Welfare and Institutions Code — Part 14 | WIC — United States — California law | Esheria

Welfare and Institutions Code

Part 14 of 35 · provisions 2,601–2,800

This section says the act is to be known as the Welfare and Institutions Code.

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About this statute

The Department of the Youth Authority may establish, maintain, or help develop regional centers for counties’ alternative placement options. When a California law mentions “Whittier State School,” it must be read as referring to Fred C. Nelles School for Boys. This section defines “Youth Authority,” “authority,” “the authority,” and “board” for this chapter. This provision states the purpose of the division: to provide protection, care, and assistance to people in need, and to promote welfare through prompt, humane aid and services without discrimination. This section states the purposes of public social services funded by state grants-in-aid to counties.

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Provisions of Welfare and Institutions Code

Showing 200 of 6,925

  1. 14452.3.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    Prepaid health plans must provide optometrist and ophthalmologist services when their contract requires vision care, and vision care must let an enrollee be seen first by either a physician or an optometrist.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14452.3. Each prepaid health plan shall provide the services of an optometrist and ophthalmologist when the prepaid health plan contract requires the provision of vision care services. Vision care services shall be provided so that an enrollee may be seen initially by either a physician or an optometrist. (Added by Stats. 1974, Ch. 983.)
  2. 14452.4.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    If a prepaid health plan offers dental services, it must provide them without requiring enrollees to get prior screening or authorization from nondental personnel.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14452.4. Where the prepaid health plan agrees to provide dental services such services shall be provided in a manner that does not require the enrollees to receive prior screening or authorization by nondental personnel. (Amended by Stats. 1977, Ch. 1036.)
  3. 14452.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    A prepaid health plan must provide psychologist and psychiatrist services when its contract requires mental health services.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14452.5. Each prepaid health plan shall provide the services of a psychologist and psychiatrist when the prepaid health plan contract requires the provision of mental health services. Mental health services shall be provided so that an enrollee may be seen initially by either a physician or a psychologist, or by psychiatric social workers under qualified supervision as otherwise allowed by law. (Added by Stats. 1977, Ch. 1036.)
  4. 14452.6.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    Prepaid health plans and their subcontractors must not bill enrollees for covered benefits when capitation has been paid, except as allowed by Article 7. Health care providers must not seek reimbursement from enrollees for services provided under this chapter.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14452.6. Prepaid health plans, or their subcontractors, shall not bill any enrollee for covered benefits provided under this chapter and for which capitation has been paid, except as provided in Article 7 (commencing with Section 14490) of this chapter. Health care providers shall not seek reimbursement from enrollees for any services provided under this chapter. (Added by Stats. 1977, Ch. 1036.)
  5. 14453.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    A prepaid health plan must not pay directors or officers at a rate substantially above the prevailing charge for similar services in the community.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14453. In compensating directors and officers, the prepaid health plan shall not compensate at a rate substantially greater than the prevailing charge for similar services in the community. For purposes of this chapter, salaries or other compensation from the prepaid health plan and its subcontractors, excluding reasonable expenses, shall be considered as one. (Repealed and added by Stats. 1977, Ch. 1036.)
  6. 14454.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    Prepaid health plans must cover and pay for covered emergency services, and reviewed emergency-service disputes cannot be billed to the enrollee.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14454. (a) The prepaid health plan shall be liable for all in-area and out-of-area emergency services which are required by the contract and rendered by a nonprepaid health plan provider. Payment for such services shall include treatment of emergency conditions and shall continue until such time as the enrollee may be transferred to any provider of the prepaid health plan. (b) Where a dispute arises between the prepaid health plan and the nonprepaid health plan provider as to the liability of the prepaid health plan for such services, the nonprepaid health plan provider may submit the matter to the director for determination in the form of a claim documenting as fully as reasonably possible the nature of the emergency, the necessity for the treatment rendered, the appropriateness of the length of stay for inpatient care, the reason the patient could not have been transferred to a provider of the prepaid health plan, and including any response by the prepaid health plan to the claim which resulted in the dispute. The director shall, by regulation, provide for resolution of the dispute in a timely fashion and in a manner guaranteeing the procedural due process requirements of the provisions of Chapter 5 (commencing with Section 11500), Part 1, Division 3, Title 2 of the Government Code, except that the department shall use its own hearing officers. The hearing officer may be assisted by a physician. To the extent feasible, the director shall consolidate the claims of the nonprepaid health plan provider against the prepaid health plan. In no event, shall the prepaid health plan or the nonprepaid health plan provider bill the enrollee for services which are or have been the subject of review by the director pursuant to this section. (c) If the director determines that the prepaid health plan is liable for the emergency service, the plan shall reimburse the nonprepaid health plan provider within 30 days. If the prepaid health plan fails to reimburse the nonprepaid health plan provider within 30 days, the director shall arrange to set off the amount of the unpaid claim or claims from no fewer than two future capitation payments owed to the prepaid health plan by the department and the department shall forward such setoff or setoffs to the nonprepaid health plan provider. In making such arrangements to set off, the director shall consult with the affected prepaid health plan in an attempt to minimize the impact of such setoff or setoffs on cash flow. When the claim of the nonprepaid health plan provider is satisfied by setoff or setoffs, the director shall satisfy the claim only with the funds of the prepaid health plan and shall in no event use state funds to satisfy such a claim. (d) Nothing in this section shall preclude prepaid health plans and nonprepaid health plan providers from entering into voluntary agreements to settle disputed claims for services by means of binding arbitration or by other means acceptable to both parties. (Amended by Stats. 1977, Ch. 1121.)
  7. 14455.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    Prepaid health plans must keep a complete medical record for each enrollee, include subcontractor treatment records, keep the records in the director-prescribed manner, and make them available for review by specified agencies.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14455. The prepaid health plan shall maintain a complete unit medical record for each enrollee. Enrollee medical records shall also include records of all treatment received from subcontractors. Such records shall be maintained and preserved in a manner prescribed by the director and shall be available for review by the department and the United States Department of Health, Education, and Welfare. (Repealed and added by Stats. 1977, Ch. 1036.)
  8. 14456.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    The department must conduct annual medical audits of each prepaid health plan, unless the director finds good cause for additional reviews.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14456. The department shall conduct annual medical audits of each prepaid health plan unless the director determines there is good cause for additional reviews. The reviews shall use the standards and criteria established pursuant to the Knox-Keene Health Care Service Plan Act of 1975, as appropriate. Except in those instances where major unanticipated administrative obstacles prevent, or after a determination by the director of good cause, the reviews shall be scheduled and carried out jointly with reviews carried out pursuant to the Knox-Keene Health Care Service Plan Act of 1975, if reviews will be carried out within time periods which satisfy the requirements of federal law. The department shall be authorized to contract with professional organizations or the Department of Managed Health Care, as appropriate, to perform the periodic review required by this section. The department, or its designee, shall make a finding of fact with respect to the ability of the prepaid health plan to provide quality health care services, effectiveness of peer review, and utilization control mechanisms, and the overall performance of the prepaid health plan in providing health care benefits to its enrollees. The director shall publicly report the findings of finalized annual medical audits conducted pursuant to this section as soon as possible, but no later than 90 days following completion of any corrective action plan initiated pursuant to the audit, if any, unless the director determines, in his or her discretion, that additional time is reasonably necessary to fully and fairly report the results of the audit. (Amended by Stats. 2014, Ch. 573, Sec. 5. (SB 964) Effective January 1, 2015.)
  9. 14456.3.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    The department must share certain audit findings and monthly provider files with the Department of Managed Health Care. Preliminary investigative audit findings communicated under this provision are exempt from disclosure under the California Public Records Act.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14456.3. (a) The department shall share with the Department of Managed Health Care its findings from medical audits and monthly provider files of a Medi-Cal managed care plan that provides services to Medi-Cal beneficiaries pursuant to Chapter 7 (commencing with Section 14000) or this chapter and is subject to Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code. (b) To the extent that the department communicates its preliminary investigative audit findings to the Department of Managed Health Care under subdivision (a), those communications shall be exempt from disclosure under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code). (Amended by Stats. 2021, Ch. 615, Sec. 457. (AB 474) Effective January 1, 2022. Operative January 1, 2023, pursuant to Sec. 463 of Stats. 2021, Ch. 615.)
  10. 14456.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    This section requires the department and Medi-Cal managed care plans to provide coverage and make timely coverage decisions for certain medically necessary prescription drugs and related services, and to give required notices and formulary information.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14456.5. (a) For purposes of this section, Medi-Cal managed care plan means any prepaid health plan or Medi-Cal managed care plan contracting with the department to provide services to enrolled Medi-Cal beneficiaries under Chapter 7 (commencing with Section 14000) or this chapter, or Part 4 (commencing with Section 101525) of Division 101 of the Health and Safety Code. (b) The department shall ensure that coverage is provided for medically necessary prescription medications and related medically necessary medical services that are prescribed by a local mental health plan provider, and are within the Medi-Cal scope of benefits, but are excluded from coverage under Chapter 8.9 (commencing with Section 14700), by doing, at least, all of the following: (1) Requiring Medi-Cal managed care plans to comply with the following standards: (A) The decision regarding responsibility and coverage for a prescription drug shall be made by the Medi-Cal managed care plan within 24 hours, or one business day, from the date the request for a decision is received by telephone or other telecommunication device. (B) The decision regarding responsibility and coverage for services, such as laboratory tests, that are medically necessary because of medications prescribed by a mental health provider, shall be made by the Medi-Cal managed care plan within seven days following the date the request for a decision is received by telephone or other telecommunication device. (C) If the decision of the Medi-Cal managed care plan on the request is a deferral because of a determination that the Medi-Cal managed care plan needs more information, the Medi-Cal managed care plan shall transmit notice of the deferral, by facsimile or by other telecommunication system, to the pharmacist or other service provider, to the prescribing mental health provider, and to a designated mental health plan representative. The notice shall set out with specificity what additional information is needed to make a medical necessity determination. (D) Any denial of authorization or payment for a prescription medication or for any services such as laboratory tests that may be medically necessary because of medications ordered by a mental health plan provider shall set forth the reasons for the denial with specificity. The denial notice shall be transmitted by facsimile or other telecommunication system to the pharmacist or other service provider, to the prescribing mental health provider, to a designated mental health plan representative, and by mail to the Medi-Cal beneficiary. (E) For purposes of subsequent requests for a medication, the local mental health plan provider prescribing the prescription medication shall be treated as a plan provider under subdivision (a) of Section 1367.22 of the Health and Safety Code. (F) If the decision cannot be made within five working days because of a request for additional information, any Medi-Cal managed care plan licensed pursuant to Division 2 (commencing with Section 1340) of the Health and Safety Code shall inform the enrollee as required by paragraph (5) of subdivision (h) of Section 1367.01 of the Health and Safety Code. In regard to any Medi-Cal managed care plan contract as described pursuant to subdivision (a) that is issued, amended, or renewed on or after January 1, 2001, with a plan not licensed pursuant to Division 2 (commencing with Section 1340) of the Health and Safety Code, if the decision cannot be made within five working days because of a request for additional information as specified in subparagraph (C), the plan shall notify the enrollee, in writing, that the plan cannot make a decision to approve, modify, or deny the request for authorization. All managed care plans shall, upon receipt of all information reasonably necessary for making the decision and that was requested by the plan, approve, modify, or deny the request for authorization within the timeframes specified in subparagraph (A) or (B), whichever applies. (2) In consultation with the Medi-Cal managed care plans and local mental health plans, establishing a process to recognize credentialing of local mental health plan providers, for the purpose of expediting approval of medications prescribed by a local mental health plan provider who is not contracting with the Medi-Cal managed care plan. In implementing this requirement, the Medi-Cal managed care plan shall not be required to violate licensure, accreditation, or certification requirements of other entities. (3) Requiring any Medi-Cal managed care plan to enter into a memorandum of understanding with the local mental health plan. The memorandum of understanding shall comply with applicable regulations. (c) The department may sanction a Medi-Cal managed care plan for violations of this section pursuant to Section 14088.23 or 14197.7. (d) Every Medi-Cal managed care plan that provides prescription drug benefits and that maintains one or more drug formularies shall provide to members of the public, upon request, a copy of the most current list of prescription drugs on the formulary of the Medi-Cal managed care plan, by therapeutic category, with an indication of whether any drugs on the list are preferred over other listed drugs. If the Medi-Cal managed care plan maintains more than one formulary, the plan shall notify the requester that a choice of formulary lists is available. (e) This section shall apply to any contracts entered into, amended, modified, or extended on or after January 1, 2001. (Amended by Stats. 2019, Ch. 465, Sec. 10. (AB 1642) Effective January 1, 2020.)
  11. 14457.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    The department must conduct periodic onsite visits of prepaid health plans, and may do extra visits if the director finds good cause.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14457. (a) In addition to the reviews required or authorized by Section 14456, the department shall conduct periodic onsite visits or additional visits after a determination by the director of good cause by departmental representatives to include observation of the general operation of the prepaid health plan, the condition of the facilities for delivering health care, the availability of emergency services, the degree of satisfaction of the enrollees, the operation of the plan’s grievance system, and the administrative and financial aspects of the operation of the prepaid health plan. (b) Except when reviewing a plan’s grievance system or marketing activities, this evaluation shall use standards and criteria established pursuant to the Knox-Keene Health Care Service Plan Act of 1975. Except in those instances where major, unanticipated administrative obstacles prevent, or after a determination by the director of good cause, the visits shall be scheduled and carried out jointly with reviews carried out pursuant to the Knox-Keene Health Care Service Plan Act of 1975, if reviews under that act will be carried out within time periods that satisfy the requirements of federal law. (c) The State Department of Health Services may contract with the Department of Managed Health Care to perform the periodic visits required by this section. (Amended by Stats. 2023, Ch. 266, Sec. 6. (AB 614) Effective January 1, 2024.)
  12. 14458.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    A prepaid health plan must set up ongoing review procedures for care quality, medical personnel performance, service use, facility use, and costs, and provide review information to the department.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14458. The prepaid health plan shall establish procedures for continuously reviewing the quality of care, performance of medical personnel, the utilization of services and facilities, and costs. Information derived from such review shall be made available to the department. (Amended by Stats. 1977, Ch. 1036.)
  13. 14459.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    Prepaid health plans must keep financial records, undergo annual audits, file certified financial statements with the department within 90 days after fiscal year end, and make books and records available for department inspection.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14459. (a) The prepaid health plan shall maintain financial records and shall have an annual audit or additional audits after a determination by the director of good cause, performed by an independent certified public accountant. A prepaid health plan operated by a public entity shall have an annual audit performed in a manner approved by the department. All certified financial statements shall be filed with the department as soon as practical after the end of the prepaid health plan’s fiscal year and in any event, within a period not to exceed 90 days thereafter. These financial statements shall be filed with the department and shall be public records. The department shall perform routine auditing of prepaid health plan contractors and their affiliated subcontractors. Except in those instances where major unanticipated obstacles prevent, or after a determination by the director of good cause, the audits shall be scheduled and carried out jointly with audits carried out pursuant to the Knox-Keene Health Care Service Plan Act of 1975, if audits under that act are carried out within time periods that satisfy the requirements of federal law. The department is authorized to contract with the Department of Managed Health Care to carry out the audits required by this section. The prepaid health plan shall make all of its books and records available for inspection, examination, or copying by the department during normal working hours at the prepaid health plan’s principal place of business or at such other place in California as the department shall designate. For good cause, the department may grant an exception to the time when annual financial statements are to be submitted to the department. The annual report required in Section 14313 shall include an itemization of expenditures made by each prepaid health plan for the following categories of expenditures: physician services, inpatient and outpatient hospital services, pharmaceutical services and prescription drugs, dental services, medical transportation services, vision care services, mental health services, laboratory services, X-ray services, enrollee education programs, marketing and enrollment costs, data-processing costs, other administrative costs and health service expenditures and any payments made to subcontractors, and the purposes of the payments, including, but not limited to, contributions to election campaigns. (b) The requirements of a financial and administrative review by the department of any health care service plan licensed by the Director of the Department of Managed Health Care pursuant to Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code may be waived upon submission of the financial audit for the same period conducted by the Department of Managed Health Care pursuant to Section 1382 of the Health and Safety Code. (Amended by Stats. 2023, Ch. 266, Sec. 7. (AB 614) Effective January 1, 2024.)
