Legislature finds that the efforts to reduce smoking in California have led to a drop in the consumption of tobacco. Although not on target to meet the goal of achieving a 75-percent reduction in tobacco consumption in California by the year 1999, the results are encouraging. (2) The Legislature further finds that as a result of the success of the programs, the money received from the taxation of tobacco has been dropping. The Legislature declares this a sign of success, not a matter of concern. (3) The Legislature further notes that programs, organizations, and individuals receiving money from the Cigarette and Tobacco Products Surtax Fund are receiving money from a declining revenue source. The Legislature finds that this success has led to an obvious concern and fear among recipients that "their money" is shrinking every year. (4) The Legislature finds that, assuming the success of the antismoking efforts continue, there will be necessary reductions in spending in the years to come. (5) The Legislature declares its intention to seek full analysis of all programs receiving money under Proposition 99 and declares its intention to critically evaluate how the money is being spent and whether the spending is achieving the results desired. (6) The Legislature specifically rejects the notion that every dollar of expenditure made by every program, organization, or activity is of equal value. Instead, the Legislature declares its intention to choose between competing programs and to allocate moneys to those programs and activities that are most successful in meeting the goals of the initiative. (b) It is the intent of the Legislature to provide for the continuation of the Cigarette and Tobacco Products Surtax Research Program to support research into tobacco-related disease. It is the intent of the Legislature that this program be administered by the University of California and that this program be administered pursuant to the following principles: (1) The research program established should adhere to the objectives stated in the provisions of the initiative act entitled Cigarette and Tobacco Products Surtax regarding research: "The Research Account . . . shall only be available for tobacco-related disease research." (2) All research funds shall be awarded on the basis of scientific merit as determined by an open, competitive peer review process that assures objectivity, consistency, and high quality. All qualified investigators, regardless of institutional affiliation, shall have equal access and opportunity to compete for the funds in the Research Account. (3) The peer review process for the selection of grants awarded under this program shall be modeled on that used by the National Institutes of Health in its grant-making process. (4) Awardees shall be reimbursed for the full cost, both direct and indirect, of conducting the sponsored research consistent with federal guidelines governing all federal research grants and contracts. 424.20. The Legislature hereby requests the University of California to continue to administer a comprehensive grant program to support research efforts related to the prevention, causes, and treatment of tobacco-related diseases. It is the intent of the Legislature that the program incorporate the principles and organizational elements specified in this article, including, but not limited to, a program office with a director and other necessary staff, a scientific advisory committee, and research review panels. 424.30. For the purposes of this article: (a) "Grantee" means any qualifying public, private, or nonprofit agency or individual including, but not limited to, colleges, universities, hospitals, laboratories, research institutions, local health departments, voluntary health agencies, health maintenance organizations, and individuals conducting research in California. (b) "Indirect costs" includes such items as use allowance for research facilities, heating, lighting, library services, health and safety services, project administration, and building maintenance, as defined by federal cost accounting guidelines for federally sponsored research. (c) "Tobacco-related disease" includes, but is not limited to, the following: (1) Coronary heart disease. (2) Cerebrovascular disease. (3) Cancer, including cancers of the lung, larynx, esophagus, bladder, pancreas, and mouth. It is the intent of the Legislature that the university further research the epidemiological link between smoking and breast cancer and prostate cancer. (4) Chronic obstructive lung disease, including emphysema, chronic bronchitis, asthma, and related lung disorders. (5) Other conditions or diseases that smoking or tobacco use has been established to be a risk factor for excess disability and illness. (d) "Tobacco-related disease research" includes, but is not limited to, research in the fields of biomedical science, the social and behavioral sciences, public policy, epidemiology, and public health. (e) "Public policy research" means research that investigates and evaluates various programs and strategies used by governmental, private, and nonprofit organizations to control tobacco use. (f) "University" means the University of California. 424.40. It is the intent of the Legislature that the university establish a scientific advisory committee to provide advice to the president of the university as to the direction, scope, and progress of the research program. (a) Responsibilities of the committee may include, but are not limited to: (1) Provision of advice on program priorities and emphasis. (2) Provision of advice on overall program budget. (3) Participation in periodic program evaluation. (4) Assistance in developing guidelines to assure fairness, neutrality, and adherence to the principles of merit and quality in the conduct of the program. (5) Assistance in developing appropriate linkages to nonacademic entities such as voluntary organizations, health care delivery institutions, industry, government agencies, and public officials. (b) Responsibilities of the committee may additionally include: (1) Development of criteria and standards for grant awards. (2) Development of administrative procedures relative to the solicitation, review, and award of grants to ensure an impartial, high quality peer review system. (3) Development and supervision of research review panels. (4) Review of research review panel reports and recommendations for grant awards. (5) Development and oversight of mechanisms for the dissemination of research results. (c) It is the intent of the Legislature that the committee consist of at least nine members representing a range of scientific expertise and experience appointed by the president of the university from nominations submitted by relevant organizations, as follows: (1) Three members from voluntary health organizations dedicated to the reduction of tobacco use. (2) One member with expertise in the field of biomedical research. (3) One member with expertise in the field of behavioral or social research. (4) One member from professional medical or health organizations. (5) One member from an independent research university in California. (6) One member drawn from other institutions engaged in research directed at tobacco-related diseases. (7) One member representing tobacco control for the State Department of Health Services. (8) One member representing a community-based provider of health education and prevention services. (d) Committee membership shall be drawn from the ranks of bona fide scientists and individuals fully conversant with the norms of scientific inquiry. (e) Members shall serve at the pleasure of the President of the University of California. Membership may be staggered in such a way as to maintain a full committee while ensuring a reasonable degree of continuity of expertise and consistency of direction. (f) Members shall serve without compensation, but may receive reimbursement for travel and other necessary expenses actually incurred in the performance of their official duties. (g) The Legislature hereby declares that public policy research is an area of compelling interest because of its potential to determine the best methods for reducing tobacco use on a wide scale among Californians. The scientific advisory committee shall give a high priority to proposals for grant awards to fund public policy research. 424.55. It is the intent of the Legislature that the university utilize peer review panels modeled upon the National Institutes of Health peer review process to review all research grants. The membership of these panels shall vary depending on the subject matter of proposals and review requirements, and shall draw on the most qualified individuals from appropriate institutions within and outside the State of California and from within and without the University of California system. The work of the peer review panels shall be administered pursuant to policies and procedures established by the scientific advisory committee. In order to avoid conflicts of interest and to ensure access to qualified reviewers, the university may utilize reviewers not only from California but also from outside the state. When serving on peer review panels, individuals who have submitted grant applications for funding by this program shall be governed by conflict-of-interest provisions consistent with the National Institutes of Health Manual, Chapter 4510 (item h). 424.60. Research projects funded under this article may include, but are not limited to: (a) Individual investigator-generated grants. These grants may be awarded to an institution on behalf of a principal investigator for a discrete project related to the investigator' s interests and competence. (b) New investigator grants. These grants may be awarded to an institution to support the work of promising individuals in the initial stages of their research careers. (c) Center grants. These grants may be awarded to institutions on behalf of a principal investigator and a group of collaborating investigators providing support for long-term multidisciplinary programs of research and development. (d) Conference grants. These grants may be awarded for funding of conferences in California to coordinate, exchange, and disseminate information related to specific research efforts. These grants may fund honoraria and travel expenses for invited participants from outside California. 424.70. It is the intent of the Legislature that the university, as lead agency, do all of the following: (a) Provide overall direction and coordination of the program. (b) Provide staff assistance to the advisory committee and review panels. (c) Provide for periodic program evaluation, to assure that work funded is consistent with program goals. (d) Maintain a system of financial reporting and accountability. (e) Transmit programmatic as well as financial reports to the state, including an annual report on grants made, grants in progress, program accomplishments, and future program directions. (f) Provide for the systematic dissemination of research results to the public and the health care community, and to provide for a mechanism to disseminate the most current research findings in the areas of smoking cessation and the prevention of tobacco use in order that these findings may be applied to the implementation of the Health Education Account. (g) Develop policies and procedures to facilitate the translation of research results into commercial applications wherever appropriate. (h) Undertake an outreach program to inform interested parties of the availability of grants for public policy research in the area of tobacco control. 424.80. It is the intent of the Legislature that projects funded under this article be reimbursed for actual costs, including direct costs and indirect costs incurred by a research institution consistent with federal guidelines. Indirect cost rates shall not exceed those allowable by the federal government for federally sponsored research. With respect to those institutions that have not negotiated a federal indirect cost reimbursement rate, the university will request information to verify the indirect cost rates. 424.90. It is the intent of the Legislature that no more than 5 percent of the Research Account be used for the purposes of the administration of this article. 424.95. No provision of this article shall apply to the University of California unless the regents of the university, by resolution, make that provision so applicable. 424.97. This article shall become inoperative on July 1, 1996, and, as of January 1, 1997, is repealed, unless a later enacted statute, which becomes effective on or before January 1, 1997, deletes or extends the dates on which it becomes inoperative and is repealed. SEC. 7. Section 1189.101 of the Health and Safety Code is amended to read: 1189.101. (a) The State Department of Health Services shall select primary care clinics that are licensed under paragraph (1) or (2) of subdivision (a) of Section 1204, or are exempt from licensure under subdivision (c) of Section 1206, to be reimbursed for delivering medical services, including preventative health care, and smoking prevention and cessation health education, to program beneficiaries. In selecting primary care clinics for reimbursement, the department shall give priority to clinics that provide services in a medically underserved area or to a medically underserved population as determined by the department. (b) As a part of the award process for funding pursuant to this part, the department shall take into account the availability of primary care services in the various geographic areas of the state. The department shall determine which areas within the state have populations which have clear and compelling difficulty in obtaining access to primary care. The department shall consider proposals from new and existing eligible providers to extend clinic services to these populations. The department shall give equal consideration to all applicants, regardless of whether or not they have previously been funded for this program by the department. (c) Each primary care clinic applying for funds pursuant to this part shall demonstrate that the funds shall be used to expand medical services, including preventative health care, and smoking prevention and cessation health education, for program beneficiaries based on the primary care clinic's projected increase in outpatient visits as compared to the outpatient visits provided in the 1988 calendar year. (d) (1) For purposes of this part, an outpatient visit shall include, diagnosis and medical treatment services, including the associated pharmacy, X-ray, and laboratory services, and prevention health and case management services that are needed as a result of the outpatient visit. For a new patient, an outpatient visit shall also include a health assessment encompassing an assessment of smoking behavior and the patient's need for appropriate health education specific to related tobacco use and exposure. (2) "Case management" includes, for this purpose, the management of all physician services, both primary and specialty, and arrangements for hospitalization, postdischarge care, and followup care. (e) (1) Payment shall be on a per visit basis at a rate that is determined by the department to be appropriate for an outpatient visit as defined in this section, not to exceed sixty-five dollars ($65) per outpatient visit. In developing a statewide uniform rate for an outpatient visit as defined in this part, the department shall consider existing rates of payments for comparable outpatient visits. The department shall review the outpatient visit rate on an annual basis. (2) The department may also pay for case management services, and may establish a separate, uniform statewide rate for these services which shall be paid in addition to the outpatient visit rate. The rate for case management shall not exceed 5 percent of the rate for an outpatient visit. If, upon establishment of the outpatient visit rate, the department determines that the rate of payment for case management is not adequate to cover the cost of the service, the department may increase the rate for case management, but the rate shall not exceed 10 percent of the outpatient visit