  14. 14459.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    The department must monitor Medicaid service quality and require managed care plans to report accreditation information and related review materials.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14459.5. (a) As delegated by the federal government, the department has responsibility for monitoring the quality of all Medicaid services provided in the state. A key component of this monitoring function is the performance of annual, independent, external reviews of the quality of services furnished under each state contract with a health maintenance organization, as specified by the federal Centers for Medicare and Medicaid Services. (b) In accordance with Section 438.332 of Title 42 of the Code of Federal Regulations, the department shall require, through its contracts, that each managed care plan inform the department whether it has been accredited by a private independent accrediting entity. (c) In accordance with Section 438.332 of Title 42 of the Code of Federal Regulations, the department shall require, through its contracts, that each managed care plan that has received accreditation by a private independent accrediting entity shall authorize the private independent accrediting entity to provide the department a copy of its most recent accreditation review, including all of the following: (1) Accreditation status, survey type, and level, as applicable. (2) Accreditation results, including recommended actions or improvements, corrective action plans, and summaries of findings. (3) Expiration date of the accreditation. (d) The Legislature finds and declares that the final report obtained from the external reviews will provide valid and reliable information regarding health care outcomes and the overall quality of care delivered by the managed care plans. (e) The department shall make the final report of each external review available, within 30 calendar days of completion, to the fiscal and health policy committees of the Legislature. (f) In accordance with Section 438.332 of Title 42 of the Code of Federal Regulations, the department shall make the accreditation status for each contracted entity available on its Internet Web site, including whether each entity has been accredited, and if applicable, the name of the accrediting entity, accreditation program, and accreditation level. The department shall update this information at least annually. (g) Subdivisions (b), (c), and (f) shall be effective for the rating period for managed care plan contracts beginning on or after July 1, 2017. (Amended by Stats. 2017, Ch. 511, Sec. 30. (AB 1688) Effective January 1, 2018.)
  15. 14459.6.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    The department must create and post dental health plan performance measures and benchmarks, and dental plans must submit several materials to the department for review and approval.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14459.6. (a) The department shall establish a list of performance measures to ensure dental health plans meet quality criteria required by the department. The list shall specify the benchmarks used by the department to determine whether and the extent to which a dental health plan meets each performance measure. Commencing January 1, 2013, and quarterly thereafter, the list of performance measures established by the department along with each plan’s performance shall be posted on the department’s Internet Web site. The Department of Managed Health Care and the advisory committee established pursuant to Section 14089.08 shall have access to all performance measures and benchmarks used by the department as described in this section. (1) Commencing April 30, 2017, the quarterly reporting required by this subdivision shall be posted in the following manner: (A) On or before April 30, 2017, the reporting shall be posted for the July 2016 to September 2016, inclusive, fiscal quarter. (B) After April 30, 2017, the reporting shall be posted on a quarterly basis on or before April 30, July 31, October 31, and January 31 for the fiscal quarter ending seven months prior. (2) The performance measures established by the department shall include, but not be limited to, all of the following: provider network adequacy, overall utilization of dental services, annual dental visits, the total number of patients seen on a per-provider basis and the total number of dental services rendered by each provider during each calendar year, use of preventive dental services, use of dental treatment services, use of examinations and oral health evaluations, sealant to restoration ratio, filling to preventive services ratio, treatment to caries prevention ratio, use of dental sealants, use of diagnostic services, and survey of member satisfaction with plans and providers. (3) The survey of member satisfaction with plans and providers shall be the same dental version of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey as used by the Healthy Families Program. (4) The department shall notify dental health plans at least 30 days prior to the implementation date of these performance measures. (5) The department shall include the initial list of performance measures and benchmarks in any dental health contracts entered into between the department and a dental health plan pursuant to Section 14204. (6) The department shall update performance measures and benchmarks and establish additional performance measures and benchmarks in accordance with all of the following: (A) The department shall consider performance measures and benchmarks established by other states, the federal government, and national organizations developing dental program performance and quality measures. (B) The department shall notify dental health plans at least 30 days prior to the implementation date of updates or changes to performance measures and benchmarks. The department shall also post these updates or changes on its Internet Web site at least 30 days prior to implementation in order to provide transparency to the public. (C) To ensure that the dental health needs of Medi-Cal beneficiaries are met, the department shall, when evaluating performance measures and benchmarks for retention on, addition to, or deletion from the list, consider all of the following criteria: (i) Monthly, quarterly, annual, and multiyear Medi-Cal dental managed care trended data. (ii) County and statewide Medi-Cal dental fee-for-service performance and quality ratings. (iii) Other state and national dental program performance and quality measures. (iv) Other state and national performance ratings. (b) In establishing and updating the performance measures and benchmarks, the department shall consult the advisory committee established pursuant to Section 14089.08, as well as dental health plan representatives and other stakeholders, including representatives from counties, local dental societies, nonprofit entities, legal aid entities, and other interested parties. (c) In evaluating a dental health plan’s ability to meet the criteria established through the performance measures and benchmarks, the department shall select specific performance measures from those established by the department in subdivision (a) as the basis for establishing financial or other incentives or disincentives, including, but not limited to, bonuses, payment withholds, and adjustments to beneficiary assignment to plan algorithms. These incentives and disincentives shall be included in the dental health plan contracts. (d) (1) The department shall designate a qualified external quality review organization (EQRO) that shall conduct external quality reviews for any dental health plan contracting with the department pursuant to Section 14204. (2) As determined by the department, but at least annually, dental health plans shall arrange for an external quality of care review with the EQRO designated by the department that evaluates the dental health plan’s performance in meeting the performance measures established in this section. Dental health plans shall cooperate with and assist the EQRO in this review. The Department of Managed Health Care shall have direct access to all external quality of care review information upon request to the department. (3) (A) No later than July 1, 2018, the department shall require that the dental EQRO shall have sufficient information to use in performing the review, and the department shall require the external quality review (EQR) to comply with the following requirements: (i) The information used to carry out the review shall be obtained from the EQR-related activities in accordance with federal Medicaid regulations, including Section 438.358 of Title 42 of the Code of Federal Regulations, or, if applicable, from a Medicare or private accreditation review as authorized under Section 438.360 of Title 42 of the Code of Federal Regulations. (ii) For each EQR-related activity, the information gathered for use in the EQR shall include the elements described in federal Medicaid regulations, including the elements described in Section 438.364(a)(2)(i) to (iv), inclusive, of Title 42 of the Code of Federal Regulations. (iii) The information provided to the EQRO in accordance with this paragraph is obtained through methods consistent with the protocols established by the federal Secretary of Health and Human Services in accordance with federal Medicaid regulations, including Section 438.352 of Title 42 of the Code of Federal Regulations. (iv) The results of the reviews are made available as specified in federal Medicaid regulations, including Section 438.364 of Title 42 of the Code of Federal Regulations. (B) The qualified EQRO shall produce and submit to the department an annual EQR technical report in accordance with Section 438.364(a) of Title 42 of the Code of Federal Regulations. The department shall finalize the annual technical report by April 30 of each year. (C) Once the annual technical report is finalized, the department shall post by April 30 of each year the most recent copy of the annual EQR technical report on the Internet Web site required under Section 438.10(c)(3) of Title 42 of the Code of Federal Regulations. (D) An external quality of care review shall include, but not be limited to, all of the following: performance on the selected performance measures and benchmarks established and updated by the department, the CAHPS member or consumer satisfaction survey referenced in paragraph (2) of subdivision (a), reporting systems, and methodologies for calculating performance measures. An external quality of care review that includes all of the above components shall be paid for by the dental health plan and posted online annually, or at any other frequency specified by the department, on the department’s Internet Web site. The department shall provide printed or electronic copies of the information specified under Section 438.364(a) of Title 42 of the Code of Federal Regulations, upon request, to interested parties, such as participating health care providers, enrollees and potential enrollees of the managed care plan entity, beneficiary advocacy groups, and members of the general public. (E) The department shall make the information specified in Section 438.364(a) of Title 42 of the Code of Federal Regulations available in alternative formats for persons with disabilities, when requested. (e) All marketing methods and activities to be used by dental plans shall comply with subdivision (b) of Section 10850, Sections 14407.1, 14408, 14409, 14410, and 14411, and Title 22 of the California Code of Regulations, including Sections 53880 and 53881 of Title 22 of the California Code of Regulations. Each dental plan shall submit its marketing plan to the department for review and approval. (f) Each dental plan shall submit its member services procedures, beneficiary informational materials, and any updates to those procedures or materials to the department for review and approval. The department shall ensure that member services procedures and beneficiary informational materials are clear and provide timely and fair processes for accepting and acting upon complaints, grievances, and disenrollment requests, including procedures for appealing decisions regarding coverage or benefits. (g) Each dental plan shall submit its provider compensation agreements to the department for review and approval. (h) The department shall post on its Internet Web site a copy of all final reports completed by the Department of Managed Health Care regarding dental managed care plans. (i) The department shall ensure, to the greatest degree possible, that the categories of data and performance measures selected under this section are consistent with the categories of data and performance measures selected under Section 14132.915. (Amended by Stats. 2017, Ch. 511, Sec. 31. (AB 1688) Effective January 1, 2018.)
  16. 14459.7.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    The department must implement and operate an MIS/DSS for Medi-Cal, report progress annually to legislative committees, and provide committee and public access by specified project stages, with safeguards protecting patient identities.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14459.7. (a) The department shall implement a Management Information System/Decision Support System (MIS/DSS) for the Medi-Cal Program, that shall integrate data from managed care plans to monitor and evaluate the quality of care provided to beneficiaries, including access to services, establish provider rates, and analyze ways to improve both the managed care and fee-for-service systems. (b) The department shall provide the fiscal and health policy committees of the Legislature with an annual progress and status report on the implementation of the MIS/DSS. The annual progress and status report shall include a description of the current status of the project, including a list of the specific project objectives that have and have not been met at the time of the report and a comparison of the actual progress of the project with the most recent project schedule approved by the Legislature. The report also shall include estimated expenditures and staffing for the current fiscal year and proposed expenditures and staffing for the next fiscal year as well as a summary of cumulative total project expenditures to date and a projection of future expenditures necessary to complete the project. (c) The department shall provide system or information access to the fiscal and health policy committees of the Legislature, with the most cost-effective technology available, by the conclusion of the third phase of this multiphase project. Access shall include both the management information system and ad hoc report systems, or their equivalent, with safeguards to block access to individual patient identities. Public access shall be provided to at least the management information system summary presentation, or an equivalent, by the time of project completion. (Added by Stats. 1997, Ch. 294, Sec. 78. Effective August 18, 1997.)
  17. 14459.8.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    The department must give the Legislature’s fiscal and appropriate policy committees a report on dental managed care in Sacramento and Los Angeles by March 15, 2013, and update it annually. The department may also seek foundation or federal grant funding to support the analysis and reporting.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14459.8. (a) By no later than March 15, 2013, with annual updates thereafter, the department shall provide the fiscal and appropriate policy committees of the Legislature with either a comprehensive report or separate reports on dental managed care in the Counties of Sacramento and Los Angeles. This report shall articulate specific changes and improvements implemented to increase Medi-Cal beneficiary access to preventive services and dental treatment, the utilization of services, and beneficiary satisfaction. Key measures, outcomes, and department findings pertaining to participating dental managed care plans and provider networks shall also be included. (b) Any report provided pursuant to subdivision (a) on the County of Sacramento shall also provide data regarding the outcomes and findings from the beneficiary dental exception (BDE) process implemented by the department pursuant to Section 14089.09, including the consideration of voluntary enrollment in the County of Sacramento as compared to the existing mandatory enrollment. (c) The department may seek foundation funding or federal grant funding to facilitate data analysis and reporting as applicable for this purpose. (Added by Stats. 2012, Ch. 23, Sec. 115. (AB 1467) Effective June 27, 2012.)
  18. 14460.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    These agencies must jointly set a schedule for reviews, visits, and audits, and the State Department of Health Services may also do reviews, visits, or audits on its own or jointly to follow up on findings.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14460. A schedule of reviews, visits, and audits shall be jointly established by the Department of Managed Health Care or the Department of Insurance, as the case may be, and the State Department of Health Services. Nothing in Section 14456, 14457, or 14459 shall be construed to prohibit the State Department of Health Services from conducting reviews, visits, or audits either jointly or individually, for the purpose of following up on findings resulting from reviews, visits, or audits carried out in accordance with this chapter. (Amended by Stats. 2000, Ch. 857, Sec. 96. Effective January 1, 2001.)
  19. 14461.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    When the department asks, each prepaid health plan must send the department a copy of any financial report it gave to another public or private organization, if that report is different in content or format from one already filed with the department.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14461. Upon request by the department, each prepaid health plan shall submit to the department a copy of any financial report submitted to any other public or private organization, if such report differs in content or format from any financial report already submitted to the department. (Added by Stats. 1977, Ch. 1036.)
  20. 14462.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    Section 15459 of the Government Code does not apply to certain hospitals.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14462. In accordance with Section 14081.5, the provisions of Section 15459 of the Government Code shall not be applicable to a hospital, whether or not it negotiates to obtain a contract pursuant to Article 2.6 (commencing with Section 14081), if the hospital predominantly serves or will predominantly serve members of a health maintenance organization that has negotiated in good faith to obtain a prepaid contract pursuant to this part or pursuant to Article 2.91 (commencing with Section 14089). (Added by Stats. 1983, Ch. 1018, Sec. 3. Effective September 22, 1983.)
  21. 14463.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    Prepaid health plans are responsible for covered costs for enrolled Medi-Cal beneficiaries, with risk-limit and reimbursement rules handled by the department.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14463. (a) Except as otherwise provided in this chapter, each prepaid health plan shall be responsible for all of the costs of services rendered under the provisions of this chapter to any Medi-Cal beneficiary enrolled in the plan. (b) The department shall bear the costs of providing to each Medi-Cal beneficiary enrolled in a prepaid health plan the services covered under the plan, to the extent that the aggregate of these costs, based on Medi-Cal reimbursement levels, and exclusive of third-party recoveries, exceeds the 12-month risk limit. The risk limit shall not exceed twenty-five thousand dollars ($25,000) based on Medi-Cal reimbursement levels, shall be specified in the contract between the department and the plan, and shall be determined concurrently with the annual determination of rates of payment. The department shall have the authority to adopt regulations to increase the risk limit, to an amount not to exceed thirty-five thousand dollars ($35,000). Regulations to increase the risk limit shall be based upon and supported by changes in prepaid health plan rates paid by the department and changes in the medical component of the Consumer Price Index (CPI) as actuarially determined by the department. It is the intent of the Legislature that these risk limit adjustments are not to exceed thirty-five thousand dollars ($35,000) until the 1986–87 fiscal year or beyond. For plans having contracts in existence on the effective date of this section, the risk limit shall be announced on or before the first day of each state fiscal year, to become effective concurrently with the effective date for the new rates of payment for the next succeeding state fiscal year. The department may negotiate with a prepaid health plan a mutually agreed-to risk limit in an amount in excess of thirty-five thousand dollars ($35,000). Within 90 days of the receipt of the documentation required under paragraph (2), the department shall pay the reimbursement provided for by this section to the extent that it determines that the services rendered were medically necessary, and that the amount of the payments sought for those services is reasonable. The department may, if a dispute exists as to whether the services rendered were medically necessary or if the amount of the payments for those services was reasonable, delay paying the reimbursement for such services until a final determination of the dispute is made. (1) Each prepaid health plan shall arrange and provide initial payment, at Medi-Cal reimbursement levels, for medically necessary care for any Medi-Cal beneficiary enrolled in the plan when the cost for this care exceeds the 12-month risk limit. No person shall be disenrolled by any prepaid health plan for the sole reason that the cost of his or her care under the plan has exceeded the risk limit. (2) As a condition of reimbursement for costs of care in excess of the risk limit as to a Medi-Cal beneficiary enrolled in a prepaid health plan, the plan must submit to the department, in a format to be designated by the department, documentation of all costs incurred for services to the beneficiary during the 12-month period. (c) No prepaid health plan may enter into any subcontract that would in any way limit its obligation assumed under this chapter to retain the significant risk of the cost of services rendered under this chapter to any Medi-Cal beneficiary enrolled in the plan. (d) As a condition of the department’s approval of any subcontract entered into by a prepaid health plan under this chapter, the plan shall specify its retention of significant risk by designating one of the options under subdivision (e) as its operating definition of significant risk, or by any other method approved by the department that would meet the requirement set forth in subdivision (c). (e) “Significant risk” means financial responsibility for either of the following: (1) All expenditures in excess of 115 percent of the specified total expenditures estimated under each subcontract. (2) All inpatient hospitalization expenditures as determined by the department, including expenditures for services connected with hospitalization. (Added by renumbering Section 14462 (as amended by Stats. 1985, Ch. 1579) by Stats. 1986, Ch. 248, Sec. 272.)
  22. 14464.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. )

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    The department may negotiate and set an individual administrative cost limit in contracts with certain prepaid health plans and Medi-Cal managed care plans.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5. Standards for Prepaid Health Plans [14450 - 14464] ( Article 5 added by Stats. 1974, Ch. 983. ) ## 14464. (a) The department may negotiate and establish an individual administrative cost limit in its contracts with each prepaid health plan or Medi-Cal managed care plan contracting under Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) providing services to Medi-Cal beneficiary enrollees. (b) As used in this section, prepaid health plan or Medi-Cal managed care plan “administrative costs” includes net profit or revenue in excess of expenditures, in addition to those items set forth in Section 1300.78 of Title 10 of the California Code of Regulations and those items set forth by the director. (Added by Stats. 1995, Ch. 859, Sec. 10. Effective January 1, 1996.)
  23. 14465.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5.3. Provision of Medical Care by Nonplan Providers to Enrollees of Prepaid Health Plans [14465 - 14466] ( Article 5.3 added by Stats. 1992, Ch. 1052, Sec. 1. )

    Verify source ↗

    This section defines “emergency services” by tying it to the meaning used in Health and Safety Code Section 1317.1.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5.3. Provision of Medical Care by Nonplan Providers to Enrollees of Prepaid Health Plans [14465 - 14466] ( Article 5.3 added by Stats. 1992, Ch. 1052, Sec. 1. ) ## 14465. For purposes of this article and Section 14454, “emergency services” shall have the same meaning as that established in Section 1317.1 of the Health and Safety Code for “emergency services and care.” (Added by Stats. 1992, Ch. 1052, Sec. 1. Effective January 1, 1993.)
  24. 14466.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5.3. Provision of Medical Care by Nonplan Providers to Enrollees of Prepaid Health Plans [14465 - 14466] ( Article 5.3 added by Stats. 1992, Ch. 1052, Sec. 1. )

    Verify source ↗

    The plan must ask the department to temporarily disenroll an enrollee for months when the patient is hospitalized, stays stable, and refuses a medically safe transfer.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 5.3. Provision of Medical Care by Nonplan Providers to Enrollees of Prepaid Health Plans [14465 - 14466] ( Article 5.3 added by Stats. 1992, Ch. 1052, Sec. 1. ) ## 14466. The plan shall make a request to the department to temporarily disenroll any enrollee for the month or months in which the patient is hospitalized and remains in stable condition, and refuses to be transferred from a nonplan provider’s facility to a plan’s facility when it is medically safe to do so. This section shall only be applicable in Los Angeles County because of problems the county has experienced in treating nonplan Medi-Cal enrollees in county hospitals. (Added by Stats. 1992, Ch. 1052, Sec. 1. Effective January 1, 1993.)
  25. 14475.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 6. Conflict of Interest [14475 - 14482] ( Article 6 added by Stats. 1974, Ch. 983. )

    Verify source ↗

    The department may not approve or renew certain prepaid health plan or pilot program contracts if covered officials, employees, or their spouse or minor child have a substantial financial interest in the contract or related contracting arrangement.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 6. Conflict of Interest [14475 - 14482] ( Article 6 added by Stats. 1974, Ch. 983. ) ## 14475. (a) No prepaid health plan or pilot program contract shall be approved or renewed by the department pursuant to this chapter if any state officer or state employee or his spouse or minor child has a substantial financial interest, as defined by Section 14478, in any of the following: (1) The contract or the contracting organization. (2) Any contract with the contracting organization. (3) Procurement of a contract for the contracting organization. (b) As used in subdivision (a), “state officer or state employee” means any person included in Section 14477 and includes any employee in the department who has a direct responsibility for the negotiation, development, or management of a prepaid health plan contracted under the provisions of this chapter. The director shall publish regulations determining the class of employees covered by this subdivision. (Repealed and added by Stats. 1977, Ch. 1036.)
  26. 14476.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 6. Conflict of Interest [14475 - 14482] ( Article 6 added by Stats. 1974, Ch. 983. )

    Verify source ↗

    Certain prepaid health plan leaders must file an annual statement with the department disclosing certain purchases or leases involving entities tied to people with a substantial financial interest.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 6. Conflict of Interest [14475 - 14482] ( Article 6 added by Stats. 1974, Ch. 983. ) ## 14476. The chief executive, sole proprietor, or managing partner of each prepaid health plan shall file with the department an annual statement disclosing any purchases or leases of services, equipment, supplies or real property by the plan from any entity in which any of the following persons have a substantial financial interest as defined by Section 14478: (a) Any person also having a substantial financial interest in the plan. (b) Any director, officer, partner, trustee or employee of the plan. (c) Any member of the immediate family of any person designated in (a) or (b). (Added by Stats. 1977, Ch. 1036.)
  27. 14477.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 6. Conflict of Interest [14475 - 14482] ( Article 6 added by Stats. 1974, Ch. 983. )

    Verify source ↗

    This section defines “state officer” and “state employee” for this article.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 6. Conflict of Interest [14475 - 14482] ( Article 6 added by Stats. 1974, Ch. 983. ) ## 14477. (a) For purposes of this article, “state officer” means a United States Senator or Member of Congress representing California, the Governor, Lieutenant Governor, Secretary of State, Controller, Treasurer, Attorney General, State Superintendent of Public Instruction, a Member of the Legislature, or a secretary of a state agency. (b) For purposes of this article, “state employee” means any staff member of a state agency secretary who holds a policymaking position, any member of the Governor’s staff who holds a policymaking position, or any administrative aide or committee consultant of the Legislature. “State employee” includes the appointive or civil service employee of the highest class or grade in each department, system, program, section, or other administrative subdivision of the State Department of Health Services as defined in regulations adopted by the department. (Amended by Stats. 1978, Ch. 429.)
  28. 14478.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 6. Conflict of Interest [14475 - 14482] ( Article 6 added by Stats. 1974, Ch. 983. )

    Verify source ↗

    This section defines “substantial financial interest” and “immediate family” for this chapter.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 6. Conflict of Interest [14475 - 14482] ( Article 6 added by Stats. 1974, Ch. 983. ) ## 14478. (a) As used in this chapter, “substantial financial interest” means the ownership of common stock, preferred stock, warrants, options, loans, partnership interests, debt instruments, or other ownership interest, if consisting of, or convertible to, equity investments in an entity contracting with the department under the provisions of this chapter or an entity contracting with a current or proposed contractor doing business with the department under the provisions of this chapter, and such ownership interest in terms of fair market value is not less than the greater of the following: (1) One thousand dollars ($1,000). (2) Five percent or more of the total fair market value of all equity investments in the entity, including ownership interests convertible to such investments. A convertible debt includes bonds, notes, debentures, and mortgages. (b) As used in this chapter, “immediate family” means an individual’s spouse and minor dependent children and any other person over which the individual has legal control. (Repealed and added by Stats. 1977, Ch. 1036.)
  29. 14479.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 6. Conflict of Interest [14475 - 14482] ( Article 6 added by Stats. 1974, Ch. 983. )

    Verify source ↗

    The department may not approve, renew, or continue certain prepaid health plan or pilot program contracts if a former state officer or employee took a management or consultant job with the contractor or subcontractor within one year after leaving state employment.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 6. Conflict of Interest [14475 - 14482] ( Article 6 added by Stats. 1974, Ch. 983. ) ## 14479. (a) No prepaid health plan or pilot program contract shall be approved, renewed or continued by the department if a state officer or state employee is employed in a management or consultant position by the contractor or a subcontractor to the contractor within one year after the state officer or state employee terminated state employment. (b) For purposes of this section, “state employee” means any appointive or civil service employee of the department or of the Health and Welfare Agency who, within two years prior to leaving state employment, was responsible for development, negotiation, contract management, or supervision of a prepaid health plan or prepaid health plan contract. For purposes of this section, employees of the department who are assigned as contract managers shall not be subject to the provisions of this section unless they are employed by a prepaid health plan or a subcontractor of a prepaid health plan for which, within two years prior to leaving state employment, they were responsible for the development, negotiation, contract management, or direct supervision over the prepaid health plan contract. This section shall not apply to any employee, appointee, or person on contract with the department who is employed, appointed, or contracted with by the department either: (1) To fulfill the purposes of a federal grant, provided that such person does not supervise, develop, manage, or negotiate a prepaid health plan contract; or (2) To fulfill on a temporary basis, not to exceed 120 days, a specific function for the department which does not include supervising, developing, managing, or negotiating a prepaid health plan contract. (c) The requirements of this section shall apply to any contract entered into on or after the operative date of this section and to any state officer or state employee who is employed by such contractor or subcontractor thereof on or after such operative date. This section shall not apply to any state officer or employee who terminated state employment prior to such operative date. (Repealed and added by Stats. 1977, Ch. 1036.)
  30. 14480.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 6. Conflict of Interest [14475 - 14482] ( Article 6 added by Stats. 1974, Ch. 983. )