rate. In developing the separate, uniform statewide rate for case management, the department shall take into account rates paid to providers for case management services under any other program funded in whole or in part by the state or federal government. The rates shall be published in accordance with subdivision (e). The department shall review the case management rate on an annual basis. (3) A primary care clinic may, at its option, and with department approval, provide and be paid for both outpatient visits and case management services. (f) Not later than January 15 of each year, the department shall adopt and provide each clinic with a schedule for programs under this part, including the date for notification of availability of funds, the deadline for the submission of a completed application, and an anticipated contract award date for successful applicants. (g) In administering the program created pursuant to this part, the department shall utilize the Medi-Cal program statutes and regulations pertaining to program participation standards, medical and administrative recordkeeping, the ability of the department to monitor and audit clinic records pertaining to program services rendered to program beneficiaries and take recoupments or recovery actions consistent with monitoring and audit findings, and the provider's appeal rights. Each primary care clinic applying for program participation shall certify that it will abide by these statutes and regulations and other program requirements set forth in this part. SEC. 8. Section 1189.103 of the Health and Safety Code is amended to read: 1189.103. (a) Each eligible entity applying for funds under this part, as specified in subdivision (a) of Section 1189.101, shall demonstrate in its application that it is providing primary care services, to a medically underserved area or population. Any applicant who has applied for and received a federal or state designation for serving a medically underserved area or population shall be deemed to meet the requirements of subdivision (a) of Section 1189.101. (b) Each applicant shall also demonstrate to the satisfaction of the department that the proposed services supplement, and do not supplant, those primary care services to program beneficiaries that are funded by any county, state, or federal program. (c) Each applicant shall demonstrate that it is an active Medi-Cal provider by having a Medi-Cal provider number and diligently billing the Medi-Cal program for services rendered to Medi-Cal eligible patients during the past three months. This subdivision shall not apply to clinics that are not currently Medi-Cal providers, and were funded participants pursuant to this part during the 1993-94 fiscal year. (d) Each application shall be evaluated by the state department prior to funding to determine all of the following: (1) The number of program beneficiaries who are in the service area of the applicant, and the number of visits, the scope of primary care services, and the proposed total budget for outpatient visits provided to beneficiaries under this part. The applicant shall provide its most recently audited financial statement to verify budget information. (2) The applicant's ability to deliver basic primary care to program beneficiaries. (3) A description of the applicant's operational quality assurance program. (4) The applicant's use of protocols for the most common diseases in the population served under this part. SEC. 9. Section 1189.105 of the Health and Safety Code is repealed. SEC. 10. Section 1189.105 is added to the Health and Safety Code, to read: 1189.105. (a) The department shall utilize existing contractual claims processing services in order to promote efficiency and to maximize use of funds. (b) The department shall certify which primary care clinics are selected to participate in the program for each specific fiscal year, and how much in program funds each selected primary care clinic will be allocated each fiscal year. (c) The department shall make an advance payment for funds appropriated for services provided under this part to the selected primary care clinics in an amount not to exceed 25 percent of a clinic's allocation for visits provided to program beneficiaries. These advance payments may only be made during the 1994-95 fiscal year. (d) In the event the department's contractual claims processing service is not ready to accept and timely adjudicate program claims by August 15, 1994, the department shall reimburse clinic billings in excess of the advance payment until such time as the contractual claims processing mechanism is viable. (e) The department shall pay claims from selected primary care clinics up to each clinic's annual allocation, adjusted for advance payments made under subdivision (c) and claims reimbursement made under subdivision (d). Once a clinic has exhausted its annual allocation, the state shall stop paying its program claims. (f) The department may adjust any selected primary care clinic's allocation to take into account: (1) An increase in program funds appropriated for the fiscal year. (2) A decrease in program funds appropriated for the fiscal year. (3) A clinic's projected inability to fully spend its allocation within the fiscal year. (4) Surplus funds reallocated from other selected primary care clinics. (g) The department shall notify all affected primary care clinics in writing prior to adjusting selected primary care clinics' allocations. (h) Cessation of program payments under subdivision (e) or adjustment of selected primary care clinic's allocations under subdivision (f) shall not be subject to the Medi-Cal appeals process referenced in subdivision (g) of Section 1189.101. SEC. 11. Section 1189.107 is added to the Health and Safety Code, to read: 1189.107. Final payment adjustments reflecting advance payments pursuant to this part shall be made pursuant to a plan of financial adjustment that is approved by the state department and submitted to the Controller. SEC. 12. Section 1189.109 of the Health and Safety Code is amended to read: 1189.109. (a) For any condition detected as part of a child health and disability prevention screen for any child eligible for services under Section 24165.3, if the child was screened by the clinic or upon referral by a child health and disability prevention program provider, unless the child is eligible to receive care with no share of cost under the Medi-Cal program, is covered under another publicly funded program, or the services are payable under private coverage, a clinic shall, as a condition of receiving funds under this article, do all of the following: (1) Insofar as the clinic directly provides these services for other patients, provide medically necessary followup treatment, including prescription drugs. (2) Insofar as the clinic does not provide treatment for the condition, arrange for the treatment to be provided. (b) (1) If any child requires treatment the clinic does not provide, the clinic shall arrange for the treatment to be provided, and the name of that provider shall be noted in the patient's medical record. (2) The clinic shall contact the provider or the patient or his or her guardian, or both, within 30 days after the arrangement for the provision of treatment is made, and shall determine if the provider has provided appropriate care, and shall note the results in the patient's medical record. (3) If the clinic is not able to determine, within 30 days after the arrangement for the provision of treatment is made, whether the needed treatment was provided, the clinic shall provide written notice to the county child health and disability prevention program director, and shall also provide a copy to the state director of the program. (c) (1) For the 1994-95 and 1995-96 fiscal years, inclusive, the state department may establish a reimbursement program for referral case management services required pursuant to subdivision (b), provided to a child pursuant to subdivision (a). (2) The state department may utilize funds appropriated for the purposes of this part for reimbursements under paragraph (1). (3) (A) The state department shall evaluate the effectiveness of the referral case management program, including the extent to which children actually receive appropriate treatment for conditions detected as part of the Child Health and Disability Prevention Program examination. (B) The state department shall report the evaluation required by subparagraph (A) to the health policy committee of each house of the Legislature no later than April 1 of each year. SEC. 13. Section 1189.113 of the Health and Safety Code is amended to read: 1189.113. This part shall remain operative only until July 1, 1996, and shall remain in effect only until January 1, 1997, and as of that date is repealed, unless a later enacted statute, which is effective on or before January 1, 1997, deletes or extends that date. SEC. 14. Section 24162 of the Health and Safety Code is amended to read: 24162. (a) There is hereby created the Tobacco Education and Research Oversight Committee in state government which shall advise the State Department of Health Services and the State Department of Education with respect to policy development, integration, and evaluation of tobacco education programs funded under this chapter, and for development of a master plan for the future implementation of tobacco education programs. (b) The Tobacco Education Oversight Committee shall be composed of 13 members to be appointed as follows: (1) Two members representing volunteer health organizations dedicated to the reduction of tobacco use appointed by the Speaker of the Assembly. (2) One member representing an organization that represents health care employees appointed by the Senate Rules Committee. (3) One member of a professional education association, such as an association of teachers, appointed by the Senate Rules Committee. (4) One member of a university facility with expertise in programs intended to reduce tobacco use appointed by the Governor. (5) Two representatives of a target population group appointed by the Governor. (6) One representative of the State Department of Health Services appointed by the Governor. (7) One representative of the State Department of Education appointed by the Superintendent of Public Instruction. (8) One member representing the interests of the general public appointed by the Governor. (9) One representative of local health departments appointed by the Governor. (10) One member representing a volunteer health organization dedicated to the reduction of tobacco associated injury appointed by the Governor. (11) One member from the Tobacco Related Disease Research Program appointed by the Governor. (c) Members shall serve for a term of two years, renewable at the option of the appointing authority. The initial appointments of members shall be for two or three years, to be drawn by random lot at the first meeting. The committee shall be staffed by the State Department of Health Services' coordinator of the program created pursuant to Section 24164. (d) The committee shall meet as often as it deems necessary, but shall meet not less than four times per year. (e) The members of the committee shall serve without compensation, but shall be reimbursed for necessary travel expenses incurred in the performance of the duties of the committee. SEC. 15. Section 24163 of the Health and Safety Code is amended to read: 24163. The committee shall be advisory to the State Department of Health Services, the University of California, and State Department of Education for the following purposes: (a) Evaluation of research, school- and community-based programs funded under this chapter as necessary in order to assess the overall effectiveness of efforts made by the programs to reduce the use of tobacco products. In order to evaluate tobacco education, research, and cessation programs, the committee shall seek the cooperation and assistance of the State Department of Health Services, the State Department of Education, county offices of education, local lead agencies, administrative representatives, target populations, school officials, and researchers. A principal measurement of effectiveness shall be reduction of smoking rates among a given target population. (b) Facilitation of programs directed at reducing and eliminating tobacco use that are operated jointly by more than one agency or entity. The committee shall propose strategies for the coordination of proposed programs administered by the State Department of Health Services, the University of California, and the State Department of Education in order to avoid the duplication of services and to maximize the public benefit of the programs. (c) Make recommendations to the State Department of Health Services, the University of California, and the State Department of Education regarding the most appropriate criteria for the selection of, standards of the operation of, and the types of programs to be funded under this chapter. (d) Reporting to the Legislature on or before January 1 of each year on the number and amount of tobacco education programs funded by the Health Education Account, created by Section 30122 of the Revenue and Taxation Code, the amount of money in the account, any moneys previously appropriated to the State Department of Health Services, the University of California, and the State Department of Education but unspent by the departments, a description and assessment of all programs funded under this chapter, and recommendations for any necessary policy changes or improvements for tobacco education programs. (e) Ensuring that the most current research findings regarding tobacco use prevention are applied in designing the tobacco education programs administered by the State Department of Health Services and the State Department of Education. The State Department of Health Services and the State Department of Education shall apply the most current findings and recommendations of research including research funded by the Research Account of the Cigarette and Tobacco Products Surtax Fund created by Section 30122 of the Revenue and Taxation Code. (f) Based on the results of programs supported by this chapter and any other proven methodologies available to the committee, produce a comprehensive master plan for implementing tobacco education programs throughout this state for the prevention and cessation of tobacco use. The master plan shall include implementation strategies for each target population specified in Section 24161.5 for programs throughout this state. The Tobacco Education and Research Oversight Committee shall submit the master plan to the Legislature on or before January 1, 1991, and shall be updated every two years thereafter until a progress report is completed on January 15, 2000. The master plan and its revisions shall include recommendations on administrative arrangements, funding priorities, integration and coordination of approaches by the State Department of Health Services, the University of California, and the State Department of Education and their support systems, as well as progress reports relating to each target population. The master plan shall establish a goal of achieving a 75-percent reduction in tobacco consumption in California by the year 1999. SEC. 16. Section 24164 of the Health and Safety Code is amended to read: 24164. (a) To prevent tobacco-related diseases and diminish tobacco use, the State Department of Health Services shall establish within the state department a program on tobacco use and health to reduce tobacco use in California by conducting health education interventions and behavior change programs at the state level, in the community, and other nonschool settings. (b) The state department shall conduct statewide surveillance of tobacco-related behaviors, knowledge, and attitudes and evaluate the state department's local and state tobacco control programs under this chapter. At a minimum, these evaluation activities shall utilize scientifically appropriate methods for monitoring the annual progress of the program in reducing the adult smoking prevalence from the 1993 benchmark rate of 20 percent and reducing cigarette consumption from the 1993 per capita benchmark