    Verify source ↗

    A prepaid health plan or pilot program contract cannot be approved or renewed if a state officer or state employee provides legal or management services to the contractor.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 6. Conflict of Interest [14475 - 14482] ( Article 6 added by Stats. 1974, Ch. 983. ) ## 14480. No prepaid health plan or pilot program contract with an existing or proposed contractor shall be approved or renewed if a state officer or state employee provides legal or management services to the contracting organization. For the purposes of this section no state officer or state employee shall share in the income or any remuneration derived from the providing of legal or management services to a contracting organization. (Amended by Stats. 1977, Ch. 1036.)
  31. 14481.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 6. Conflict of Interest [14475 - 14482] ( Article 6 added by Stats. 1974, Ch. 983. )

    Verify source ↗

    A prepaid health plan or pilot program contract cannot be approved or renewed if a state officer or state employee receives something of value to influence the negotiations.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 6. Conflict of Interest [14475 - 14482] ( Article 6 added by Stats. 1974, Ch. 983. ) ## 14481. No prepaid health plan or pilot program contract shall be approved or renewed if any state officer or state employee receives anything of value for the purpose of influencing or attempting to influence the negotiations for approval or renewal of the contract. (Amended by Stats. 1977, Ch. 1036.)
  32. 14482.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 6. Conflict of Interest [14475 - 14482] ( Article 6 added by Stats. 1974, Ch. 983. )

    Verify source ↗

    A prepaid health plan generally may not contract with a subcontractor if certain connected people have a substantial financial interest in that subcontractor, except for listed related corporate entities.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 6. Conflict of Interest [14475 - 14482] ( Article 6 added by Stats. 1974, Ch. 983. ) ## 14482. No prepaid health plan shall contract with any subcontractor other than the plan’s subsidiary corporation, its parent corporation, or another subsidiary of its parent corporation, or an affiliate of the prepaid health plan whose financial statements are consolidated with that of the prepaid health plan at the time of the annual audit by the independent auditors of the plan and when the quarterly and annual financial statements are filed with the Director of the Department of Managed Health Care, if any of the following persons connected with the plan have a substantial financial interest, as defined by Section 14478, in such subcontractor: (a) Any person also having a substantial financial interest in the plan. (b) Any director, officer, partner, trustee, or employee of the plan. (c) Any member of the immediate family of any person designated in (a) or (b). (Amended by Stats. 2000, Ch. 857, Sec. 97. Effective January 1, 2001.)
  33. 14490.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. )

    Verify source ↗

    The director must seek alternative financing and delivery methods for health care services and contract to create pilot programs, which must run for no more than five years and be evaluated annually.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. ) ## 14490. In providing benefits under this chapter and Chapter 7 (commencing with Section 14000), the director shall aggressively seek the development of alternative forms of financing and delivering health care services. In carrying out the intent of this article, the director shall contract with institutional providers, counties, or other organizations to establish pilot programs that demonstrate the value, or lack thereof, of such a program in delivering or financing health care services in such a manner. Each pilot program shall be for a specified duration not to exceed five years, and each pilot program shall be evaluated annually for its efficiency, effectiveness, and quality. Upon a finding by the director that a pilot program contributes substantially to the availability of high quality health services and that those services are cost-effective, the director shall enter into a contract for a period of up to five years. Where the director recommends implementation of a pilot program on a permanent basis, but finds that he or she is not able to implement on a permanent basis that program immediately upon conclusion of the program’s term, he or she may extend the duration of the pilot program until the evaluation or permanent implementation can be accomplished. The extension shall be for a term not in excess of one year, but may be renewed for additional one-year terms, provided that the director has completed an evaluation to include findings that would qualify an extension. (Amended by Stats. 1997, Ch. 17, Sec. 154. Effective January 1, 1998.)
  34. 14491.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. )

    Verify source ↗

    The director must pursue the feasibility of establishing specified pilot programs.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. ) ## 14491. The director shall pursue the feasibility of establishing the following as pilot programs: (a) A capitated, risk-assuming contract with one or more regional fiscal intermediaries. (b) A capitated, risk-assuming contract with acute care hospitals within a county or region. (c) A capitated, risk-assuming contract with one or more organizations which provide payment to a specified class or classes of providers. For purposes of this section, “risk-assuming” means the pilot program contractor agrees to assume the risk of utilization of services or costs of services, or both. (Added by Stats. 1977, Ch. 1036.)
  35. 14493.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. )

    Verify source ↗

    The director must consider certain programs that use health personnel innovatively and economically and that are approved under a referenced Health and Safety Code article.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. ) ## 14493. The director shall also consider programs which demonstrate an innovative and economical use of health personnel and are approved pursuant to Article 18 (commencing with Section 429.70), Chapter 2, Part 1, Division 1 of the Health and Safety Code. (Added by Stats. 1977, Ch. 1036.)
  36. 14494.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. )

    Verify source ↗

    The director may enter into other contracts under this article for listed pilot-program purposes.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. ) ## 14494. The director may enter into other contracts under this article which do one or more of the following: (a) Demonstrate an innovative and economical use of health personnel. (b) Emphasize preventive care. (c) Stress new methods for controlling utilization of services. (d) Stress new methods of reviewing provider competency or quality of care. (e) Stress a more economical organization of health care resources and delivery systems. (f) Provide an incentive to beneficiaries to seek the most economical level of care. (g) Demonstrate innovative methods for health care financing, such as prospective budgeting in regard to enrolled population or volume of services. (h) Test or demonstrate the feasibility of allowing California citizens to purchase Medi-Cal coverage at a premium rate determined by the department on an actuarial basis. (Added by Stats. 1977, Ch. 1036.)
  37. 14495.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. )

    Verify source ↗

    The director may set up pilot programs and adjust certain Medi-Cal benefit and eligibility rules for those programs. Eligible people assigned to a pilot program may disenroll for any cause within 30 days after enrollment and receive a Medi-Cal card.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. ) ## 14495. In establishing pilot programs, the director may do the following: (a) Provide benefits based on class of recipient, class of benefit, geographical area, or any other reasonable classification. (b) Modify, to the extent permitted by federal law, the scope and duration of benefits provided by Section 14132. The extent of coverage may be limited to a fixed number of days or to amount or duration of services. (c) Modify, to the extent permitted by federal law, Medi-Cal eligibility determination processes or criteria. (d) Allow for the provision of Medi-Cal benefits on a prepaid basis in a given geographical area exclusively by the pilot program. (e) Assign persons eligible for Medi-Cal benefits to a pilot program or a prepaid health plan on a pilot basis, provided such persons shall be entitled to disenroll for any cause for a period of 30 days following the effective date of enrollment and to receive a Medi-Cal card pursuant to Section 14017. (Added by Stats. 1977, Ch. 1036.)
  38. 14495.10.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. )

    Verify source ↗

    This section creates a Medi-Cal pilot program for continuous skilled nursing care, sets participation and waiver conditions, and gives the department authority to administer it.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. ) ## 14495.10. (a) The department shall establish a pilot program to provide continuous skilled nursing care as a benefit of the Medi-Cal program, when those services are provided in accordance with an approved federal waiver meeting the requirements of subdivision (b). “Continuous skilled nursing care” means medically necessary care provided by, or under the supervision of, a registered nurse within his or her scope of practice, seven days a week, 24 hours per day, in a health facility participating in the pilot program. This care shall include a minimum of eight hours per day provided by or under the direct supervision of a registered nurse. Each health facility providing continuous skilled nursing care in the pilot program shall have a minimum of one registered nurse or one licensed vocational nurse awake and in the facility at all times. (b) The department shall submit to the federal Centers for Medicare and Medicaid Services, no later than April 1, 2000, a federal waiver request developed in consultation with the State Department of Developmental Services and the Association of Regional Center Agencies, pursuant to Section 1915(b) of the federal Social Security Act (42 U.S.C. Sec. 1396n(c)) to provide continuous skilled nursing care services under the pilot program. (c) (1) The pilot program shall be conducted to explore more flexible models of health facility licensure to provide continuous skilled nursing care to developmentally disabled individuals in the least restrictive health facility setting, and to evaluate the effect of the pilot program on the health, safety, and quality of life of individuals, and the cost-effectiveness of this care. The evaluation shall include a review of the pilot program by an independent agency. (2) Participation in the pilot program shall include 10 health facilities provided that the facilities meet all eligibility requirements. The facilities shall be approved by the department, in consultation with the State Department of Developmental Services and the appropriate regional center agencies, and shall meet the requirements of subdivision (e). Priority shall be given to facilities with four to six beds, to the extent those facilities meet all other eligibility requirements. (d) Under the pilot program established in this section, a developmentally disabled individual is eligible to receive continuous skilled nursing care if all of the following conditions are met: (1) The developmentally disabled individual meets the criteria as specified in the federal waiver. (2) The developmentally disabled individual resides in a health facility that meets the provider participation criteria as specified in the federal waiver. (3) The continuous skilled nursing care services are provided in accordance with the federal waiver. (4) The continuous skilled nursing care services provided to the developmentally disabled individual do not result in costs that exceed the fiscal limit established in the federal waiver. (e) A health facility seeking to participate in the pilot program shall provide care for developmentally disabled individuals who require the availability of continuous skilled nursing care, in accordance with the terms of the pilot program. During participation in the pilot program, the health facility shall comply with all the terms and conditions of the federal waiver described in subdivision (b), and shall not be subject to licensure or inspection under Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code. Upon termination of the pilot program and verification of compliance with Section 1265 of the Health and Safety Code, the department shall immediately reinstate the participating health facility’s previous license for the balance of time remaining on the license when the health facility began participation in the pilot program. (f) The department shall implement this pilot program only to the extent it can demonstrate fiscal neutrality, as required under the terms of the federal waiver, and only if the department has obtained the necessary approvals to implement the pilot program and receives federal financial participation from the federal Centers for Medicare and Medicaid Services. (g) In implementing this article, the department may enter into contracts for the provision of essential administration and other services. Contracts entered into under this section may be on a noncompetitive bid basis and shall be exempt from the requirements of Chapter 2 (commencing with Section 10290) of Part 2 of Division 2 of the Public Contract Code. (h) This section shall be repealed if and when the federal Centers for Medicare and Medicaid Services approve a federal waiver pursuant to Section 1915(c) of the federal Social Security Act (42 U.S.C. Sec. 1396n(c)) or approve a state plan amendment to make this pilot program a permanent program. If the federal Centers for Medicare and Medicaid Services provide that approval, the Director of Health Care Services shall execute a declaration stating that this approval has been granted. The director shall retain the declaration and this section shall be repealed on the date that the director executes a declaration pursuant to this subdivision. (Amended by Stats. 2009, 4th Ex. Sess., Ch. 5, Sec. 51. Effective July 28, 2009. Repealed conditionally as prescribed by its own provisions.)
  39. 14496.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. )

    Verify source ↗

    The director must update Medi-Cal provider payment regulations and, with Finance’s written approval, may adopt them as emergency regulations. The director and contractor must also amend the pilot project contract within 60 days after certain budget-related enactments.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. ) ## 14496. (a) Alternate methods of payment for a pilot program may include, but shall not be limited to, a prospectively negotiated reimbursement rate, fee-for-service, retainer, capitation, or other basis. (b) In order to implement expeditiously the budgeting decisions of the Legislature, the director shall, to the extent permitted by federal law, adopt regulations setting rates payable to providers which reflect such decisions 30 days after the enactment of the Budget Act and of any other appropriation which changes the level of funding for Medi-Cal services. The proposed regulations shall be submitted to the Department of Finance five days prior to the date of adoption. With the written approval of the Department of Finance, the director shall adopt such regulations as emergency regulations in accordance with the provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340), Part 1, Division 3, Title 2 of the Government Code). For purposes of such act, the adoption of such regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health, and safety or general welfare. (c) In order to implement expeditiously the budgeting decisions of the Legislature, the director and the contractor shall, to the extent permitted by federal law, amend the pilot project contract to reflect such decisions 60 days after the enactment of the Budget Act and of any other appropriation which changes the level of funding for Medi-Cal services. Any approvals, ratifications, reviews, or analyses of such amendments required to be undertaken by any state agency or state department shall be completed within the 60-day period specified in this subdivision. (Amended by Stats. 1990, Ch. 1516, Sec. 3. Effective September 30, 1990.)
  40. 14497.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. )

    Verify source ↗

    The director must hold a public hearing before entering into or renewing a pilot program, and must make certain pilot program materials public at least five days before the hearing.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. ) ## 14497. The director shall call a public hearing pursuant to Section 14300 prior to entering into or renewing a pilot program. The director shall make available to the public a statement of objectives, program proposal, pilot program contract, and other details regarding the pilot program not less than five days prior to the public hearing. (Added by Stats. 1977, Ch. 1036.)
  41. 14499.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. )