rate of 4.84 packs per quarter. These surveillance and evaluation activities may include, but need not be limited to, the following: (1) Be based on sound evaluation principles and include, to the extent feasible, elements of controlled experimental methods. (2) Monitor the overall statewide effect of health education efforts on smoking and tobacco use, and, to the extent feasible, the resulting effects on health. (3) Monitor the effect of the programs on individual target populations identified by this chapter or designated by the state department as meriting special attention. (4) Provide an evaluation of the comparative effectiveness of individual program designs which shall be used in funding decisions and program modifications. (5) Incorporate other aspects into the evaluation which have been identified by the state department in consultation with state and local advisory groups, local lead agencies, and other interested parties. (6) Funds permitting, utilize a sample size that is adequate to produce county, regional, and ethnic specific estimates. (c) The state department shall produce or contract for, and update biennially, a description of programs determined to be effective in reducing smoking and tobacco use, and the identification of portions of target populations that need information regarding the hazards of tobacco use. The state department, in consultation with the State Department of Education, shall conduct, or contract for an evaluation of the effectiveness of the tobacco use prevention and education program as implemented in the public schools that receive funding for tobacco use prevention education pursuant to Sections 24167, 24168, 24168.1, and 24168.5. The purpose of the evaluation shall be to direct the most efficient allocation of resources appropriated under this chapter to accomplish the maximum prevention and reduction of tobacco use. The comprehensive evaluation shall be designed to measure the extent to which programs funded pursuant to this chapter promote the goals identified in this chapter and in Proposition 99 of the November 1988 general election. All information resulting from the evaluation shall be made available to the State Department of Education for purposes of improving its ability to implement and oversee the provision of effective tobacco use prevention education programs. The evaluator shall: (1) Assess the effectiveness of tobacco use prevention education programs designed to prevent and reduce tobacco use among students. In support of this primary goal, the evaluation shall: (A) Report findings on the effectiveness of programs and strategies currently in use in California schools that prevent and reduce tobacco use. (B) Select a research strategy that will identify formal and informal factors that might account for differences in tobacco use by students, including, but not limited to, formal education prevention strategies. (C) Incorporate in the evaluation quantitative as well as qualitative data. The data shall include, but are not limited to: (i) Student data, including attitudes, knowledge, and behavior based upon a statistically valid random sample of school districts and students. (ii) Curriculum data, including diversity of curricula, evidence of appropriateness to grade level, gender, and ethnicity, and the extent of the inclusion of prevention approaches identified in research literature. (iii) School data, including intensity of emphasis on tobacco use prevention and evidence of counseling or treatment referral systems. (iv) Community data, including the existence of parent networks and the participation of community service organizations including local lead agencies, in prevention. (2) Develop and test a regular tobacco use prevention and education information system for use by the State Department of Education, using the resulting information to establish the extent of implementation of tobacco use prevention education programs statewide and the degree of student exposure to these programs at selected grade levels. (3) Ensure provision of a fourth administration of a statewide, biennial survey of attitudes toward tobacco and prevalence of tobacco use among public school students. To the extent possible, existing survey data shall be utilized. (4) Provide recommendations to the Legislature and the State Department of Education on tobacco-use-prevention education program changes. (5) Assist the State Department of Education in identifying and developing instructional materials and curricula in school-based programs, designed to enhance the prevention of and encouraging the cessation of the continuing use of, tobacco products. The materials and curricula shall address the specific needs of persons in grades 4 to 12, inclusive, and in adult education programs. (d) School districts shall agree, as a condition of receiving money pursuant to this chapter, to participate in the evaluation if chosen by the evaluator. (e) (1) The State Department of Health Services shall contract with one or more qualified agencies for production and implementation of an ongoing public awareness of tobacco-related diseases by developing an information campaign using a variety of media approaches. The department shall issue a request for proposals biennially. Any media campaign funded with this part shall stress the importance of both preventing the initiation of tobacco use and quitting smoking and shall be based on professional market research and surveys necessary to determine the most effective method of diminishing tobacco use among specified target populations. Initial media efforts shall be directed to specific target populations. The contractors selected shall be provided with all available survey information resulting from ongoing programs funded under this chapter. Priority shall be given to minor children, ages 6 to 14, inclusive. The medium used shall be determined to be the most effective at reaching this targeted age group. With respect to the broadcast media, the message shall be aired at times expected to reach the priority age group. With respect to the print media, publications to be used shall be those which appeal to the priority age group. (2) No media campaign funded pursuant to this chapter shall feature in any manner the image or voice of any elected public official or candidate for elected office, or directly represent the views of any elected public official or candidate for elected office. (f) The department shall provide or contract for training, consultation, support, and continuing education to health professionals, and others interested in developing programs and services directed at preventing tobacco use and promoting smoking cessation, utilizing, when available and determined appropriate by the state department, the expertise of universities in this state and schools of public health. The training, consultation, support, and continuing education shall include advice and support in creating a smoke-free environment. (g) The department shall conduct an awards program to acknowledge the outstanding achievements of those communities, organizations, and groups that have fostered movement toward a smoke-free society or have reduced the consumption of tobacco. (h) The department shall issue guidelines for local plans for education against tobacco use. The guidelines shall require local public health departments to provide services directed at preventing tobacco use and promoting smoking cessation to the target populations enumerated in Section 24161.5 and to persons under 19 years of age who no longer attend school and to youth attending school who are not served through State Department of Education funded programs. The guidelines shall require for each target population to be served a description of the services to be provided, an estimate of the number to be served, an estimate of the success rate, and a method to determine to what extent goals have been achieved. Beginning with the 1990-91 fiscal year, and for each fiscal year thereafter, the guidelines shall require local lead agencies to describe how local funding decisions will take into account evaluations of program effectiveness and efficiency. The guidelines shall require the submission of a budget and information on staffing configurations. (i) By December 31, 1989, the department shall issue guidelines for fiscal year 1989-90 and by July 1, 1990, the department shall issue guidelines to local lead agencies on how to prepare a local plan for a comprehensive community intervention program against tobacco use. (j) The department shall provide technical assistance to local lead agencies for the development of plans required by Section 24165.5 so that the local lead agencies are able to comply with the schedule for the submission of plans specified in Section 24165.5. The technical assistance shall include, but not be limited to, the following: (1) Developing and disseminating preventive health education program options for local communities. (2) Providing training, consultation, and technical assistance to local health departments, local advisory committees, and service providers. (k) The department shall receive and approve local plans submitted by local lead agencies and provide technical assistance and guidance as necessary to ensure the compliance of the local lead agencies with this chapter. Every effort shall be made to approve or provide a list of necessary amendments to a local plan within 30 days of receipt of the local plan. The state department may authorize a local lead agency to begin implementation of its local plan on a provisional basis, with final approval of the local plan contingent on satisfying conditions specified by the state department. (l) The department shall work in collaboration with the public and private sectors in implementing the activities required of the state department and provide access upon request to local plans, program statistics, and other readily available information. (m) The department shall provide staff, assistance, and support needed by the committee. (n) In consultation with the committee, the department shall develop a comprehensive master plan for implementing tobacco education programs throughout the state for the prevention and cessation of tobacco use. (o) The department shall consult regularly with the University of California regarding trends in the frequency and the cost of treating tobacco-related diseases and the success of research efforts to reduce tobacco use and limit its adverse health effects. (p) The department shall establish, in consultation with the State Department of Education and county offices of education, a data collection and data management program to study effective tobacco use interventions. Under this program the department may contract for studies and evaluations in school-based and community-based programs. The department shall consult with the State Department of Education regarding the collection and evaluation of program data. (1) The department shall require, by contract, that local lead agencies use a uniform management data and information system which will permit comparisons of workload, unit costs, and outcome measurements on a statewide basis. The department shall specify data reporting requirements for local lead agencies and their subcontractors. (2) The department shall approve local lead agency and grantee computer software and hardware in order to ensure systemwide compatibility and capacity to expand. Departmental guidelines for local plans shall require local lead agencies to set forth their hardware and software plans and needs. (3) The department may contract for the development or operation of a computerized management information system. (4) The department shall consult the State Department of Education regarding computer software and hardware systems for school-based programs. SEC. 17. Section 24167 of the Health and Safety Code is amended to read: 24167. The State Department of Education shall provide the leadership for the successful implementation of this chapter in programs administered by local public and private schools, school districts, and county offices of education. The State Department of Education shall do all of the following: (a) Provide a planning and technical assistance program to carry out its responsibilities under this chapter. (b) Provide guidelines for schools, school districts, and school district consortia to follow in the preparation of plans for implementation of antitobacco use programs for schoolage populations. The guidelines shall: (1) Require the applicant agency to select one or more model program designs and shall permit the applicant to modify the model program designs to take special local needs and conditions into account. (2) Require the applicant agency to prepare for each target population to be served a description of the service to be provided, an estimate of the number to be served, an estimate of the success rate and a method to determine to what extent goals have been achieved. (3) Require plan submissions to include a staffing configuration and a budget setting forth use and distribution of funds in a clear and detailed manner. (c) Prepare model program designs and information for local schools, local school districts, consortia, and county offices of education to follow in establishing direct service programs to targeted populations. Model program designs shall, to the extent feasible, be based on studies and evaluations that determine which service delivery systems are effective in reducing tobacco use and are cost-effective. The State Department of Education shall consult with the State Department of Health Services, and school districts with existing antitobacco programs in the preparation of model program designs and information. (d) Provide technical assistance for local schools, local school districts, and county offices of education regarding the prevention and cessation of tobacco use. In fulfilling its technical assistance responsibilities, the State Department of Education may establish a center for tobacco use prevention which shall identify, maintain, and develop instructional materials and curricula encouraging the prevention or cessation of tobacco use. The State Department of Education shall consult with the State Department of Health Services and others with expertise in antitobacco materials or curricula in the preparation of these materials and curricula. (e) Monitor the implementation of programs which it has approved under this chapter to ensure successful implementation. (f) Prepare guidelines within 180 days of the effective date of this chapter for a school-based program of outreach, education, intervention, counseling, peer counseling, and other activities to reduce and prevent smoking among schoolage youth. (g) Assist county offices of education to employ a tobacco use prevention coordinator to assist local schools and local public and community agencies in preventing tobacco use by pupils. (h) Train the tobacco-use-prevention coordinators of county offices of education so that they are: (1) Familiar with relevant research regarding the effectiveness of various kinds of antitobacco use programs. (2) Familiar with department guidelines and requirements for submission, review, and approval of school-based plans. (3) Able to provide effective technical assistance to schools and school districts. (i) Establish a tobacco-use-prevention innovation program effort directed at specific pupil populations. (j) Establish a competitive grants program to develop innovative programs promoting the avoidance, abatement, and cessation of tobacco use among pupils. (k) Establish a tobacco-free school recognition awards program. (l) As a condition of receiving funds pursuant to this chapter, the State Department of Education, county offices of education, and local school districts shall ensure that they coordinate their efforts toward smoking prevention and cessation with the lead local agency in the community where the local school district is located. (m) (1) Develop, in coordination with the county offices of education, a formula which allocates funds for school-based, antitobacco education programs to school districts and county offices of education for all