    Verify source ↗

    The director must contract for one local pilot program, give special consideration to a Santa Barbara County county-government proposal, and may contract or extend contracts there for up to three years.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. ) ## 14499.5. (a) (1) In carrying out the intent of this article, the director shall contract for the operation of one local pilot program. Special consideration shall be given to approving a program contracted through county government in Santa Barbara County. (2) Notwithstanding the limitations contained in Section 14490, the director may enter into, or extend, contracts with the local pilot program in Santa Barbara County pursuant to paragraph (1) for periods that do not exceed three years. (b) The establishment of a pilot program pursuant to this section shall be contingent upon the availability of state and federal funding. The program shall include the following components: (1) Local authority for administration, fiscal management, and delivery of services, but not including eligibility determination. (2) Physician case management. (3) Cost containment through provider incentives and other means. (c) The program for the pilot project shall include a plan and budget for delivery of services, administration, and evaluation. During the first year of the pilot program, the amount of the state contract shall equal 95 percent of total projected Medi-Cal expenditures for delivery of services and for administration based on fee-for-service conditions in the program county. During the remaining years of the pilot project Medi-Cal expenditures in the program county shall be no more than 100 percent of total projected expenditures for delivery of services and for administration based on any combination of the following paragraphs: (1) Relevant prior fee-for-service Medi-Cal experience in the program county. (2) The fee-for-service Medi-Cal experience in comparable counties or groups of counties. (3) Medi-Cal experience of the pilot project in the program county if, as determined by the department, the scope, level, and duration of, and expenditures for, any services used in setting the rates under this paragraph would be comparable to fee-for-service conditions were they to exist in the program county and would be more actuarially reliable for use in ratesetting than data available for use in applying paragraph (1) or (2). The projected total expenditure shall be determined annually according to an acceptable actuarial process. The data elements used by the department shall be shared with the proposed contractor. (d) The director shall accept or reject the proposal within 30 days after the date of receipt. If a decision is made to reject the proposal, the director shall set forth the reasons for this decision in writing. Upon approval of the proposal, a contract shall be written within 60 days. After signature by the local contractor, the State Department of Health Care Services and the Department of General Services shall execute the contract within 60 days. (e) The director shall seek the necessary state and federal waivers to enable operation of the program. If the federal waivers for delivery of services under this plan are not granted, the department is under no obligation to contract for implementation of the program. (f) For purposes of Section 1343 of the Health and Safety Code, the Santa Barbara Regional Health Authority shall be considered to be a county-operated pilot program contracting with the State Department of Health Care Services pursuant to this article, and notwithstanding any other provision of law, during the period that this contract is in effect, the contractor shall be exempt from the provisions of the Knox-Keene Health Care Service Plan Act of 1975, Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code, relative to the services provided to Medi-Cal beneficiaries under the terms and provisions of the pilot program. (g) Dental services may be included within the services provided in this pilot program. (h) Any federal demonstration funding for this pilot program shall be made available to the county within 60 days upon notification of the award without the state retaining any portion not previously specified in the grant application as submitted. (i) (1) (A) The department may negotiate exclusive contracts and rates with the Santa Barbara Regional Health Authority in the implementation of this section. (B) Contracts entered into under this article may be on a noncompetitive bid basis and shall be exempt from Chapter 2 (commencing with Section 10290) of Part 2 of Division 2 of the Public Contract Code. (C) The department shall enter into contracts pursuant to this article, and shall be bound by the terms and conditions related to the rates negotiated by the negotiator. (2) The department shall implement this subdivision to the extent that the following apply: (A) Its implementation does not revise the status of the pilot program as a federal demonstration project. (B) Existing federal waivers apply to the pilot program as revised by this subdivision, or the federal government extends the applicability of the existing federal waivers or authorizes additional federal waivers for the implementation of the program. (3) The implementation of this subdivision shall not affect the pilot program’s having met any of the requirements of Part 3.5 (commencing with Section 1175) of Division 1 of the Health and Safety Code and this division applicable to the pilot program with respect to the negotiations of contracts and rates by the department. (Amended by Stats. 2007, Ch. 188, Sec. 93. Effective August 24, 2007.)
  42. 14499.6.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. )

    Verify source ↗

    The authority may arrange certain out-of-county hospital services for eligible Medi-Cal beneficiaries, and those hospitals generally may not charge more than negotiated rates.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 7. Pilot Programs [14490 - 14499.6] ( Article 7 added by Stats. 1977, Ch. 1036. ) ## 14499.6. (a) The Santa Barbara Regional Health Authority may arrange with out-of-county Selective Provider Contracting Program hospitals that have negotiated hospital contracts and per diem rates under Article 5.1 (commencing with Section 14165) of Chapter 7, to provide medically justified emergency services or to provide specialized hospital services not available within Santa Barbara County to Medi-Cal beneficiaries who reside in Santa Barbara County. The authority may arrange medically justified inpatient hospital services with out-of-county program hospitals for those beneficiaries whose county of residence for purposes of eligibility determination is Santa Barbara, but who for medical or legal reasons physically reside in a county other than Santa Barbara. (b) The out-of-county program hospitals shall not charge the authority more than their program negotiated rates when providing hospital services to authority patients under this section, except as provided in subdivision (c). (c) In cases where an out-of-county program hospital can demonstrate that the cost of the services it is rendering to authority patients was not contemplated in the case mix and acuity assumptions on which the program rates are based, the program hospital and the authority shall negotiate in good faith equitable rates for payment for the provision of hospital services to authority patients. The established program rate shall serve as the base for those negotiations. (d) (1) Notwithstanding any other provision of law, any records maintained by the authority that would enable a determination to be made regarding rates negotiated pursuant to Article 5.1 (commencing with Section 14165) of Chapter 7, shall be exempt from the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code). (2) The authority shall establish guidelines to ensure that these rates are maintained as confidential records and that access to these records is restricted. (3) The authority shall submit the established guidelines to the department for approval. (Amended by Stats. 2021, Ch. 615, Sec. 458. (AB 474) Effective January 1, 2022. Operative January 1, 2023, pursuant to Sec. 463 of Stats. 2021, Ch. 615.)
  43. 14499.7.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 8. Medi-Cal At-Risk Fiscal Intermediaries [14499.7 - 14499.77] ( Article 8 added by Stats. 1985, Ch. 1579, Sec. 4. )

    Verify source ↗

    The department may contract with one or more fiscal intermediaries to pay authorized benefits, and those contracts may be awarded on either a bid or nonbid basis.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 8. Medi-Cal At-Risk Fiscal Intermediaries [14499.7 - 14499.77] ( Article 8 added by Stats. 1985, Ch. 1579, Sec. 4. ) ## 14499.7. The department may contract with one or more fiscal intermediaries in order to pay for benefits authorized under this chapter and Chapter 7 (commencing with Section 14000). Contracts entered into pursuant to this article may be awarded on a bid or nonbid basis. (Added by Stats. 1985, Ch. 1579, Sec. 4.)
  44. 14499.71.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 8. Medi-Cal At-Risk Fiscal Intermediaries [14499.7 - 14499.77] ( Article 8 added by Stats. 1985, Ch. 1579, Sec. 4. )

    Verify source ↗

    This section defines “fiscal intermediary” for this article.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 8. Medi-Cal At-Risk Fiscal Intermediaries [14499.7 - 14499.77] ( Article 8 added by Stats. 1985, Ch. 1579, Sec. 4. ) ## 14499.71. For the purposes of this article, “fiscal intermediary” means an entity that agrees to pay for covered services provided to Medi-Cal eligibles in exchange for a premium, subscription charge, or capitation payment; to assume an underwriting risk; and is licensed by the Director of the Department of Managed Health Care under the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code). (Amended by Stats. 2015, Ch. 455, Sec. 54. (SB 804) Effective January 1, 2016.)
  45. 14499.73.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 8. Medi-Cal At-Risk Fiscal Intermediaries [14499.7 - 14499.77] ( Article 8 added by Stats. 1985, Ch. 1579, Sec. 4. )

    Verify source ↗

    A fiscal intermediary under a contract in this article must provide enough primary care and supportive specialty care physicians, and must run a reporting system to track service costs for Medi-Cal recipients.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 8. Medi-Cal At-Risk Fiscal Intermediaries [14499.7 - 14499.77] ( Article 8 added by Stats. 1985, Ch. 1579, Sec. 4. ) ## 14499.73. A contract entered into under this article shall provide that a fiscal intermediary meets both of the following criteria: (a) The fiscal intermediary shall provide or arrange for an adequate number of primary care physicians and supportive specialty care physicians. (b) The fiscal intermediary shall implement a management and information reporting system in order to determine the costs of each type of health care service rendered to Medi-Cal recipients. (Added by Stats. 1985, Ch. 1579, Sec. 4.)
  46. 14499.74.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 8. Medi-Cal At-Risk Fiscal Intermediaries [14499.7 - 14499.77] ( Article 8 added by Stats. 1985, Ch. 1579, Sec. 4. )

    Verify source ↗

    The department must use specified data methods to set capitated rates for a fiscal intermediary, and the rates may not exceed a stated per-capita ceiling.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 8. Medi-Cal At-Risk Fiscal Intermediaries [14499.7 - 14499.77] ( Article 8 added by Stats. 1985, Ch. 1579, Sec. 4. ) ## 14499.74. In determining the capitated rates to be paid to a fiscal intermediary during the first year of contracting under this article, the department shall utilize an acceptable actuarial process and historical data concerning Medi-Cal recipients in the geographical area which will, or is being, served by the fiscal intermediary. During the remaining years of the contract with the fiscal intermediary, the department shall utilize data concerning Medi-Cal expenditures for delivery of services based on the fee-for-service experience in comparable geographic areas. The capitated rates shall not exceed the total per capita amount (including the cost of adjustments to provide actuarial equivalence) which would be payable for all services and requirements covered under the fiscal intermediary contract adopted pursuant to this article if all those services and requirements were to be furnished to Medi-Cal beneficiaries under the fee-for-service Medi-Cal program provided for by Chapter 7 (commencing with Section 14000). (Added by Stats. 1985, Ch. 1579, Sec. 4.)
  47. 14499.75.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 8. Medi-Cal At-Risk Fiscal Intermediaries [14499.7 - 14499.77] ( Article 8 added by Stats. 1985, Ch. 1579, Sec. 4. )

    Verify source ↗

    A fiscal intermediary may contract with providers that would be eligible to provide services on a fee-for-service basis without using a fiscal intermediary.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 8. Medi-Cal At-Risk Fiscal Intermediaries [14499.7 - 14499.77] ( Article 8 added by Stats. 1985, Ch. 1579, Sec. 4. ) ## 14499.75. A fiscal intermediary may contract for the provision of services with any provider who would be eligible to provide services if services were to be provided on a fee-for-service basis without the use of a fiscal intermediary pursuant to this article. (Added by Stats. 1985, Ch. 1579, Sec. 4.)
  48. 14499.77.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 8. Medi-Cal At-Risk Fiscal Intermediaries [14499.7 - 14499.77] ( Article 8 added by Stats. 1985, Ch. 1579, Sec. 4. )

    Verify source ↗

    The fiscal intermediary must pay for covered services for Medi-Cal recipients in its area, except services the department excludes. Services may be provided only by providers with agreements with the fiscal intermediary unless the intermediary authorizes otherwise.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8. Prepaid Plans [14200 - 14499.77] ( Chapter 8 added by Stats. 1972, Ch. 1366. ) ## ARTICLE 8. Medi-Cal At-Risk Fiscal Intermediaries [14499.7 - 14499.77] ( Article 8 added by Stats. 1985, Ch. 1579, Sec. 4. ) ## 14499.77. All services, except those specified for exclusion by the department, received by Medi-Cal recipients residing in the geographical area served by the fiscal intermediary shall be paid for by the fiscal intermediary. Services shall be provided only by providers which have entered into agreements with the fiscal intermediary, unless authorized by the fiscal intermediary. (Added by Stats. 1985, Ch. 1579, Sec. 4.)
  49. 1450.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 1. General Provisions [1450 - 1451] ( Article 1 added by Stats. 2018, Ch. 36, Sec. 33. )