students in grades 4 to 8, inclusive, on the basis of the average daily attendance (ADA) of pupils. School districts shall provide tobacco-use-prevention instruction for students, grades 4 to 8, inclusive, that address the following essential topics: (A) Immediate and long-term undesirable physiologic, cosmetic, and social consequences of tobacco use. (B) Reasons that adolescents say they smoke or use tobacco. (C) Peer norms and social influences that promote tobacco use. (D) Refusal skills for resisting social influences that promote tobacco use. (2) Develop a competitive grants program administered by the State Department of Education directed at students in grades 9 to 12, inclusive. The purpose of the grant program shall be to conduct tobacco-use-prevention and cessation activities targeted to high-risk students and groups in order to reduce the number of persons beginning to use tobacco, or continuing to use tobacco. The State Department of Education shall consult with local lead agencies, the Tobacco Education and Research Oversight Committee, and representatives from nonprofit groups dedicated to the reduction of tobacco-associated disease in making grant award determinations. Grant award amounts shall be determined by available funds. The State Department of Education shall give priority to programs, including, but not limited to, the following: (A) Target current smokers and students most at risk for beginning to use tobacco. (B) Offer or refer students to cessation classes for current smokers. (C) Utilize existing antismoking resources, including local antismoking efforts by local lead agencies and competitive grant recipients. (n) (1) Allocate funds for administration to county offices of education for implementation of Tobacco Use Prevention Programs. The funds shall be allocated according to the following schedule based on average daily attendance in the prior year credited to all elementary, high, and unified school districts, and to all county superintendents of schools within the county as certified by the Superintendent of Public Instruction: (A) For counties with over 400,000 average daily attendance, thirty cents ($0.30) per average daily attendance. (B) For counties with more than 100,000 and less then 400,000 average daily attendance, sixty-five cents ($0.65) per average daily attendance. (C) For counties with more than 50,000 and less than 100,000 average daily attendance, ninety cents ($0.90) per average daily attendance. (D) For counties with more than 25,000 and less than 50,000 average daily attendance, one dollar ($1) per average daily attendance. (E) For counties with less than 25,000 average daily attendance, twenty-five thousand dollars ($25,000). (2) In the event that funds appropriated for this purpose are insufficient, the Superintendent of Public Instruction shall prorate available funds among participating county offices of education. (o) Allocate funds appropriated by the act adding this subdivision for local assistance to school districts and county offices of education based on average daily attendance reported in the second principal apportionment in the prior fiscal year. Those school districts and county offices of education that receive one hundred thousand dollars ($100,000) or more of local assistance pursuant to this part shall target 30 percent of those funds for allocation to schools that enroll a disproportionate share of students at risk for tobacco use. (p) (1) Provide that all school districts and county offices of education that receive funding under subdivision (o) make reasonable progress toward providing a tobacco-free environment in school facilities for students and employees. (2) All school districts and county offices of education that receive funding pursuant to paragraph (1) shall adopt and enforce a tobacco-free campus policy no later than July 1, 1995. The policy shall prohibit the use of tobacco products, any time, in district-owned or leased buildings, on district property and in district vehicles. Information about the policy and enforcement procedures shall be communicated clearly to school personnel, parents, students, and the larger community. Signs stating "Tobacco use is prohibited" shall be prominently displayed at all entrances to school property. Information about smoking cessation support programs shall be made available and encouraged for students and staff. Any school district or county office of education that does not have a tobacco-free district policy implemented by July 1, 1995, shall not be eligible to apply for funds from the Cigarette and Tobacco Products Surtax Fund in the 1995-96 fiscal year and until the tobacco-free policy is implemented. Funds that are withheld from school districts that fail to comply with the tobacco-free policy shall be available for allocation to school districts implementing a tobacco-use-prevention education program, pursuant to subdivision (m). SEC. 18. Section 24168.6 of the Health and Safety Code is amended to read: 24168.6. (a) The State Department of Education shall develop a common reporting format for districts receiving tobacco-use-prevention funds under this chapter. (b) The format required by subdivision (a) shall be designed to provide annual data on all of the following: (1) Tobacco-use-prevention education program expenditures. (2) Tobacco-use-prevention education program instructional and other services to targeted and general student populations. (3) Tobacco-use-prevention education program staff development and parent training. (4) Other information determined to be appropriate by the state department. (c) The information provided by the format required by subdivision (a) shall be in a quantitative format that describes the number of individuals who are served and the number of individuals receiving each type of service. (d) In addition to the requirements of subdivision (c), the information to be provided by the format required by subdivision (a) shall include, at a minimum, all of the following: (1) (A) The number of students receiving tobacco-use-prevention instruction and the type of curriculum used. (B) The format required by subdivision (a) shall show, by category, those students listed for the purpose of subparagraph (A), in each target group listed in Section 24161.5. (2) Other programmatic activities directly targeted to students, and the number of students participating in each. (3) The types of staff development or other tobacco-use-prevention training and, by staff classification, the number of staff members receiving such training. (4) The number of parents receiving training and the types of training provided. (5) The types of programs geared toward community involvement and the number of people served by each type. (6) The types of services provided to target populations which are in addition to services provided to other students. (7) The number and size of schools which are tobacco-free. (8) The ways in which money appropriated for the purpose of this chapter has been spent, including the following categories: salaries, including, but limited to, personnel, and substitute teacher costs; benefits; travel; consultant services; operating expenses, including, but not limited to, curriculum and instructional materials, supplies, other; capital outlay; and indirect costs. (e) (1) Each county office of education shall provide to the State Department of Education an annual report on district expenditures and services within its respective county pursuant to the common reporting format developed by the State Department of Education. (2) The county shall provide an annual report of the information required in paragraph (8) of subdivision (d). (f) (1) For the 1991-92 fiscal year and fiscal years thereafter, the State Department of Education shall report to the Legislature on local district expenditures and services statewide. (2) The state department shall make the report required by paragraph (1) on or before January 1 of each year. SEC. 19. Section 24168.7 of the Health and Safety Code is amended to read: 24168.7. (a) The State Department of Education shall monitor and ensure implementation of district and county offices of education tobacco-free policies and tobacco-use prevention education programs in districts receiving funding from the Cigarette and Tobacco Products Surtax Fund through procedures in the Coordinated Compliance Review Manual provided to school districts by the Superintendent of Public Education. (b) The state department shall develop and adopt yearly quantifiable targets for the reduction of tobacco use in those programs funded on a competitive grant basis for secondary school implementation. SEC. 20. Section 24168.8 of the Health and Safety Code is amended to read: 24168.8. (a) Each school district receiving funds from the Cigarette and Tobacco Products Surtax Fund shall make all of the following services available to every pregnant minor and minor parent enrolled in the school district: (1) Referral to perinatal and related support services. (2) Outreach services and assessment of smoking status. (3) Individualized counseling and advocacy services. (4) Motivational messages. (5) Cessation services, if appropriate. (6) Incentives to maintain a healthy lifestyle. (7) Followup assessment. (8) Maintenance and relapse prevention services. (b) Where appropriate, those services listed in subdivision (a) shall be integrated with existing programs for pregnant minors and minor parents. (c) Each district plan submitted in application for funds under this chapter shall include a description of the availability of the services required by this section. SEC. 21. Section 24169.8 of the Health and Safety Code is amended to read: 24169.8. This chapter shall remain operative only until July 1, 1996, and shall remain in effect only until January 1, 1997, and as of that date is repealed, unless a later enacted statute, which is effective on or before January 1, 1997, deletes or extends that date. SEC. 22. Section 12696.05 of the Insurance Code is amended to read: 12696.05. The board may do all of the following: (a) Determine eligibility criteria for the program. These criteria shall include the requirements set forth in Section 12698. (b) Determine the eligibility of applicants. (c) Determine when subscribers are covered and the extent and scope of coverage. (d) Determine subscriber contribution amounts schedules. Subscriber contribution amounts shall be indexed to the federal poverty level and shall not exceed 2 percent of a subscriber's annual gross family income. (e) Provide coverage through participating health plans or through coordination with other state programs, and contract for the processing of applications and the enrollment of subscribers. Any contract entered into pursuant to this part shall be exempt from any provision of law relating to competitive bidding, and shall be exempt from the review or approval of any division of the Department of General Services. The board shall not be required to specify the amounts encumbered for each contract, but may allocate funds to each contract based on projected and actual subscriber enrollments in a total amount not to exceed the amount appropriated for the program. (f) Authorize expenditures from the fund to pay program expenses which exceed subscriber contributions, and to administer the program as necessary. (g) Develop a promotional component of the program to make Californians aware of the program and the opportunity that it presents. (h) Issue rules and regulations as necessary to administer the program. Until January 1, 1997, any rules and regulations issued pursuant to this subdivision may be adopted as emergency regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). The adoption of these regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health, and safety, or general welfare. The regulations shall become effective immediately upon filing with the Secretary of State. (i) Exercise all powers reasonably necessary to carry out the powers and responsibilities expressly granted or imposed by this part. SEC. 23. Section 12698 of the Insurance Code is amended to read: 12698. To be eligible to participate in the program, a person shall meet all of the following requirements: (a) Be a resident of the state for at least six continuous months prior to application. (b) (1) Until the first day of the second month following the effective date of the amendment made to this subdivision in 1994, have a household income that does not exceed 250 percent of the official federal poverty level unless the board determines that the program funds are adequate to serve households above that level. (2) Upon the first day of the second month following the effective date of the amendment made to this subdivision in 1994, have a household income that is above 200 percent of the official federal poverty level but does not exceed 250 percent of the official federal poverty level unless the board determines that the program funds are adequate to serve households above the 250 percent of the official federal poverty level. (c) Pay an initial subscriber contribution of not more than fifty dollars ($50), and agree to the payment of the complete subscriber contribution. SEC. 24. Section 12699 of the Insurance Code is amended to read: 12699. (a) The Perinatal Insurance Fund is hereby created in the State Treasury. (b) Amounts deposited in the fund shall only be used for the purposes specified by this chapter. (c) Notwithstanding Section 13340 of the Government Code, the fund is hereby continuously appropriated, without regard to fiscal years, to the board, for the purposes specified in this part. SEC. 25. Section 12699.50 of the Insurance Code is amended to read: 12699.50. This part shall remain operative only until July 1, 1996, shall remain in effect only until January 1, 1997, and as of that date is repealed, unless a later enacted statute, which is effective on or before January 1, 1997, deletes or extends that date. SEC. 26. Section 12733 of the Insurance Code is amended to read: 12733. Subscribers and their dependents who become eligible for Part A and Part B of Medicare, excluding those on Medicare solely because of end-stage renal disease, shall not be enrolled, or continue to be enrolled, in major risk medical coverage afforded by this part. SEC. 27. Section 14148.5 of the Welfare and Institutions Code is amended to read: 14148.5. (a) State funded perinatal services shall be provided under the Medi-Cal program to pregnant women and state funded medical services to infants up to one year of age in families with incomes above 185 percent, but not more than 200 percent of the federal poverty level, in the same manner that these services are being provided to the Medi-Cal population, including eligibility requirements and integration of eligibility determinations and payment of claims, except as follows: (1) The assets of the family shall not be considered in making the eligibility determination. (2) The income deduction specified in subdivision (f) of Section 14148 shall not be applied. (b) Services provided under this section shall not be subject to any share-of-cost requirements. (c) (1) The department, in implementing the Medi-Cal program and public health programs, in coordination with the Major Risk Medical Insurance Programs Access for Infants and Mothers component shall provide for outreach activities in order to enhance participation and access to perinatal services. Notwithstanding Section 30122 of the Revenue and Taxation Code, funding for these outreach activities shall be made available from the funds appropriated for purposes of this section, and to the extent permissible, from funding received pursuant to Subchapter XIX (commencing with Section 1396) of Chapter 7 of Title 42 of the United States Code. Funding received pursuant to the federal provisions shall be used to expand perinatal outreach activities. (2) Those outreach activities required by paragraph (1) shall be targeted toward both Medi-Cal and non-Medi-Cal eligible high risk or uninsured pregnant women and infants. Outreach activities may include, but not be limited to, all of the following: (A) Education of the targeted women on the availability and importance of early prenatal care and referral to Medi-Cal and other programs. (B) Information provided through toll-free telephone numbers. (C) Recruitment and retention of perinatal providers. (d) The amendment made to paragraph (1) of subdivision (c) by Senate Bill 99 of the 1991-92 Regular Session constitutes an amendment to the Tobacco Tax and Health Protection Act of 1988. (e) This section shall remain operative only until July 1, 1996, and shall remain in effect only until January 1, 1997, and as of that date is repealed, unless a later enacted statute, which is effective on or before January 1, 1997, deletes or extends that date. SEC. 29. Section 14148.99 of the Welfare and Institutions Code is amended to read: 14148.99. This article shall remain operative only until July 1, 1996, shall remain in effect only until January 1, 1997, and as of that date is repealed, unless a later enacted statute, which is effective on or before January 1, 1997, deletes or extends that date. SEC. 30. Section 16809.5 of the Welfare and Institutions Code is amended to read: 16809.5. (a) Funds appropriated for the purposes of this section shall be allocated on a monthly basis. (b) Money allocated for the purposes of this section may be used to expand the scope of benefits, to fund special projects which alleviate problems of access to health and dental care under the County Medical Services Program and to compensate hospitals and other emergency health service providers for emergency treatment of out-of-county indigent patients and shall not be used to fund existing levels of service. (c) Funds available from appropriations for the purposes of this chapter may be utilized to fund increased program costs due to caseload increases and provider rate increases. (d) Unexpended funds allocated from the fiscal year 1990-91 appropriation for purposes of improving dental access may be utilized in fiscal year 1991-92 for the continuation and completion of projects developed to improve dental access. (e) This section shall remain operative only until July 1, 1996, and shall remain in effect only until January 1, 1997, and as of that date is repealed, unless a later enacted statute, which is effective on or before January 1, 1997, deletes or extends that date. SEC. 31. Section 16909 of the Welfare and Institutions Code is amended to read: 16909. (a) Any county which receives funds pursuant to this part shall deposit them in a special revenue fund or trust fund established solely for this purpose, in a hospital services account, a physician services account, and other county health services account, and any other account or subaccount the department may require, before transferring or expending them for any of the uses allowed in this part. (b) Any county subject to the requirements of subdivision (a) shall deposit the funds in the special revenue fund or trust fund before transferring the funds to the county emergency medical services fund, as provided in subdivision (c) of Section 16933 and Section 16951. (c) (1) Interest on each fund, account, or subaccount shall accrue to the benefit of the fund, account, or subaccount, and shall be expended for the same purposes as the other funds in the account or subaccount. (2) Interest or other increments resulting from funds transferred to the county for noncounty hospitals pursuant to paragraph (1) or (2) of subdivision (b) of Section 16946 shall be expended under paragraph (1) or (2) of subdivision (b) of Section 16946. (d) For the period July 1, 1991, to June 30, 1996, inclusive, counties shall submit a report that displays cost and utilization data for each account in the trust fund established pursuant to this section, to the department on a semiannual, preliminary annual, and final annual basis, in a form prescribed by the department. (e) Data required by subdivision (d) shall include, but not be limited to, all of the following: (1) For the Hospital Services Account, the data shall include all of the following: (A) Inpatient stay, including child health and disability prevention followup treatment, including the following information: (i) Facility name. (ii) Amount paid by the county. (iii) Number of discharges. (iv) Patient days. (B) Outpatient visits, including child health and disability prevention followup treatment, including the following information: (i) Facility name. (ii) Amount paid by the county. (iii) Number of visits. (C) Emergency room. (i) Facility name. (ii) Amount paid by the county. (iii) Number of visits. (2) For the Physician Services Account, the data shall include all of the following: (A) Emergency services, including the following information: (i) The number of providers. (ii) The number of visits. (iii) The amount paid by the county. (B) Obstetrics, including the following information: (i) The number of providers. (ii) The number of visits. (iii) The amount paid by the county. (C) Pediatrics, including the following information: (i) The number of providers. (ii) The number of visits. (iii) The amount paid by the county. (D) Child health and disability prevention followup treatment, including the following information: (i) The number of providers. (ii) The number of visits. (iii) The amount paid by the county. (3) For the other county health services account, the data shall include all of the following: (A) For funds expended for hospital services, those data in paragraph (1) of subdivision (e). (B) For funds expended for physician services, those data in paragraph (2) of subdivision (e). (C) For funds expended for services other than those provided and billed for by a hospital or physician, the data shall include: (i) The number of providers by type of service. (ii) The number of visits or units, or both, by type of service. (iii) The amount paid by the county by type of service. (D) Child health and disability prevention followup treatment, including the following information: (i) The number of providers. (ii) The number of visits. (iii) The amount paid by the county. (f) The Director of Health Services shall withhold, in part or in whole, payment of moneys governed by Chapter 4 (commencing with Section 16930) and Chapter 5 (commencing with Section 16940) of this part to a county, until the reports specified in this section have been submitted to the department in the form and according to the procedures established by the department. SEC. 32. Section 16918 of the Welfare and Institutions Code is amended to read: 16918. (a) Counties shall report information on indigent health care program demographic, expenditure, and utilization data, in a form which will provide a count of persons using services funded under this part, to the department, on a quarterly basis. (b) Data required by subdivision (a) shall include all of the following information: (1) For the Hospital Services Account, the Physician Services Account, and the Other County Health Services Account in the trust fund established pursuant to Section 16909, the period commencing July 1, 1989, to June 30, 1991, inclusive, the data shall include all of the following: (A) Date of birth. (B) Sex. (C) Residence ZIP Code. (D) Child Health and Disability Prevention Program followup. (E) Other potential third-party payer source. (F) Amount billed to the county. (2) For the Physician Services Account and the Other County Health Services Account established pursuant to Section 16909, the following demographic data shall be reported on a minimum of 5 percent of patients eligible under this part, for the period commencing April 1, 1990, to June 30, 1991 ; for the Hospital Services Account in the fund, for the period commencing April 1, 1990, to June 30, 1991, the following demographic data shall be reported on a minimum of 5 percent of patients eligible under this part; for the period commencing July 1, 1990, to June 30, 1991, the level of data reported shall be on a per hospital basis as determined by the department: (A) Ethnicity. (B) Family size. (C) Family gross monthly income. (D) Family principal income source. (3) For the Hospital Services Account, the data shall include all of the following: (A) Date of service or inpatient admission. (B) Type of service. (C) Number of inpatient days; and the number of outpatient and emergency room visits. (D) Diagnosis (inpatient only). (4) For the Physician Services Account in the fund, the data shall include all of the following: (A) Date of service. (B) Type of service. (C) Service setting. (D) Physician specialty. (5) For the Other County Health Services Account during the period commencing July 1, 1989, to June 30, 1996, inclusive, the data shall include all of the following: (A) Date of service or inpatient admission. (B) Type of service. (C) Number of units. (D) Type of units. (c) (1) Physicians shall provide data under subdivision (b) for services provided in a hospital to the extent the information is available from the hospital. (2) Physicians shall provide data under subdivision (b) for services performed in an office setting on 5 percent of patients for whom payment is received pursuant to Article 3.5 (commencing with Section 16951) of Chapter 5. SEC. 33. Section 16930 of the Welfare and Institutions Code is amended to read: 16930. (a) (1) There is in the County Health Services Fund, created pursuant to Section 16803, the Rural Health Services Account. (2) For purposes of this chapter, "account" means the account created by paragraph (1). (b) All money appropriated for the purposes of this chapter shall be deposited in the account. (c) The department shall administer moneys deposited in the account on an accrual basis, and notwithstanding any other provision of law, except as provided in this chapter, those moneys shall not be transferred to any other fund or account except for purposes of investment, as provided in Article 4 (commencing with Section 16470) of Chapter 3 of Part 2 of Division 4 of Title 2 of the Government Code. SEC. 34. Section 16931 of the Welfare and Institutions Code is amended to read: 16931. (a) Funds appropriated for the purposes of this chapter shall be used to enhance and maintain rural health services provided by counties, hospitals, physicians, and other providers of services to patients who cannot afford to pay for those services, and for whom payment will not be made through any private coverage or by any program funded in whole or in part by the federal government. (b) The requirements of Sections 16804.1 and 16818 apply to services supported by funds appropriated for the purposes of this chapter. (c) Except as specifically provided in this chapter, the authority of each county established pursuant to Section 16817 shall remain unaffected. SEC. 35. Section 16934.5 of the Welfare and Institutions Code is amended to read: 16934.5. (a) For the 1990-91 fiscal year and subsequent fiscal years, each county may enter into a contract with the department in which the department agrees to assume the responsibility to pay for the cost of treatment service provided on or after July 1, 1990, to children pursuant to Section 16934. If a county contracting with the department pursuant to Section 16809 does not apply for or rescinds its application for funds under this chapter, the department may use all or part of that county's allocation, as calculated pursuant to paragraph (3), to pay for the costs of treatment services to children pursuant to Section 16934. (1) Each county intending to contract with the department shall submit to the department a notice of intent to contract adopted by the board of supervisors no later than June 1, 1990. For each fiscal year thereafter a notice adopted by the board of supervisors shall be submitted no later than April 1 of the fiscal year preceding the fiscal year for which the agreement will be in effect, in accordance with procedures established by the department. As a condition of contracting with the department, the department may establish uniform standards, forms, and procedures for the processing and payment of claims for treatment services. (2) (A) Each county contracting with the department pursuant to this subdivision for the 1991-92 fiscal year that has previously contracted with the department pursuant to this section shall agree that the department shall retain 10 percent of the allocation it would otherwise have received under this chapter. The department shall transfer amounts retained on a monthly basis to the CHDP Treatment Account established in subdivision (b). (B) Any county that contracts with the department pursuant to this subdivision during the 1991-92 fiscal year that has not previously contracted with the department pursuant to this section shall agree that the department shall retain 20 percent of the allocation the county would otherwise have received under this chapter for that portion of the year for which it contracts under this section. (3) In future fiscal years the percentage retained by the department may be adjusted to reflect actual payments, projected expenditures, funds appropriated by the Legislature for treatment services, and the overall status of the account established in subdivision (b). (b) Beginning with the 1990-91 fiscal year, the department shall establish a separate Child Health and Disability Prevention Treatment Account. For purposes of this chapter "CHDP Treatment Account" means the account established pursuant to this subdivision. (1) The following funds shall be deposited into the CHDP Treatment Account: (A) Funds appropriated by the Legislature to fund the reinsurance account established in subdivision (b) of Section 16934.2 which are not expended or encumbered for that purpose. (B) Any funds recouped from those counties electing to establish a 15 percent reserve pursuant to subdivision (a) of Section 16934.2. (C) Funds retained by the department pursuant to subdivision (a). (D) Interest earnings on funds. (E) Any additional funds appropriated by the Legislature. (2) Funds deposited in the CHDP Treatment Account shall be administered on an accrual basis and notwithstanding any other provision of law, except as provided in this chapter, shall not be transferred to any other fund or account except for purposes of investment as provided in Article 4 (commencing with Section 16470) of Chapter 3 of Part 2 of Division 4 of Title 2 of the Government Code. (3) Moneys deposited into the account shall constitute a risk pool which shall be used for any or all of the following purposes: (A) Payment for services provided pursuant to Section 16934 in counties which have contracted with the department pursuant to subdivision (a). (B) State administrative costs, including any costs associated with a contract for processing claims. (C) If the projected expenditure of funds from the CHDP Treatment Account for any fiscal year exceeds available revenues, the department may adjust payments for the remainder of the fiscal year to providers on a pro rata basis in order to ensure that expenditures do not exceed available revenues. SEC. 36. Section 16935 of the Welfare and Institutions Code is amended to read: 16935. (a) A CMSP county electing to have the state administer its medically indigent adult program as authorized by Section 16809 may also elect to have the state administer its physician services account. Each CMSP county electing to have the state administer its physician services account shall do all of the following: (1) Enter into a contract with the department to administer its county physician services account. (2) Authorize the department to act on its behalf and to assume all responsibilities for the distribution and monitoring of funds in its physician services account pursuant to subdivision (c) of Section 16952. (3) Agree to comply with uniform policies, procedures, and program standards, including, but not limited to, eligibility levels established mutually by the department and the participating counties. (4) Transfer funds allocated to the county for purposes of the county physician services account, less any funds retained pursuant to subdivision (a) of Section 16934.5 to the department under such conditions as the department may require. (b) The department may use funds retained or transferred to it by the county pursuant to this subdivision for purposes of administering the county's physician services account in