    Verify source ↗

    This section creates the Youth Reinvestment Grant Program and directs certain appropriated funds to be used for grants and administrative costs.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 1. General Provisions [1450 - 1451] ( Article 1 added by Stats. 2018, Ch. 36, Sec. 33. ) ## 1450. (a) There is hereby established the Youth Reinvestment Grant Program within the Board of State and Community Corrections to grant funds pursuant to this chapter, upon an appropriation of funds for the purposes described in this chapter. (b) (1) Notwithstanding any other law, the board may use any funds that were appropriated to the board in the Budget Act of 2018, but that have not been allocated as of January 1, 2020, for grants, as prescribed in Article 4 (commencing with Section 1456). (2) Funds appropriated to the board in the Budget Act of 2019 for purposes of the Youth Reinvestment Fund grant program shall be used for grants, as prescribed in Article 4 (commencing with Section 1456). (3) Funds appropriated to the board in the Budget Act of 2019 for purposes of the Tribal Youth Diversion grant program shall be used for grants, as prescribed in Article 2 (commencing with Section 1452). (c) Three percent of the funds in the Youth Reinvestment Grant Program shall be used for administrative costs to the board resulting from the implementation of this chapter. (Amended by Stats. 2019, Ch. 584, Sec. 1. (AB 1454) Effective January 1, 2020.)
  50. 14500.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    The State Department of Health Services must establish an Office of Family Planning, and the State Director of Health Services must appoint its coordinator.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14500. An Office of Family Planning shall be established within the State Department of Health Services. The Office of Family Planning shall be under the control of an executive officer who shall be known as the Coordinator of the Office of Family Planning. The coordinator shall be appointed by the State Director of Health Services and shall be an individual with training and experience in family planning. (Amended by Stats. 1977, Ch. 1252.)
  51. 14500.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    This section says family planning includes methods and services to improve reproductive health, prevent disease, reduce unintended pregnancies, and reduce demand for abortions, and it defines key terms used in the chapter.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14500.5. (a) It is the intent of the Legislature that family planning includes, but is not limited to, an effective means to improve reproductive health by disease prevention and treatment, to reduce the incidence of unintended pregnancies, and to reduce the demand for abortions. It is the intent of the Legislature that no family planning shall be expended other than for the services enumerated in this chapter. It is also the intent of the Legislature that no funds received pursuant to this chapter be used for abortions or services ancillary to abortions. (b) For purposes of this chapter, the following definitions shall apply: (1) “Family planning” means the process of establishing objectives for the number and spacing of children, and selecting the means by which those objectives may be achieved. These means include a broad range of acceptable and effective methods and services to limit or enhance fertility, including contraceptive methods, natural family planning, abstinence methods, and the management of infertility. Family planning services include preconceptional counseling, maternal and fetal health counseling, and general reproductive health care, including diagnosis and treatment of infections and conditions, including cancer, that threaten reproductive capability, and other services as described in Section 14503, except for abortions and services ancillary to abortions as prohibited in Section 14509. Family planning does not include abortion, pregnancy testing solely for the purposes of referral for abortion or services ancillary to abortions, or pregnancy care which is not incident to the diagnosis of a pregnancy, except as otherwise provided for in this chapter. (2) “Abortion as a method of family planning” means the deliberate choice of abortion over other methods to limit the number, gender, and spacing of children, including, but not limited to, contraception, abstinence, and natural family planning methods. (3) “Department” means the State Department of Health Care Services. (4) “Director” means the Director of Health Care Services. (5) “Grantee” means an agency, institution, or organization approved by the department to provide family planning services pursuant to this chapter. (Amended by Stats. 2012, Ch. 23, Sec. 116. (AB 1467) Effective June 27, 2012.)
  52. 14501.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    The Office of Family Planning must carry out listed family-planning functions, including public information, consultation, coordination, surveys, program development, grants, reports, and annual data analysis.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14501. The Office of Family Planning has all of the following functions, powers, and duties: (a) To make available to citizens of the state of childbearing age comprehensive medical knowledge, assistance, and services relating to the planning of families. (b) To consult with state and local agencies that provide or administer family planning services and to participate in the formulation of regulations and other policy decisions governing the provision or administration of family planning services pursuant to state law or regulation. (c) To establish goals and priorities for all state agencies providing or administering family planning services. (d) To coordinate all family planning services and related programs conducted or administered by state agencies with the federal government so as to maximize the availability of these services by utilizing all available federal funds. (e) To conduct a survey of all of the existing facilities within the state having to do with family planning and infertility and the rendering of advice and assistance on birth control techniques and information. (f) To evaluate all existing programs and to establish in each county a viable program for the dispensation of family planning, infertility, and birth control information and techniques. (g) To develop and administer scientific investigation into problems of infertility and existing and new family planning and birth control techniques. (h) To survey, evaluate, and establish programs of professional education and training for physicians, nurses, medical and nursing students, and other health care practitioners in rendering advice on family planning, infertility, and birth control techniques and information. (i) To enter into agreements with, and award grants to, individuals, colleges, universities, associations, corporations, municipalities, and other units of government as may be deemed necessary and advisable to carry out the general intent and purposes of this chapter, which may provide for payment by the state within the limit of funds available for material, equipment, and services. (j) To post annual reports on its internet website, including, but not limited to, the subjects specified in subdivisions (a) to (i), inclusive. (k) To annually update and analyze family planning data. The data shall include, but not be limited to, the following: (1) Client number. (2) Ethnicity. (3) Family size. (4) Method. (5) Family income. (6) Service type. (7) Birthdate. (8) Total billing amount. (9) Pay source. (10) Date of visit. (11) Site number. (12) County of residence. (13) Updated estimates of women in need of subsidized family planning services from the federal government, when available, for all Office of Family Planning clinical service grantees by county of service, as well as statewide totals. (Amended by Stats. 2025, Ch. 105, Sec. 64. (AB 144) Effective September 17, 2025.)
  53. 14501.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    The Office of Family Planning must create and run a sliding fee schedule for family planning services.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14501.5. The Office of Family Planning shall develop and implement a sliding fee schedule for family planning services provided to individuals under this chapter. The fee schedule shall be based on family size and income. (Added by Stats. 1981, Ch. 69, Sec. 26. Effective June 17, 1981. Operative July 1, 1981, by Sec. 35 of Ch. 69.)
  54. 14502.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    The Office of Family Planning may advance up to 25% of a yearly allocation to a grant recipient, if funds are available and no more than once a year.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14502. The Office of Family Planning may, to the extent funds are available, and not more frequently than once each year, advance up to 25 percent of the yearly allocation to an individual or entity to which it has awarded a grant, pursuant to subdivision (i) of Section 14501, to provide material, equipment, and services. (Amended by Stats. 2002, Ch. 641, Sec. 3. Effective January 1, 2003.)
  55. 14503.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    Family planning services must be offered to eligible recipients of childbearing age and to eligible individuals who ask for them, and consent cannot be required from anyone other than the patient.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14503. (a) Family planning services shall be offered to all former, current, or potential recipients of childbearing age (as provided by Public Law 92-603) and provided to all eligible individuals who voluntarily request the services. The services shall be offered and provided without regard to marital status, age, or parenthood. Notwithstanding any other provisions of law, the furnishing of these family planning services shall not require the consent of anyone other than the person who is to receive them. Within the meaning of this section, the term “former, current, or potential recipient” means all persons eligible for Medi-Cal benefits under Chapter 7 (commencing with Section 14000) and all persons eligible for public social services for which federal reimbursement is available under the federal Social Security Act (42 U.S.C. Sec. 301 et seq.), except that the term “potential recipients” includes all persons in a family where current social, economic, and health conditions of the family indicate that the family would likely become a recipient of financial assistance within the next five years. (b) Family planning services shall include, but not be limited to: (1) Medical treatment and procedures defined as family planning services under the published Medi-Cal scope of benefits. (2) Medical contraceptive services such as diagnosis, treatment, supplies, and followup. (3) Informational and educational services. (4) Facilitating services such as transportation and child care services needed to attend clinic or other appointments. (5) Screening for chlamydia. (c) To the extent the services under this section are not available under the Medi-Cal program, they shall be provided by a grantee pursuant to a grant awarded by the Office of Family Planning. These grants shall include to the maximum extent possible, cooperative funding and other financial arrangements that permit maximum use of available federal funds. All grants awarded by the Office of Family Planning shall be exempt from Division 2 (commencing with Section 1100) of the Public Contract Code. Information and referral services only shall be available to all other families and children. (d) As the single state agency responsible for the state plan under Title XX of the federal Social Security Act (42 U.S.C. Sec. 1397 et seq.), the State Department of Social Services may provide family planning services pursuant to a purchase of services agreement with the department from funds appropriated for those services. The agreement shall authorize the Office of Family Planning to implement a sliding fee schedule for family planning services provided to clients pursuant to Title XX of the federal Social Security Act in accordance with Section 14501.5. (Amended by Stats. 2002, Ch. 641, Sec. 4. Effective January 1, 2003.)
  56. 14503.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    Certain family planning programs must give clients HIV/AIDS information materials and, as needed, referrals to testing, counseling, education, and support services.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14503.5. (a) As used in this section: (1) “AIDS” means acquired immune deficiency syndrome. (2) “Human immunodeficiency virus” or “HIV” means the etiologic virus of AIDS. (3) “HIV test” means “HIV test” as defined in Section 120775 of the Health and Safety Code. (b) The purpose of this article is to ensure that state-funded family planning programs offer AIDS information and referral services to their client population. (c) It is the intent of the Legislature that family planning clients learn how to prevent the transmission of HIV, and that they take steps to prevent its transmission. (d) For purposes of this section, “clients” shall include, but shall not be limited to, all of the following: (1) New clients to a family planning program. (2) Clients making annual visits to a family planning program. (3) Clients seeking pregnancy testing or family planning services. (4) Clients seeking diagnosis and treatment for sexually transmitted diseases. (e) Any family planning program that has a grant from the Office of Family Planning to provide family planning services shall do all of the following: (1) Provide brochures or other written materials to family planning clients that describe the high-risk conditions and behaviors for becoming infected with HIV and ways to prevent the transmission of HIV infection. To the maximum extent possible, the brochure or other written materials provided by any family planning program shall be culturally relevant and appropriate to the client populations served by the programs. (2) Provide, as needed, family planning clients with information about and referrals to local confidential or anonymous testing and counseling sites, AIDS education programs, and other supportive services. (f) Brochures and information required pursuant to subdivision (e) may be incorporated into existing information and health education programs provided by a family planning program. (g) The department shall make every effort to obtain brochures and other written materials from existing resources. Local family planning programs are encouraged to supplement the brochures with other available resources, to the extent that they deem necessary and appropriate. (Amended by Stats. 2002, Ch. 641, Sec. 5. Effective January 1, 2003.)
  57. 14504.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    The Male Involvement Program must continue within the Office of Family Planning and help local programs promote teen pregnancy prevention among adolescent boys and young men.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14504. (a) The Male Involvement Program shall be a continuing program within the Office of Family Planning with the goal of reducing teenage pregnancy through promoting primary prevention skills and motivation in adolescent boys and young men. In order to accomplish this goal, the program shall assist local programs to do all of the following: (1) Increase community and individual awareness regarding the importance of the roles and responsibilities of adolescent boys and young men in the reduction of teenage pregnancies. (2) Reinforce community values that support these roles and responsibilities. (3) Increase knowledge, skills, and motivation of at-risk adolescent boys and young adult men in order to actively promote their role in reducing teenage pregnancies. (b) Grants shall be made available to qualifying public or private nonprofit providers for implementation of the Male Involvement Program. (c) This section shall be implemented to the extent funding is made available through the federal government, or in the annual Budget Act or another state statute, or any combination of any sources of funding. (Amended by Stats. 2006, Ch. 538, Sec. 710. Effective January 1, 2007.)
  58. 14504.1.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    The Community Challenge Grants Program is a continuing program in the Office of Family Planning, and school-based programs with sexuality education must follow specified Education Code requirements.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14504.1. (a) The Community Challenge Grants Program shall be a continuing program within the Office of Family Planning with the goal of reducing the number of teenage pregnancies and teenage single parents, and promoting responsible parenting and the involvement of the biological father in economic, social, and emotional support of his children. (b) The program may target the following specific population groups: (1) Presexually active adolescents. (2) Sexually active adolescents. (3) Pregnant and parenting teens. (4) Parents and families. (5) Adults at risk for unwed motherhood or absentee fatherhood. (c) School-based programs that include sexuality education shall comply with the requirements of Section 51553 of the Education Code relative to the content of sex education courses, Section 51201.5 of the Education Code, which governs HIV/AIDS prevention, and Section 220 of the Education Code, which prohibits discrimination in schools based on sexual orientation. (d) Grants shall be made available to qualifying community-based nonprofit organizations and priority shall be given to those organizations with community-based partnerships that have developed effective local prevention programs. (e) This section shall be implemented to the extent funding is made available through the federal government, or in the annual Budget Act or another state statute, or any combination of any sources of funding. (Added by Stats. 2003, Ch. 643, Sec. 2. Effective January 1, 2004.)
  59. 14504.2.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    TeenSMART is a continuing program in the Office of Family Planning that must provide counseling and local outreach for teens at high risk of pregnancy, and grants are to be made available to qualified nonprofit providers to implement it.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14504.2. (a) The TeenSMART Program shall be a continuing program within the Office of Family Planning with the goal of reducing teenage pregnancies and reducing the incidence of sexually transmitted infections among sexually active teens through enhanced reproductive health care counseling, pregnancy prevention education, and sexually transmitted infection risk reduction efforts for adolescents accessing Family PACT TeenSMART clinics. (b) The services to be provided through TeenSMART shall include counseling services and outreach in local communities to assist teens who are at high risk of pregnancy to access clinical family planning services. Outreach activities may include, but are not limited to, establishing referral networks, providing information about clinic services to teens in either formal group presentations or small group education and counseling sessions, and one-on-one education and counseling sessions. (c) Grants shall be made available to qualified public or private nonprofit providers for implementation of the TeenSMART Program. (d) This section shall be implemented to the extent funding is made available through the federal government, or in the annual Budget Act or another state statute, or any combination of any sources of funding. (Added by Stats. 2003, Ch. 643, Sec. 3. Effective January 1, 2004.)
  60. 14504.3.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    The Information and Education Program must operate within the Office of Family Planning and focus on helping teens at risk of pregnancy, their parents, and other adults who serve them.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14504.3. (a) The Information and Education Program shall be a continuing program within the Office of Family Planning with the goal of decreasing teenage pregnancies through educational programs that equip teens at high risk for pregnancy with the knowledge, understanding, and behavioral skills necessary to make responsible decisions regarding at-risk behavior. (b) (1) The program shall target youths in a variety of settings, including, but not limited to, schools, juvenile justice facilities, community-based settings, social services and youth agencies, and foster care programs. (2) The program shall also focus on parents of high-risk youths and other adults responsible for serving youths at risk in an effort to assist them with effective tools for counseling at-risk youth regarding responsible behavior. (c) Priority for funding under this program shall be given to the following: (1) Programs that will increase youths’ knowledge and ability to deal responsibly with their own sexuality and the social pressures affecting them. (2) Programs that will enhance the ability of parents and other parenting adults to fulfill their roles as the primary sex educators of their children. (d) Grants shall be made available to qualified public or private nonprofit providers for implementation of the Information and Education Program. (e) This section shall be implemented to the extent funding is made available through the federal government, or in the annual Budget Act or another state statute, or any combination of any sources of funding. (Added by Stats. 2003, Ch. 643, Sec. 4. Effective January 1, 2004.)
  61. 14505.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