accordance with Sections 16952 to 16958, inclusive. (c) For the 1989-90 fiscal year, any county which intends to contract with the department for the administration of moneys allocated from the Physician Services Account in the fund pursuant to subdivision (c) of Section 16952 shall submit, to the department, a notice of intent to contract which has been adopted by the county board of supervisors, not later than November 15, 1989. (d) For the 1990-91 fiscal year and subsequent fiscal years, any county which intends to contract with the department for the administration of moneys allocated from the Physician Services Account in the fund shall submit to the department a notice of intent to contract, which has been adopted by the county board of supervisors, not later than April 1 of the fiscal year preceding the fiscal year for which the contract will be in effect and in accordance with procedures established by the department. SEC. 37. Section 16935.5 is added to the Welfare and Institutions Code, to read: 16935.5. The department may administer the distribution and monitoring of funds allocated from the Hospital Services Account pursuant to subdivision (b) of Section 16946 and from the Physician Services Account pursuant to subdivision (c) of Section 16952, less funds retained by the department for the administration of the children's treatment program pursuant to Section 16934, for any county contracting with the department pursuant to Section 16809 that does not apply for, or rescinds its application for, funds under this chapter. Allocations for a particular county shall generally be utilized for payments to eligible providers in that county. SEC. 38. Section 16936 of the Welfare and Institutions Code is amended to read: 16936. (a) (1) Any county that requests funds under this chapter shall submit to the department, for approval by the department, an application for initial funding and a description of the proposed use and expenditure of the moneys, as a component of the county health services plan and budget submitted pursuant to Section 16800. The department shall review and approve this information for compliance with this part. (2) Beginning in the 1990-91 fiscal year, any county which does not contract with the department pursuant to subdivision (a) of Section 16934.5 shall include in the application an estimate of the costs and funding arrangement for dental services. (b) The department shall review each county's application and proposed use of funds for compliance with this chapter. (c) The department shall make initial monthly payments upon approval of the county's request for funds containing assurances that the county will comply with this chapter and other applicable provisions of this part. (d) Payments made beyond April 15, 1990, and February 1 of each subsequent fiscal year, shall be contingent upon the signing of an agreement between the county board of supervisors and the department. SEC. 39. Section 16937 of the Welfare and Institutions Code is amended to read: 16937. (a) Services, associated costs, and sociodemographic characteristics of persons served by each county under Section 17000 and supported in whole or in part by funds appropriated for purposes of this chapter shall be incorporated into the information required pursuant to Section 16915. (b) Not later than July 1, 1991, to the extent possible, each county shall incorporate the data required by Section 16915 in the reports specified in subdivision (a). SEC. 40. Section 16938 of the Welfare and Institutions Code is amended to read: 16938. (a) Each county shall submit a report of expenditures and other information to the department according to the procedures established by the department. (b) The department shall review the reports submitted pursuant to subdivision (a) and recoup unspent moneys and expenditures that are not in compliance with this chapter or the requirements established by the department. SEC. 41. Section 16941.1 of the Welfare and Institutions Code is amended to read: 16941.1. For the 1991-92 fiscal year and each fiscal year thereafter, any county that elects to participate in the County Medical Services Program pursuant to paragraphs (1) and (2) of subdivision (b) of Section 16809 shall have the amounts allocated to that county pursuant to this chapter transferred as follows: (a) Of the moneys allocated from the Hospital Services Account pursuant to Section 16943, seven-seventeenths of the transferable amount shall be transferred to the Rural Health Services Account for hospital services governed by Section 16932. The remainder of this amount shall be transferred to the County Medical Services Program Account and shall be utilized for the purposes specified in Section 16809.5. (b) Of the moneys allocated from the Physician Services Account pursuant to Section 16950, seven-seventeenths of the transferable amount shall be transferred to the Rural Health Services Account for physician services governed by Section 16933. The remainder of this amount shall be transferred to the County Medical Services Program Account and shall be utilized for the purposes specified in Section 16809.5. (c) Of the moneys allocated from the Unallocated Account governed by Section 16960, seven-seventeenths of the transferable amount shall be transferred to the Rural Health Services Account for other health services governed by the provisions of Section 16933. The remainder of this amount shall be transferred to the County Medical Services Program Account and shall be utilized for the purposes specified in Section 16809.5. (d) Funds transferred pursuant to this section shall be subject to all applicable statutes. SEC. 42. Section 16942 of the Welfare and Institutions Code is amended to read: 16942. (a) It is the intent of the Legislature that funds appropriated for the purposes of this chapter be administered, to the extent possible, in the same manner and according to same conditions and requirements as funds accounted for pursuant to Part 4.6 (commencing with Section 16800.5). The requirements of Sections 16804.1 and 16818 apply to services supported by funds appropriated for the purposes of this chapter. (b) Except as specifically provided in this chapter, the authority of each county established pursuant to Section 16817 shall remain unaffected. (c) Services, associated costs, and socio-demographic characteristics of persons served by each county under Section 17000 and supported in whole or in part by funds appropriated pursuant to this chapter shall be incorporated into the information required pursuant to Section 16915. SEC. 43. Section 16945 of the Welfare and Institutions Code is amended to read: 16945. (a) The department shall annually verify and transmit to each MISP county and each CMSP county the figures specified in subdivision (c), using data supplied by the office. (b) (1) For purposes specified in subdivision (c), the office shall use data from the quarterly reports required by Section 443.32 of the Health and Safety Code. (2) For the 1989-90 fiscal year computations, the office shall use the 1988 calendar year data, as adjusted by the office, existing on the statewide file on September 1, 1989. (3) For the computations for fiscal years after the 1989-90 fiscal year, the office shall use the data from the quarterly reports for the calendar year preceding the computational fiscal year, as adjusted by the office, existing on the statewide file on April 15 immediately preceding the computational fiscal year. (4) (A) Except as provided in subparagraphs (B), (C), and (D), the definitions, procedures, and data elements specified in Chapter 3 (commencing with Section 16920) shall be used in all computations required in subdivision (c). (B) For the 1991-92 fiscal year, the following definitions shall be used in all computations required in subdivision (c): (i) "Uncompensated care charges" means the sum of the charges related to patients falling within the charity-other category in the 1990 calendar year and 25 percent of the charges related to patients falling within the bad debts category in the first two quarters of the 1990 calendar year, as both categories of charges are reported quarterly to the office pursuant to Section 443.32 of the Health and Safety Code. (ii) "Uncompensated care costs" means that amount calculated by applying an overall hospital cost-to-charge ratio, calculated by dividing gross operating expenses by gross inpatient and outpatient revenue, as reported quarterly to the office, to uncompensated care charges. (C) For the 1992-93 fiscal year, the following definitions shall be used in all computations required in subdivision (c): (i) "Uncompensated care charges" means the charges related to patients falling within charity-other, as reported quarterly to the office pursuant to Section 443.32 of the Health and Safety Code. (ii) "Uncompensated care costs" means that amount calculated by applying an overall hospital cost-to-charge ratio, calculated by dividing gross operating expenses by gross inpatient and outpatient revenue, as reported quarterly to the office, to uncompensated care charges. (D) For the 1993-94, 1994-95, and 1995-96 fiscal years, the following definitions shall be used in all computation required in subdivision (c): (i) (I) For county hospitals and for all hospitals operating in counties with no county hospital, "uncompensated care charges" means the charges related to patients falling within charity-other, gross inpatient revenue-county indigent programs and gross outpatient revenue-county indigent programs, as reported quarterly to the office pursuant to Section 443.32 of the Health and Safety Code. (II) For noncounty hospitals operating in a county with a county hospital, "uncompensated care charges" means the charges related to patients falling within charity-other and county indigent programs contractual adjustments, as reported quarterly to the office pursuant to Section 443.32 of the Health and Safety Code. (ii) "Uncompensated care costs" means that amount calculated by applying an overall hospital cost-to-charge ratio, calculated by dividing gross operating expenses less other operating revenue by gross inpatient and outpatient revenue, as reported quarterly to the office, to uncompensated care charges. (c) The office shall compute the following data on uncompensated care costs reported by hospitals located within each MISP county and each CMSP county: (1) The sum of uncompensated care costs for all hospitals. (2) The sum of uncompensated care costs for all noncounty hospitals. (3) The sum of uncompensated care costs for all county hospitals. (4) The uncompensated care costs of each hospital within the county. (5) The percentage derived from dividing the result of paragraph (2) by the result of paragraph (1). (6) The percentage derived from dividing the result of paragraph (3) by the result of paragraph (1). (7) The percentage for each individual hospital derived from dividing each noncounty hospital's uncompensated care cost in paragraph (4) by the amount in paragraph (2). (d) The office shall transmit to the department the data specified in subdivision (c) within 30 days of the dates specified in paragraph (2) of subdivision (b) and paragraph (3) of subdivision (b) of this section. SEC. 44. Section 16948 of the Welfare and Institutions Code is amended to read: 16948. (a) Commencing with the 1990-91 fiscal year, within 10 working days of receipt of funds allocated pursuant to Section 16941 and Section 16932, the county shall distribute to each noncounty hospital that hospital's share of the funds pursuant to paragraph (1) of subdivision (b) of Section 16946. (b) Each noncounty hospital which receives funds pursuant to paragraph (1) of subdivision (b) of Section 16946 shall report to the county within 30 days after the receipt of the funds, information on patients for whom the distributions were used, pursuant to Section 16918. (c) The county shall suspend distribution of funds to any noncounty hospital which fails to provide the information required pursuant to subdivision (b) until the hospital provides the required information. SEC. 45. Section 16952 of the Welfare and Institutions Code is amended to read: 16952. (a) (1) Each county shall establish within its emergency medical services fund a Physician Services Account. Each county shall deposit in the Physician Services Account those funds appropriated by the Legislature for the purposes of the Physician Services Account of the fund. (2) (A) Each county may encumber sufficient funds to reimburse physician losses incurred during the fiscal year for which bills will not be received until after the fiscal year. (B) Each county shall provide a reasonable basis for its estimate of the necessary amount encumbered. (C) All funds which are encumbered for a fiscal year shall be expended or disencumbered prior to the submission of the report of actual expenditures required by Sections 16938 and 16980. (b) Funds deposited in the Physician Services Account in the county emergency medical services fund shall be exempt from the percentage allocations set forth in subdivision (a) of Section 1797.98. However, funds in the county Physician Services Account shall not be used to reimburse for physician services provided by physicians employed by county hospitals. No physician who provides physician services in a primary care clinic which receives funds from this act shall be eligible for reimbursement from the Physician Services Account for any losses incurred in the provision of those services. (c) The county physician services account shall be administered by each county, except that a county electing to have the state administer its medically indigent adult program as authorized by Section 16809, may also elect to have its county physician services account administered by the state in accordance with Section 16954. (d) Costs of administering the account shall be reimbursed by the account, up to 10 percent of the amount of the account. (e) For purposes of this article "administering agency" means the agency designated by the board of supervisors to administer this article, or the department, in the case of those CMSP counties electing to have the state administer this article on their behalf. (f) The county Physician Services Account shall be used to reimburse physicians for losses incurred for services provided during the fiscal year of allocation due to patients who cannot afford to pay for those services, and for whom payment will not be made through any private coverage or by any program funded in whole or in part by the federal government. (g) (1) Reimbursement for losses shall be limited to emergency services as defined in Section 16953, obstetric, and pediatric services as defined in Sections 16905.5 and 16907.5, respectively. (2) It is the intent of this subdivision to allow reimbursement for all of the following: (A) All inpatient and outpatient obstetric services which are medically necessary, as determined by the attending physician. (B) All inpatient and outpatient pediatric services which are medically necessary, as determined by the attending physician. (h) No physician shall be reimbursed for more than 50 percent of the losses submitted to the administering agency. SEC. 46. Section 16954 of the Welfare and Institutions Code is repealed. SEC. 47. Section 16970 of the Welfare and Institutions Code is amended to read: 16970. (a) As a condition of receiving funds under this chapter, a county shall provide, or arrange and pay for, medically necessary followup treatment, including necessary followup dental treatment and prescription drugs, for any condition detected as part of a child health and disability prevention screen for any child eligible for services under Section 24165.3 of the Health and Safety Code if the child was screened by the county or upon referral by a Child Health and Disability Prevention Program provider, unless the child is eligible to receive care with no share of cost under the Medi-Cal program or is covered under another publicly funded program, or the services are payable under private insurance coverage. (b) A county may require that hospitals, physicians, dentists, and other providers receiving funds appropriated pursuant to this part