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    The State Department of Health Services and the State Department of Social Services take over certain family-planning claim duties from the Department of Benefit Payments, and the Director of Benefit Payments must make related funds available to them after appropriation or receipt.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14505. The State Department of Health Services succeeds to and is vested with the duties, purposes, responsibilities, and jurisdiction heretofore exercised by the Department of Benefit Payments with respect to the processing, audit, and payment of claims for family planning services under this part to the extent they are performed pursuant to the state plan under Title XIX of the federal Social Security Act (Medi-Cal). The State Department of Social Services succeeds to and is vested with the duties, purposes, responsibilities, and jurisdiction heretofore exercised by the Department of Benefit Payments with respect to the processing, audit, and payment of claims for family planning services under this part to the extent they are performed pursuant to the state plan under Title XX of the federal Social Security Act. Moneys, funds, and appropriations available to the Department of Benefit Payments for the purposes of this section shall be made available to the State Department of Health Services and to the State Department of Social Services by the Director of Benefit Payments for the purposes of this section after such moneys, funds, and appropriations have been appropriated to or received by the Department of Benefit Payments. (Added by renumbering Section 10053.5 by Stats. 1978, Ch. 432.)
  62. 14506.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    Two state departments must have possession and control of certain records, papers, equipment, and supplies tied to the Director of Benefit Payments and Section 14505.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14506. The State Department of Health Services shall have the possession and control of all records, papers, equipment, and supplies held for the benefit or use of the Director of Benefit Payments in the performance of his duties, powers, purposes, responsibilities, and jurisdiction that are vested in the State Department of Health Services by Section 14505. The State Department of Social Services shall have possession and control of all records, papers, equipment, and supplies held for the benefit or use of the Director of Benefit Payments in the performance of his duties, powers, purposes, responsibilities, and jurisdiction that are vested in the State Department of Social Services by Section 14505. (Added by renumbering Section 10053.6 by Stats. 1978, Ch. 432.)
  63. 14507.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    Certain non-temporary civil service officers and employees of the Director of Benefit Payments must be transferred to the State Department of Health Services.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14507. All officers and employees of the Director of Benefit Payments who on the operative date of this section are serving in the state civil service, other than as temporary employees, and engaged in the performance of a function vested in the State Department of Health Services by Section 14505 shall be transferred to the State Department of Health Services. The status, positions, and rights of such persons shall not be affected by the transfer and shall be retained by them as officers and employees of the State Department of Health Services pursuant to the State Civil Service Act, except as to positions exempt from civil service. (Added by renumbering Section 10053.7 by Stats. 1978, Ch. 432.)
  64. 14508.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    Eligible family planning service recipients must keep receiving services even if federal regulations change.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14508. It is the intent of the Legislature that all persons eligible for family planning services under Title IV-A of the Social Security Act and Title X of the U.S. Public Health Service Act on January 1, 1974, shall continue to be provided services notwithstanding changes in federal regulations. (Added by renumbering Section 10053.20 by Stats. 1978, Ch. 432.)
  65. 14509.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    The department must award family planning grants, and grant funds may not be used for abortions or services ancillary to abortions.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14509. (a) The department shall award grants to persons to provide family planning services pursuant to this chapter. (b) No funds received pursuant to grants awarded by the department pursuant to this chapter shall be used to perform abortions. (c) No funds received pursuant to grants awarded by the department pursuant to this chapter shall be used to fund services ancillary to abortions, including, but not limited to, postabortion examinations. Nothing in this chapter shall be construed to limit the provision of pregnancy testing and counseling as required by the Office of Family Planning on the effective date of this section. (d) Any person awarded a grant by the department pursuant to this chapter shall agree that during the term of the grant it will not be a group, clinic, or organization that, with funds provided pursuant to this chapter, advertises, advocates, or promotes abortion as a method of family planning, or that receives any fee or other consideration as payment for referrals for abortion services. Any person awarded a grant by the department pursuant to this chapter shall agree to the termination of the grant and to return all unexpended funds to the department that have been received from the department pursuant to that grant if the department finds that the grantee has violated this section. (Amended by Stats. 2002, Ch. 641, Sec. 6. Effective January 1, 2003.)
  66. 14509.1.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    Grantees must keep family planning records and accounts, make them available for examination, and retain them for specified periods. They must also arrange an independent audit.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14509.1. (a) A grantee shall maintain records and accounts, including property, personnel, and financial records, in a form, format, and content that ensures a proper accounting for all family planning funds received pursuant to this chapter. These records shall be made available for examination during normal business hours, and shall be retained at a location determined by the director for four years after the expiration of the grant, with the exception of patient medical records, which shall be retained for at least seven years. Records for nonexpendable personal property shall be retained for three years after final disposition. (b) A grantee shall arrange for an independent audit of the family planning program. The audit shall be done in accordance with department directives and with generally accepted accounting principles for nonprofit corporations and governmental entities. (Amended by Stats. 2002, Ch. 641, Sec. 7. Effective January 1, 2003.)
  67. 1451.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 1. General Provisions [1450 - 1451] ( Article 1 added by Stats. 2018, Ch. 36, Sec. 33. )

    Verify source ↗

    This section defines “Board,” “High rate,” and “Trauma-informed” for use in Article 3 starting at Section 1454.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 1. General Provisions [1450 - 1451] ( Article 1 added by Stats. 2018, Ch. 36, Sec. 33. ) ## 1451. For purposes of Article 3 (commencing with Section 1454), the following definitions apply: (a) “Board” means the Board of State and Community Corrections. (b) “High rate” means a rate that exceeds the state average. (c) “Trauma-informed” means an approach that involves an understanding of adverse childhood experiences and responding to symptoms of chronic interpersonal trauma and traumatic stress across the lifespan of an individual. (Amended by Stats. 2019, Ch. 584, Sec. 2. (AB 1454) Effective January 1, 2020.)
  68. 14510.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    The department must put chapter requirements into grants, set up a copayment system, and require grantees to get client signatures confirming income eligibility. People with documented family income at or below 100% of the federal poverty level cannot be charged copayments.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14510. (a) The department shall include provisions in grants with all grantees that explicitly describe the requirements and restrictions of this chapter. (b) The department shall establish a copayment system for services provided pursuant to this chapter. No person whose documented family income is at or below 100 percent of the federal poverty level shall be subject to copayments. (c) The department shall require a grantee to obtain the signature of clients receiving services pursuant to this chapter on a document that, under penalty of perjury, acknowledges that the client meets and complies with the income eligibility requirements of this chapter. (Amended by Stats. 2002, Ch. 641, Sec. 8. Effective January 1, 2003.)
  69. 14511.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    If Division 24 is repealed, the statewide program for comprehensive clinical family planning services remains operative and the State Department of Health Services must administer it.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14511. Notwithstanding any other provision of law, on and after the effective date of any repeal of Division 24 (commencing with Section 24000) of the Welfare and Institutions Code, the general statewide program for the provision of comprehensive clinical family planning services as referenced in this chapter shall be deemed to be operative in all respects, and the State Department of Health Services shall administer the program accordingly. It is the intent of the Legislature that appropriate funding be made available at that time for the general statewide program for the provision of comprehensive clinical family planning services as set forth in this chapter through the annual budget process. (Added by Stats. 1996, Ch. 197, Sec. 49. Effective July 22, 1996.)
  70. 14512.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. )

    Verify source ↗

    The Office of Family Planning must competitively award all grants for direct services under this chapter.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.5. Family Planning [14500 - 14512] ( Heading of Chapter 8.5 renumbered from Chapter 8 (as added by Stats. 1973, Ch. 1213) by Stats. 1977, Ch. 579. ) ## 14512. It is the intent of the Legislature that all grants for the provision of direct services entered into by the Office of Family Planning under this chapter shall be competitively awarded. (Amended by Stats. 2002, Ch. 641, Sec. 9. Effective January 1, 2003.)
  71. 1452.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 2. Trauma-Informed Diversion Programs for Indian Children [1452 - 1453] ( Article 2 added by Stats. 2018, Ch. 36, Sec. 33. )

    Verify source ↗

    For this article, “Indian child” and “Indian tribe” mean the same as in Section 224.1.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 2. Trauma-Informed Diversion Programs for Indian Children [1452 - 1453] ( Article 2 added by Stats. 2018, Ch. 36, Sec. 33. ) ## 1452. For purposes of this article, “Indian child” and “Indian tribe” shall have the same meaning as provided in Section 224.1. (Added by Stats. 2018, Ch. 36, Sec. 33. (AB 1812) Effective June 27, 2018.)
  72. 14520.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 1. General Provisions [14520 - 14522.4] ( Article 1 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    This chapter may be cited as the Adult Day Health Medi-Cal Law.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 1. General Provisions [14520 - 14522.4] ( Article 1 added by Stats. 1977, Ch. 1066. ) ## 14520. This chapter shall be known and may be cited as the Adult Day Health Medi-Cal Law. (Added by Stats. 1977, Ch. 1066.)
  73. 14521.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 1. General Provisions [14520 - 14522.4] ( Article 1 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    The Legislature states that this chapter is intended to establish adult day health care as a Medi-Cal benefit and to let eligible persons with medical or psychiatric impairments receive adult day health care services.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 1. General Provisions [14520 - 14522.4] ( Article 1 added by Stats. 1977, Ch. 1066. ) ## 14521. It is the intent of the Legislature in enacting this chapter to establish adult day health care as a Medi-Cal benefit and allow persons eligible to receive the benefits under Chapter 7 (commencing with Section 14000) of this part, and who have medical or psychiatric impairments, to receive adult day health care services. It is the intent of the Legislature in authorizing this Medi-Cal benefit to establish and continue a community-based system of quality adult day health care services that will accomplish all of the following: (a) Ensure that elderly persons and adults with disabilities will not be institutionalized prematurely and inappropriately. (b) Provide appropriate health and social services designed to maintain elderly persons in their own communities. (c) Establish adult day health care centers in locations easily accessible to persons who are economically disadvantaged. (d) Encourage the establishment of rural alternative adult day health care centers that are designed to make adult day health care accessible to elderly persons and adults with disabilities living in rural areas. (Amended by Stats. 2008, Ch. 648, Sec. 7. Effective January 1, 2009.)
  74. 14521.1.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 1. General Provisions [14520 - 14522.4] ( Article 1 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    If existing regulations conflict with adult day health care laws in effect on or after January 1, 2007, the department must issue guidance to adult day health care providers through provider bulletins until new regulations are adopted.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 1. General Provisions [14520 - 14522.4] ( Article 1 added by Stats. 1977, Ch. 1066. ) ## 14521.1. If a conflict exists between existing regulations and adult day health care laws in effect on and after January 1, 2007, the department shall, until new regulations are adopted, issue guidance to adult day health care providers through provider bulletins to clarify the adult day health care laws and regulations that are in effect. (Amended by Stats. 2012, Ch. 728, Sec. 208. (SB 71) Effective January 1, 2013.)
  75. 14522.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 1. General Provisions [14520 - 14522.4] ( Article 1 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    This section says certain definitions from other code provisions control how this chapter is interpreted, unless the context requires otherwise.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 1. General Provisions [14520 - 14522.4] ( Article 1 added by Stats. 1977, Ch. 1066. ) ## 14522. Unless the context otherwise requires, the definitions contained in Part 7 (commencing with Section 14000) of this part and in Chapter 3.5 (commencing with Section 1570) of Division 2 of the Health and Safety Code shall govern the construction of this chapter. (Added by Stats. 1977, Ch. 1066.)
  76. 14522.3.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 1. General Provisions [14520 - 14522.4] ( Article 1 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    This section defines key terms used in the chapter on adult day health care programs.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 1. General Provisions [14520 - 14522.4] ( Article 1 added by Stats. 1977, Ch. 1066. ) ## 14522.3. The following definitions shall apply for the purposes of this chapter: (a) “Activities of daily living” (ADL) means activities performed by the participant for essential living purposes, including bathing, dressing, self-feeding, toileting, ambulation, and transferring. (b) “Instrumental activities of daily living” (IADL) means functions or tasks of independent living, including hygiene, medication management, transportation, money management, shopping, meal preparation, laundry, accessing resources, and housework. (c) “Personal health care provider” means the participant’s personal physician, physician’s assistant, or nurse practitioner, operating within his or her scope of practice. (d) “Care coordination” means the process of obtaining information from, or providing information to, the participant, the participant’s family, the participant’s primary health care provider, or social services agencies to facilitate the delivery of services designed to meet the needs of the participant, as identified by one or more members of the multidisciplinary team. (e) “Facilitated participation” means an interaction to support a participant’s involvement in a group or individual activity, whether or not the participant takes active part in the activity itself. (f) “Group work” means a social work service in which a variety of therapeutic methods are applied within a small group setting to promote participants’ self-expression and positive adaptation to their environment. (g) “Professional nursing” means services provided by a registered nurse or licensed vocational nurse functioning within his or her scope of practice. (h) “Psychosocial” means a participant’s psychological status in relation to the participant’s social and physical environment. (Added by Stats. 2006, Ch. 691, Sec. 2. Effective January 1, 2007. Repealed as of date prescribed in Section 14522.4. After repeal, see related provisions in Section 14522.4.)
  77. 14522.4.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 1. General Provisions [14520 - 14522.4] ( Article 1 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    This section defines terms used in adult day health care programs and states when the section becomes operative.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 1. General Provisions [14520 - 14522.4] ( Article 1 added by Stats. 1977, Ch. 1066. ) ## 14522.4. (a) The following definitions shall apply for the purposes of this chapter: (1) “Activities of daily living (ADL)” means activities performed by the participant for essential living purposes, including bathing, dressing, self-feeding, toileting, ambulation, and transferring. (2) “Instrumental activities of daily living (IADL)” means functions or tasks of independent living limited to hygiene and medication management. (3) “Personal health care provider” means the participant’s personal physician, physician’s assistant, or nurse practitioner, operating within his or her scope of practice. (4) “Care coordination” means the process of obtaining information from, or providing information to, the participant, the participant’s family, the participant’s personal health care provider, or social services agencies to facilitate the delivery of services designed to meet the needs of the participant, as identified by one or more members of the multidisciplinary team. (5) “Facilitated participation” means an interaction to support a participant’s involvement in a group or individual activity, whether or not the participant takes active part in the activity itself. (6) “Group work” means a social work service in which a variety of therapeutic methods are applied within a small group setting to promote participants’ self-expression and positive adaptation to their environment. (7) “Professional nursing” means services provided by a registered nurse or licensed vocational nurse functioning within his or her scope of practice. (8) “Psychosocial” means a participant’s psychological status in relation to the participant’s social and physical environment. (9) “Assistance” means verbal or physical prompting or aid, including cueing, supervision, stand-by assistance, or hands-on support to complete the task correctly. (10) “Substantial human assistance” means direct, hands-on assistance provided by a qualified caregiver, which entails physically helping the participant perform the essential elements of the ADLs and IADLs. It entails more than cueing, supervision, or stand-by assistance to perform the ADLs and IADLs. It also includes the performance of the entire ADL or IADL for participants totally dependent on human assistance. (11) “Cognitive impairment” means the loss or deterioration of intellectual capacity characterized by impairments in short- or long-term memory, language, concentration and attention, orientation to people, place, or time, visual-spatial abilities or executive functions, or both, including, but not limited to, judgment, reasoning, or the ability to inhibit behaviors that interfere with social, occupational, or everyday functioning due to conditions, including, but not limited to, mild cognitive impairment, Alzheimer’s disease or other form of dementia, or brain injury. (b) Upon the date of execution of the declaration described under subdivision (g) of Section 14525.1, this section shall become operative and Section 14522.3 shall become inoperative and on that date is repealed. (Amended by Stats. 2010, Ch. 328, Sec. 255. (SB 1330) Effective January 1, 2011. Section operative on date prescribed in subd. (b).)
  78. 14525.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    Adults who qualify for Chapter 7 benefits are eligible for adult day health care services if they meet the listed medical, functional, supervision, and service-need criteria.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. ) ## 14525. Any adult eligible for benefits under Chapter 7 (commencing with Section 14000) shall be eligible for adult day health care services if that person meets all of the following criteria: (a) The person is 18 years of age or older and has one or more chronic or postacute medical, cognitive, or mental health conditions, and a physician, nurse practitioner, or other health care provider has, within his or her scope of practice, requested adult day health care services for the person. (b) The person has functional impairments in two or more activities of daily living, instrumental activities of daily living, or one or more of each, and requires assistance or supervision in performing these activities. (c) The person requires ongoing or intermittent protective supervision, skilled observation, assessment, or intervention by a skilled health or mental health professional to improve, stabilize, maintain, or minimize deterioration of the medical, cognitive, or mental health condition. (d) The person requires adult day health care services, as defined in Section 14550, that are individualized and planned, including, when necessary, the coordination of formal and informal services outside of the adult day health care program to support the individual and his or her family or caregiver in the living arrangement of his or her choice and to avoid or delay the use of institutional services, including, but not limited to, hospital emergency department services, inpatient acute care hospital services, inpatient mental health services, or placement in a nursing facility or a nursing or intermediate care facility for the developmentally disabled providing continuous nursing care. (e) Notwithstanding the criteria established in subdivisions (a) to (d), inclusive, of this section, any person who is a resident of an intermediate care facility for the developmentally disabled-habilitative shall be eligible for adult day health care services if that resident has disabilities and a level of functioning that are of such a nature that, without supplemental intervention through adult day health care, placement to a more costly institutional level of care would be likely to occur. (Repealed and added by Stats. 2006, Ch. 691, Sec. 4. Effective January 1, 2007. Note: Section 14525.1, in subd. (g), prescribes conditions for possible inoperation of this section.)
  79. 14525.1.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    This section makes certain people eligible for adult day health care services if they meet listed medical, functional, and care-needs criteria.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. ) ## 14525.1. (a) Except as provided in subdivisions (b) and (c), any adult eligible for benefits under Chapter 7 (commencing with Section 14000) shall be eligible for adult day health care services if that person meets all of the following criteria: (1) The person is 18 years of age or older and has one or more chronic or postacute medical, cognitive, or mental health conditions, and a physician, nurse practitioner, or other health care provider has, within his or her scope of practice, requested adult day health care services for the person. (2) The person has two or more functional impairments involving ambulation, bathing, dressing, self-feeding, toileting, transferring, medication management, and hygiene. (3) (A) Except as provided under subparagraph (B), the person requires substantial human assistance in performing these activities. (B) The persons described in subdivisions (b) and (c) shall only require assistance in performing these activities. (4) The person requires ongoing or intermittent protective supervision, assessment, or intervention by a skilled health or mental health professional to improve, stabilize, maintain, or minimize deterioration of the medical, cognitive, or mental health condition. (5) The person requires adult day health care services, as defined in Section 14550, that are individualized and planned, including, when necessary, the coordination of formal and informal services outside of the adult day health care program to support the individual and his or her family or caregiver in the living arrangement of his or her choice and to avoid or delay the use of institutional services, including, but not limited to, hospital emergency department services, inpatient acute care hospital services, inpatient mental health services, or placement in a nursing facility or a nursing or intermediate care facility for the developmentally disabled providing continuous nursing care. (6) The person meets the level of care set forth in Section 51120 of Title 22 of the California Code of Regulations. (b) A resident of an intermediate care facility for the developmentally disabled-habilitative shall be eligible for adult day health care services if that resident meets the criteria set forth in paragraphs (1) to (5), inclusive, of subdivision (a) and has disabilities and a level of functioning that are of such a nature that, without supplemental intervention through adult day health care, placement to a more costly institutional level of care would be likely to occur. (c) Persons having chronic mental illness or moderate to severe Alzheimer’s disease or other cognitive impairments shall be eligible for adult day health care services if they meet the criteria established in paragraphs (1) to (5), inclusive, of subdivision (a). (d) This section shall only be implemented to the extent permitted by federal law. (e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement the provisions of this section by means of all-county letters, provider bulletins, or similar instructions without taking further regulatory action. (f) Prior to implementing this section, the department shall meet and confer with provider representatives, including, but not limited to, adult day health care, home- and community-based services, and nursing facilities for the purpose of presenting and discussing information and evidence to assist the department as it determines the methods and procedures necessary to implement this section. (g) Upon the determination of the director that all necessary methods and procedures described in subdivision (f) have been ascertained and are sufficient to implement the purposes of this section, the director shall execute and retain a declaration indicating that this determination has been made. Subdivisions (a) to (e), inclusive, shall be inoperative, until the date of execution of the declaration. Upon the date of execution of such a declaration, subdivisions (a) to (e), inclusive of this section shall become operative and Section 14525 shall become inoperative. (Amended by Stats. 2009, Ch. 165, Sec. 1. (SB 117) Effective January 1, 2010. Subds. (a) to (e) are nonoperative as provided in subd. (g).)
  80. 14526.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. )