participate in complying with this section, provided that: (1) Hospitals that receive an allocation pursuant to paragraph (1) of subdivision (b) of Section 16946 and physicians who receive payment from the Physician Services Account of the emergency medical services fund established pursuant to Article 3.5 (commencing with Section 16951) shall not be required to participate in complying with subdivision (a) as a condition of receiving those allocations or payments. (2) Only providers that contract with the county and receive funds disbursed from the Unallocated Account pursuant to Article 4 (commencing with Section 16960) or from the discretionary portion of the Physician Services Account pursuant to subdivision (b) of Section 16950, or from the discretionary portion of the Hospital Services Account pursuant to paragraph (2) of subdivision (b) of Section 16946 may be required to participate in complying with subdivision (a). (c) Dental services provided pursuant to this section shall be at least equal in scope and frequency to dental services available to Medi-Cal eligible children of the same age. (d) Counties shall implement this section in consultation and coordination with their child health disability prevention programs. SEC. 48. Section 16980 of the Welfare and Institutions Code is amended to read: 16980. (a) The department shall make initial monthly payments of county allocations made pursuant to Section 16941 upon application of the county assuring that it will comply with the provisions of this part. Payments shall be made on a monthly basis. Payments made beyond February 15 of each fiscal year, shall be contingent upon the signing of an agreement between the county board of supervisors and the department. (b) (1) Each county shall submit a report of expenditures and other information to the department according to procedures established by the department. The department shall review the report submitted pursuant to this paragraph and recoup unspent moneys, or any expenditures that are not in compliance with this chapter or the requirements established pursuant to Section 16990. (2) Beginning with the 1990-91 fiscal year, each county shall include an estimate of, and the costs and funding arrangement for, dental services in its information submitted pursuant to paragraph (1). SEC. 49. Section 16981 of the Welfare and Institutions Code is amended to read: 16981. (a) The department shall conduct fiscal and program reviews to ensure county compliance with the provisions of this part, and shall report annually the results of these reviews to the Legislature. The department may withhold funds, up to the total amount of funds allocated under this chapter, if a county fails to correct deficiencies in the program after receiving written notice of noncompliance from the department. (b) The department shall recoup funds which were provided pursuant to this chapter and Chapter 4 (commencing with Section 16930) if they were not encumbered or expended according to the requirements of this chapter or Chapter 4 respectively within the fiscal year according to procedures and reports required by the department. The funds shall revert to the CHIP Account or Rural Health Services Account respectively. SEC. 50. Section 16997.1 of the Welfare and Institutions Code is amended to read: 16997.1. This part shall remain operative only until July 1, 1996, and shall remain in effect only until January 1, 1997, and as of that date is repealed, unless a later enacted statute, which is effective on or before January 1, 1997, deletes or extends that date. SEC. 51. Section 43 of Chapter 278 of the Statutes of 1991 is amended to read: Sec. 43. In the event that funds in the Cigarette and Tobacco Products Surtax Fund are insufficient to fund the appropriations set forth in this act or the appropriation for a particular program is insufficient to meet the expenditure needs, the following provisions shall apply: (a) (1) The Director of Finance may authorize the augmentation or reduction of the amount available for expenditure for a program designated in the schedule set forth for any appropriation in this act by transfer from or transfer to any of the other designated programs within this act. These transfers may be authorized not sooner than 60 days after notification in writing of the necessity thereof is provided to the chairpersons of the committees in each house which consider appropriations, and the Chairperson of the Joint Legislative Budget Committee, the chairs of the committees of each house which consider health policy, or not sooner than whatever lesser time the Chairperson of the Joint Legislative Budget Committee, or his or her designee, may in each instance determine. (2) Copies of any notifications required by subparagraph (A) shall be provided to organizations representing programs that receive funding under this act, and to counties, which request in writing that they be informed of such notifications. (b) The Director of Finance may not authorize the augmentation of the amount available for expenditure from the Cigarette and Tobacco Products Surtax Fund for any new program activities not identified in the schedule set forth in this act. (c) (1) The Director of Finance shall provide sufficient funding for those programs authorized pursuant to Section 14148.5 of the Welfare and Institutions Code, Section 16809.5 of the Welfare and Institutions Code, and Section 24165.3 of the Health and Safety Code and the media campaign under subdivision (e) of Section 24164 of the Health and Safety Code, as amended by this act, and shall reduce funding for the remaining programs on a pro rata basis except as provided in paragraph (2). Those pro rata reductions may include reductions necessary to ensure an adequate reserve in each account, not to exceed 2 percent of the estimated funds available for expenditure in each account during a fiscal year. (2) In the 1994-95 fiscal year, funding from the Cigarette and Tobacco Products Surtax Fund for programs authorized in Part 6.3 (commencing with Section 12695) and Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code shall not be reduced or increased by the Director of Finance pursuant to this section. The reserve in each account may be expended to meet the cost of caseload growth and other increases in program costs. (d) Any revenues in excess of the amount needed to fund appropriations in this act shall be included in the reserves identified in subdivision (c). SEC. 53. For the 1994-95 fiscal year, the sum of three hundred ninety-six million one hundred fifty-eight thousand dollars ($396,158,000) is appropriated from the Cigarette and Tobacco Products Surtax Fund for the purposes of this act according to the following schedule: (a) Eighteen million eight hundred eight thousand dollars ($18,808,000) to the State Department of Education as follows: (1) Six hundred twenty-two thousand dollars ($622,000) for state administration. (2) One million three hundred eighty-three thousand dollars ($1,383,000) for county offices of education. (3) Sixteen million eight hundred three thousand dollars ($16,803,000) for local assistance. (b) Seventy million eight hundred ninety-nine thousand dollars ($70,899,000) from the Health Education Account to the State Department of Health Services, as follows: (1) Eight hundred fifteen thousand dollars ($815,000) for state administration. (2) Twelve million one hundred ninety-seven thousand dollars ($12,197,000) for the health education media campaign pursuant to Section 24164 of the Health and Safety Code. (3) Twenty-nine million eight hundred sixty-nine thousand dollars ($29,869,000) for health screening and education services provided through the Child Health Disability Program contained in Article 3.4 (commencing with Section 320) of Chapter 2 of Part 1 of Division 1 of the Health and Safety Code pursuant to Section 24165.3 of the Health and Safety Code. (4) Ten million nine hundred thirty-nine thousand dollars ($10,939,000) for establishment of competitive grants pursuant to Section 24165 of the Health and Safety Code. (5) Seventeen million seventy-nine thousand dollars ($17,079,000) for allocation to local lead agencies upon the approval of the local plans by the State Department of Health Services pursuant to Section 24165.5 of the Health and Safety Code. (c) One hundred thirty-three million six hundred thirty thousand dollars ($133,630,000) from the Hospital Services Account to the State Department of Health Services, as follows: (1) One million one hundred fifteen thousand dollars ($1,115,000) for allocation to children's hospitals pursuant to Chapter 6 (commencing with Section 16996) of Part 4.7 of Division 9 of the Welfare and Institutions Code. (2) Four million nine hundred sixty-one thousand dollars ($4,961,000) for allocation to CMSP counties for expansion of services. (3) One hundred twenty million five hundred sixty-eight thousand dollars ($120,568,000) for allocation to counties participating in the California Healthcare for Indigents Program pursuant to Chapter 5 (commencing with Section 16940) of Part 4.7 of Division 9 of the Welfare and Institutions Code. (4) One million four hundred seventeen thousand dollars ($1,417,000) for allocation to counties for uncompensated rural health services under Chapter 4 (commencing with Section 16930) of Part 4.7 of Division 9 of the Welfare and Institutions Code. (5) Nine hundred ninety-four thousand dollars ($994,000) to the State Department of Health Services for state administration. (6) One million nine hundred eighty-one thousand dollars ($1,981,000) for expansion of perinatal services pursuant to Section 14148.5 of the Welfare and Institutions Code. (7) Two million five hundred ninety-four thousand ($2,594,000) for allocation to the counties participating in the California Healthcare for Indigents Program pursuant to Chapter 5 (commencing with Section 16940) of Part 4.7 of Division 9 of the Welfare and Institutions Code. (d) Four million nine hundred thirty-nine thousand dollars ($4,939,000) from the Hospital Services Account for transfer to the Perinatal Insurance Fund for the implementation of Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code. (e) Twenty million four hundred thirty-seven thousand dollars ($20,437,000) from the Physicians Services Account to the State Department of Health Services, as follows: (1) Two million one hundred six thousand dollars ($2,106,000) for clinic services pursuant to Part 6.9 (commencing with Section 1189.101) of Division 1 of the Health and Safety Code. (2) One million nine hundred eighty-one thousand dollars ($1,981,000) for expansion of perinatal services pursuant to Section 14148.5 of the Welfare and Institutions Code. (3) One million nine hundred eighty-six thousand dollars ($1,986,000) for allocation to CMSP counties for expansion of health services. (4) Thirteen million three hundred seventy-four thousand dollars ($13,374,000) for allocation to counties participating in the California Healthcare for Indigents Program pursuant to Chapter 5 (commencing with Section 16930) of Part 4.7 of Division 9 of the Welfare and Institutions Code. (5) Seven hundred twenty-eight thousand dollars ($728,000) for allocation to counties for rural health services pursuant to Chapter 4 (commencing with Section 16930) of Part 4.7 of Division 9 of the Welfare and Institutions Code. (6) Two hundred sixty-two thousand dollars ($262,000) to the State Department of Health Services for state administration. (f) Thirteen million six hundred seventy-six thousand dollars ($13,676,000) from the Physician Services Account for transfer to the Perinatal Insurance Fund for the implementation of Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code. (g) Sixty-one million twelve thousand dollars ($61,012,000) from the Unallocated Account to the State Department of Health Services, as follows: (1) Eight million nine hundred three thousand dollars ($8,903,000) for clinic services pursuant to Part 6.9 (commencing with Section 1189.101) of Division 1 of the Health and Safety Code. (2) Five million seventy-one thousand dollars ($5,071,000) for allocation to CMSP counties for expansion of health services. (3) Thirty-four million four hundred eleven thousand dollars ($34,411,000) for allocation to counties participating in the California Healthcare for Indigents Program pursuant to Chapter 5 (commencing with Section 16940) of Part 4.7 of Division 9 of the Welfare and Institutions Code. (4) Seven hundred ninety-eight thousand dollars ($798,000) for allocation to counties for uncompensated rural health services under Chapter 4 (commencing with Section 16930) of Part 4.7 of Division 9 of the Welfare and Institutions Code. (5) Three million sixty-eight thousand dollars ($3,068,000) for state administration. (6) Eight million seven hundred sixty-one thousand dollars ($8,761,000) for education and screening services provided through the Child Health Disability Prevention Program contained in Article 3.4 (commencing with Section 320) of Chapter 2 of Part 1 of Division 1 of the Health and Safety Code pursuant to Section 24165.3 of the Health and Safety Code. (h) Thirty-nine million dollars ($39,000,000) from the Unallocated Account for transfer to the Perinatal Insurance Fund for the implementation of Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code. (i) Three hundred thirty-nine thousand dollars ($339,000) from the Unallocated Account to the State Department of Education for local assistance pursuant to Section 24167 of the Health and Safety Code. (j) Four million dollars ($4,000,000) from the Research Account to the University of California. Of this amount, three hundred fifty thousand dollars ($350,000) shall be used for an antitobacco student health assessment pursuant to Section 49460 of the Education Code. (k) Three million dollars ($3,000,000) from the Research Account for clinic services pursuant to Part 6.9 (commencing with Section 1189.101) of Division 1 of the Health and Safety Code. (l) Three million three hundred thousand dollars ($3,300,000) from the Research Account for health screening services provided through the Children's Health Disability Prevention Program contained in Article 3.4 (commencing with Section 320) of the Health and Safety Code. (m) Five million dollars ($5,000,000) from the Research Account for the California Children's Services program contained in Article 2 (commencing with Section 248) of Chapter 2 of Division 1 of the Health and Safety Code. (n) Four million dollars ($4,000,000) from the Research Account for the Genetically Handicapped Persons Program contained in Article 3.6 (commencing with Section 340) of Chapter 2 of Part 1 of Division 1 of the Health and Safety Code. (o) Three million one hundred eighteen thousand dollars ($3,118,000) from the Research Account for operation of the Tobacco Education and Research Oversight Committee under Section 24162 of the Health and Safety Code and for a systematic and independent research and evaluation conducted pursuant to Section 24164 of the Health and Safety Code and Section 58 of this act. (p) Eleven million dollars ($11,000,000) from the Research Account for transfer to the Perinatal Insurance Fund for the implementation of Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code. SEC. 54. For the 1995-96 fiscal year, the sum of three hundred eighty-one million twenty-four thousand dollars ($381,024,000) is appropriated from the Cigarette and Tobacco Products Surtax Fund for the purposes of this act according to the following schedule: (a) Sixteen million seven hundred fifty-seven thousand dollars ($16,757,000) to the State Department of Education as follows: (1) Five hundred forty-two thousand dollars ($542,000) for state administration. (2) One million two hundred thirty-three thousand dollars ($1,233,000) for county offices of education. (3) Fourteen million nine hundred eighty-two thousand dollars ($14,982,000) for local assistance. (b) Seventy million four hundred thirty-seven thousand dollars ($70,437,000) from the Health Education Account to the State Department of Health Services, as follows: (1) Seven hundred twenty-six thousand dollars ($726,000) for state administration. (2) Twelve million one hundred ninety-seven thousand dollars ($12,197,000) to the health education media campaign pursuant to Section 24164 of the Health and Safety Code. (3) Thirty-two million five hundred thirty-one thousand dollars ($32,531,000) for health screening and education services provided through the Child Health Disability Program contained in Article 3.4 (commencing with Section 320) of Chapter 2 of Part 1 of Division 1 of the Health and Safety Code pursuant to Section 24165.3 of the Health and Safety Code. (4) Nine million seven hundred fifty-four thousand dollars ($9,754,000) for establishment of competitive grants pursuant to Section 24165 of the Health and Safety Code. (5) Fifteen million two hundred twenty-nine thousand dollars ($15,229,000) for allocation to local lead agencies upon the approval of the local plans by the State Department of Health Services pursuant to Section 24165.5 of the Health and Safety Code. (c) One hundred twenty-nine million four hundred ninety-eight thousand dollars ($129,498,000) from the Hospital Services Account to the State Department of Health Services, as follows: (1) One million seventy-eight thousand dollars ($1,078,000) for allocation to children's hospitals pursuant to Chapter 6 (commencing with Section 16996) of Part 4.7 of Division 9 of the Welfare and Institutions Code. (2) Four million nine hundred sixty-one thousand dollars ($4,961,000) for allocation to CMSP counties for expansion of services. (3) One hundred sixteen million five hundred ninety-five thousand dollars ($116,595,000) for allocation to counties participating in the California Healthcare for Indigents Program pursuant to Chapter 5 (commencing with Section 16940) of Part 4.7 of Division 9 of the Welfare and Institutions Code. (4) One million three hundred seventy thousand dollars ($1,370,000) for allocation to counties for uncompensated rural health services under Chapter 4 (commencing with Section 16930) of Part 4.7 of Division 9 of the Welfare and Institutions Code. (5) Nine hundred sixty-two thousand dollars ($962,000) to the State Department of Health Services for state administration. (6) One million nine hundred eighty-one thousand dollars ($1,981,000) for expansion of perinatal services pursuant to Section 14148.5 of the Welfare and Institutions Code. (7) Two million five hundred fifty-one thousand dollars ($2,551,000) for allocation to the counties participating in the California Healthcare for Indigents Program pursuant to Chapter 5 (commencing with Section 16940) of Part 4.7 of Division 9 of the Welfare and Institutions Code. (d) Four million nine hundred thirty-nine thousand dollars ($4,939,000) from the Hospital Services Account for transfer to the Perinatal Insurance Fund for the implementation of Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code. (e) Eighteen million eight hundred fifty-six thousand dollars ($18,856,000) from the Physicians Services Account to the State Department of Health Services, as follows: (1) One million nine hundred four thousand dollars ($1,904,000) for clinic services pursuant to Part 6.9 (commencing with Section 1189.101) of Division 1 of the Health and Safety Code. (2) One million nine hundred eighty-one thousand dollars ($1,981,000) for expansion of perinatal services pursuant to Section 14148.5 of the Welfare and Institutions Code. (3) One million nine hundred eighty-six thousand dollars ($1,986,000) for allocation to CMSP counties for expansion of health services. (4) Twelve million ninety thousand dollars ($12,090,000) for allocation to counties participating in the California Healthcare for Indigents Program pursuant to Chapter 5 (commencing with Section 16940) of Part 4.7 of Division 9 of the Welfare and Institutions Code. (5) Six hundred fifty-eight thousand dollars ($658,000) for allocation to counties for rural health services pursuant to Chapter 4 (commencing with Section 16930) of Part 4.7 of Division 9 of the Welfare and Institutions Code. (6) Two hundred thirty-seven thousand dollars ($237,000) to the State Department of Health Services for state administration. (f) Thirteen million six hundred seventy-six thousand dollars ($13,676,000) from the Physician Services Account for transfer to the Perinatal Insurance Fund for the implementation of Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code. (g) Fifty-seven million four hundred thirty thousand dollars ($57,430,000) from the Unallocated Account to the State Department of Health Services, as follows: (1) Eight million two hundred twenty-seven thousand dollars ($8,227,000) for clinic services pursuant to Part 6.9 (commencing with Section 1189.101) of Division 1 of the Health and Safety Code. (2) Five million seventy-one thousand dollars ($5,071,000) for allocation to CMSP counties for expansion of health services. (3) Thirty-one million seven hundred ninety-seven thousand dollars ($31,797,000) for allocation to counties participating in the California Healthcare for Indigents Program pursuant to Chapter 5 (commencing with Section 16940) of Part 4.7 of Division 9 of the Welfare and Institutions Code. (4) Seven hundred thirty-eight thousand dollars ($738,000) for allocation to counties for uncompensated rural health services under Chapter 4 (commencing with Section 16930) of Part 4.7 of Division 9 of the Welfare and Institutions Code. (5) Two million eight hundred thirty-six thousand dollars ($2,836,000) for state administration. (6) Eight million seven hundred sixty-one thousand dollars ($8,761,000) for education and screening services provided through the Child Health Disability Prevention Program contained in Article 3.4 (commencing with Section 320) of Chapter 2 of Part 1 of Division 1 of the Health and Safety Code pursuant to Section 24165.3 of the Health and Safety Code. (h) Thirty-nine million dollars ($39,000,000) from the Unallocated Account for transfer to the Perinatal Insurance Fund for the implementation of Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code. (i) Three hundred thirteen thousand dollars ($313,000) from the Unallocated Account to the State Department of Education for local assistance pursuant to Section 24167 of the Health and Safety Code. (j) Four million dollars ($4,000,000) from the Research Account to the University of California. (k) Three million dollars ($3,000,000) from the Research Account for clinic services pursuant to Part 6.9 (commencing with Section 1189.101) of Division 1 of the Health and Safety Code. (l) Five million dollars ($5,000,000) from the Research Account for the California Children's Services program contained in Article 2 (commencing with Section 248) of Chapter 2 of Division 1 of the Health and Safety Code. (m) Four million dollars ($4,000,000) from the Research Account for the Genetically Handicapped Persons Program contained in Article 3.6 (commencing with Section 340) of Chapter 2 of Part 1 of Division 1 of the Health and Safety Code. (n) Three million one hundred eighteen thousand dollars ($3,118,000) from the Research Account for operation of the Tobacco Education and Research Oversight Committee under Section 24162 of the Health and Safety Code and for a systematic and independent research and evaluation conducted pursuant to Section 24164 of the Health and Safety Code and Section 58 of this act. (o) Eleven million dollars ($11,000,000) from the Research Account for transfer to the Perinatal Insurance Fund for the implementation of Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code. SEC. 55. The State Department of Health Services may adopt emergency regulations pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code and Sections 14105.4 and 14105.5 of the Welfare and Institutions Code to implement this act. The adoption of these regulations shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health, or safety. SEC. 56. All funds derived from the imposition of taxes pursuant to Article 2 (commencing with Section 30121) of Chapter 2 of Part 13 of Division 2 of the Revenue and Taxation Code, which are appropriated for the purposes of this act, shall be used to supplement existing levels of services provided and shall not be used to fund existing levels of service. SEC. 57. No funds derived from the imposition of taxes pursuant to Article 2 (commencing with Section 30121) of Chapter 2 of Part 13 of Division 2 of the Revenue and Taxation Code, which are appropriated from the Hospital Services Account, the Physician Services Account, or the Unallocated Account in the Cigarette and Tobacco Products Surtax Fund, for the purposes of this act, shall be used to pay for services except for the treatment of patients who cannot afford to pay for those services, and for whom payment will not be made through any private coverage or by any program funded in whole or in part by the federal government. SEC. 58. (a) The State Department of Health Services shall contract for an evaluation of the effectiveness of the Child Health and Disability Prevention Program provided in Article 3.4 (commencing with Section 320) of Chapter 2 of Division 1 of the Health and Safety Code in meeting its statutory mandate to incorporate an antitobacco education component into the Child Health and Disability Prevention Program health assessment process. (b) The organization receiving the contract to provide the evaluation shall have recognized expertise in the area of health program evaluation and shall not be a current recipient of grant funds from the Health Education Account of the Cigarette and Tobacco Products Surtax Fund. (c) The evaluation required by this section shall include a consideration, at a minimum, of all the following factors: (1) The protocols developed by the Child Health and Disability Prevention Program as a guideline for providers to use in incorporating tobacco education into the health assessment process. (2) Training and other resources that were made available to providers to facilitate exploration, counseling, and referral in connection with tobacco use. (3) The effect of the addition of three tobacco use questions to the PM-160 invoice and data form on provider behavior in dealing with tobacco use issues. (4) Changes in provider behavior as a result of training and resources provided through the Child Health and Disability Prevention Program, including provider behavior with respect to patients and parents who are not under the Child Health and Disability Prevention Program. (5) Measurable changes in the behavior of patients or parents, or both, as a result of providers' questions, advice, and counseling or referral or both. (d) It the intent of the Legislature that, at a minimum, information for the evaluation shall be gathered from Child Health and Disability Prevention Program providers, county Child Health and Disability Prevention Program staff, children who have received services under the Child Health and Disability Prevention Program or their parents, or both. (e) Samples gathered for the evaluation required by this section shall appropriately reflect the age, gender, and ethnicity of groups from which information is gathered pursuant to this section. (f) The State Department of Health Services shall provide the results of the evaluation required by this section to the appropriate committees of the Legislature no later than January 1, 1996. SEC. 59. (a) It is the intent of the Legislature that the University of California contract for an independent research, evaluation, and monitoring of all health spending funded by the Tobacco Tax and Health Protection Act of 1988. (b) The evaluation should contain recommendations to the appropriate committees of the Legislature for program spending priorities with respect to the expenditure of funds from the Cigarette and Tobacco Products Surtax Fund to achieve the stated purposes of the Tobacco Tax and Health Protection Act of 1988 if cigarette tax revenues continue to decline. (c) (1) It is the intent of the Legislature that the University of California, in consultation with the State Department of Health Services, not later than January 1, 1995, contract for an evaluation of the effectiveness of health care services funded by the Tobacco Tax and Health Protection Act of 1988. (2) It is the intent of the Legislature that the evaluator should submit to the Governor and the appropriate committees of the Legislature a report that contains an evaluation of the performance of indigent care programs that are funded by the Tobacco Tax and Health Protection Act of 1988. (3) It is intent of the Legislature that the reports specified in paragraphs (1) and (2) consider outcomes, access, and eligibility for services. The report should also include the following: (A) The populations served by Proposition 99 funded indigent care programs. (B) The effect of Proposition 99 on the financing, organization, and delivery of indigent health care services in California. (C) The impact of state and county fiscal conditions on the provision of indigent care services and the use of Proposition 99 funds. (D) The effect of the implementation of Proposition 99 and spending priorities on other state policies relating to indigent care. (E) Changes in federal, state, and county funding for indigent care since the passage of Proposition 99. (d) It is the intent of the Legislature that the report specified in subdivision (c) cover the period commencing January 1, 1989, and ending January 1, 1995, and include recommendations for a future appropriation schedule of funds from the Cigarette and Tobacco Products Surtax Fund, including alternative spending plans that would target children, pregnant mothers, the uninsured, the medically indigent, and those persons who are uninsurable. SEC. 60. If any provision of this act or the application thereof to any person or circumstances is held invalid, that invalidity shall not affect other provisions or applications of the act that can be given effect without the invalid provision or application, and to this end the provisions of this act are severable. SEC. 61. Moneys in the Hospital Services Account, the Physician Services Account, the Health Education Account, and the Unallocated Account in the Cigarette and Tobacco Products Surtax Fund shall not be transferred to any other fund or account in the State Treasury, except as provided in this act or other legislation, and except for purposes of investment as provided in Article 4 (commencing with Section 16470) of Chapter 3 of Part 2 of Division 4 of Title 2 of the Government Code. All interest or other increment resulting from investment shall be deposited to the respective account. SEC. 62. The departmental review staff required to implement Section 24165.3 of the Health and Safety Code, shall include a sufficient number of dental hygienists or similar classifications to enable the department to determine if adequate screening to detect dental disease has taken place and if followup dental treatment has occurred where indicated by the screen. The State Department of Health Services and the Department of Finance shall, to the extent there are sufficient resources available to support the activities of the program, give high priority to dental positions for Child Health and Disability Prevention Program reviews funded with Tobacco Tax revenues in order to implement the dental review required by Section 24165.3 of the Health and Safety Code. SEC. 63. Due to the necessity to implement the mandates of Article 2 (commencing with Section 30121) of Chapter 2 of Part 13 of Division 2 of the Revenue and Taxation Code, any contract made pursuant to this act shall not be subject to Part 2 (commencing with Section 10100) of the Public Contract Code. SEC. 64. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs which may be incurred by a local agency or school district pursuant to this act will be funded through this act. Notwithstanding Section 17580 of the Government Code, unless otherwise specified in this act, the provisions of this act shall become operative on the same date that the act takes effect pursuant to the California Constitution. SEC. 65. This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are: In order to timely provide for the administration of this act for the 1994-95 fiscal year and subsequent fiscal years, it is necessary that this act take effect immediately.