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    A provider must start the authorization request for adult day health care program participation, and the request must include the provider team’s screening results and the individualized plan of care.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. ) ## 14526. Participation in an adult day health care program shall require prior authorization by the department. The authorization request shall be initiated by the provider and shall include the results of the assessment screening conducted by the provider’s multidisciplinary team and the resulting individualized plan of care. Participation shall begin upon application by the prospective participant or upon referral from community or health agencies, or the physician, hospital, family, or friends of a potential participant. (Amended by Stats. 2004, Ch. 797, Sec. 1. Effective January 1, 2005.)
  81. 14526.1.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. )

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    Adult day health care centers must start treatment authorization requests, and every six months must request an updated history and physical form. The department may inspect records and observe care when checking medical necessity, and certain authorizations are granted only if listed criteria are met.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. ) ## 14526.1. (a) Initial and subsequent treatment authorization requests may be granted for up to six calendar months. (b) Treatment authorization requests shall be initiated by the adult day health care center, and shall include all of the following: (1) The signature page of the history and physical form that shall serve to document the request for adult day health care services. A complete history and physical form, including a request for adult day health care services signed by the participant’s personal health care provider, shall be maintained in the participant’s health record. This history and physical form shall be developed by the department and published in the inpatient/outpatient provider manual. The department shall develop this form jointly with the statewide association representing adult day health care providers. (2) The participant’s individual plan of care, pursuant to Section 54211 of Title 22 of the California Code of Regulations. (c) Every six months, the adult day health care center shall initiate a request for an updated history and physical form from the participant’s personal health care provider using a standard update form that shall be maintained in the participant’s health record. This update form shall be developed by the department for that use and shall be published in the inpatient/outpatient provider manual. The department shall develop this form jointly with the statewide association representing adult day health care providers. (d) Except for participants residing in an intermediate care facility/developmentally disabled-habilitative, authorization or reauthorization of an adult day health care treatment authorization request shall be granted only if the participant meets all of the following medical necessity criteria: (1) The participant has one or more chronic or post acute medical, cognitive, or mental health conditions that are identified by the participant’s personal health care provider as requiring one or more of the following, without which the participant’s condition will likely deteriorate and require emergency department visits, hospitalization, or other institutionalization: (A) Monitoring. (B) Treatment. (C) Intervention. (2) The participant has a condition or conditions resulting in both of the following: (A) Limitations in the performance of two or more activities of daily living or instrumental activities of daily living, as those terms are defined in Section 14522.3, or one or more from each category. (B) A need for assistance or supervision in performing the activities identified in subparagraph (A) as related to the condition or conditions specified in paragraph (1) of subdivision (d). That assistance or supervision shall be in addition to any other nonadult day health care support the participant is currently receiving in his or her place of residence. (3) The participant’s network of non-adult day health care center supports is insufficient to maintain the individual in the community, demonstrated by at least one of the following: (A) The participant lives alone and has no family or caregivers available to provide sufficient and necessary care or supervision. (B) The participant resides with one or more related or unrelated individuals, but they are unwilling or unable to provide sufficient and necessary care or supervision to the participant. (C) The participant has family or caregivers available, but those individuals require respite in order to continue providing sufficient and necessary care or supervision to the participant. (4) A high potential exists for the deterioration of the participant’s medical, cognitive, or mental health condition or conditions in a manner likely to result in emergency department visits, hospitalization, or other institutionalization if adult day health care services are not provided. (5) The participant’s condition or conditions require adult day health care services specified in subdivisions (a) to (d), inclusive, of Section 14550.5, on each day of attendance, that are individualized and designed to maintain the ability of the participant to remain in the community and avoid emergency department visits, hospitalizations, or other institutionalization. (e) When determining whether a provider has demonstrated that a participant meets the medical necessity criteria, the department may enter an adult day health care center and review participants’ medical records and observe participants receiving care identified in the individual plan of care in addition to reviewing the information provided on or with the TAR. (f) Reauthorization of an adult day health care treatment authorization request shall be granted when the criteria specified in subdivision (d) or (g), as appropriate, have been met and the participant’s condition would likely deteriorate if the adult day health care services were denied. (g) For individuals residing in an intermediate care facility/developmentally disabled-habilitative, authorization or reauthorization of an adult day health care treatment authorization request shall be granted only if the resident has disabilities and a level of functioning that are of such a nature that, without supplemental intervention through adult day health care, placement to a more costly institutional level of care would be likely to occur. (h) Subdivision (e) shall become operative commencing on the first day of the month following 30 days after the effective date of the act adding this subdivision. (Amended by Stats. 2009, Ch. 165, Sec. 2. (SB 117) Effective January 1, 2010. Repealed on date prescribed in Section 14526.2. After repeal, see related provisions in Section 14526.2.)
  82. 14526.2.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    Adult day health care centers must start treatment authorization requests and submit required medical forms; the department can grant authorizations only when medical-necessity criteria are met.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. ) ## 14526.2. (a) Initial and subsequent treatment authorization requests may be granted for up to six calendar months, initial and subsequent treatment authorization requests may, at the discretion of the department, be granted for up to 12 calendar months. (b) Treatment authorization requests shall be initiated by the adult day health care center, and shall include all of the following: (1) A complete history and physical form, including a request for adult day health care services signed by the participant’s personal health care provider shall be obtained annually. A copy of the history and physical form shall be submitted with an initial treatment authorization request and maintained in the participant’s health record. This history and physical form shall be developed by the department and published in the inpatient/outpatient provider manual. (2) The participant’s individual plan of care, pursuant to Section 54211 of Title 22 of the California Code of Regulations. (c) Whenever a subsequent treatment authorization request is submitted, the adult day health care center shall obtain and submit an updated history and physical form from the participant’s personal health care provider using a standard update form that shall be maintained in the participant’s health record. This update form shall be developed by the department for that use and shall be published in the inpatient/outpatient provider manual. (d) Authorization or reauthorization of an adult day health care treatment authorization request shall be granted only if the participant meets all of the following medical necessity criteria: (1) The participant has one or more chronic or post acute medical, cognitive, or mental health conditions that are identified by the participant’s personal health care provider as requiring one or more of the following, without which the participant’s condition will likely deteriorate and require emergency department visits, hospitalization, or other institutionalization: (A) Assessment and monitoring. (B) Treatment. (C) Intervention. (2) The participant has a condition or conditions resulting in both of the following: (A) Two or more functional impairments involving ambulation, bathing, dressing, self-feeding, toileting, transferring, medication management, and hygiene. (B) As set forth in subparagraph (A) and (B) of paragraph (3) of subdivision (a) of Section 14525.1, the need for assistance or substantial human assistance in performing the activities identified in subparagraph (A) as related to the condition or conditions specified in paragraph (1). That assistance or substantial human assistance shall be in addition to any other nonadult day health care support the participant is currently receiving in his or her place of residence. (3) Except for participants residing in an intermediate care facility/developmentally disabled-habilitative, the participant’s network of nonadult day health care center supports is insufficient to maintain the individual in the community, demonstrated by at least one of the following: (A) The participant lives alone and has no family or caregivers available to provide sufficient and necessary care or supervision. (B) The participant resides with one or more related or unrelated individuals, but they are unwilling or unable to provide sufficient and necessary care or supervision to the participant. (4) A high potential exists for the deterioration of the participant’s medical, cognitive, or mental health condition or conditions in a manner likely to result in emergency department visits, hospitalization, or other institutionalization if adult day health care services are not provided. (5) The participant’s condition or conditions require adult day health care services specified in subdivisions (a) to (d), inclusive, of Section 14550.6, on each day of attendance, that are individualized and designed to maintain the ability of the participant to remain in the community and avoid emergency department visits, hospitalizations, or other institutionalization. (e) When determining whether a provider has demonstrated that a participant meets the medical necessity criteria, the department may enter an adult day health care center and review participants’ medical records and observe participants receiving care identified in the individual plan of care in addition to reviewing the information provided on or with the TAR. (f) Reauthorization of an adult day health care treatment authorization request shall be granted when the criteria specified in subdivision (d) or (g), as appropriate, have been met and the participant’s condition would likely deteriorate if the adult day health care services were denied. (g) For individuals residing in an intermediate care facility/developmentally disabled-habilitative, authorization or reauthorization of an adult day health care treatment authorization request shall be granted only if the resident has disabilities and a level of functioning that are of such a nature that, without supplemental intervention through adult day health care, placement to a more costly institutional level of care would be likely to occur. (h) This section shall only be implemented to the extent permitted by federal law. (i) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement the provisions of this section by means of all-county letters, provider bulletins, or similar instructions without taking further regulatory action. (j) Upon the date of execution of the declaration described under subdivision (g) of Section 14525.1, this section shall become operative and Section 14526.1 shall become inoperative and on that date is repealed. (Added by Stats. 2009, 4th Ex. Sess., Ch. 5, Sec. 55. Effective July 28, 2009. Section conditionally operative on date prescribed in subd. (j). After repeal, see related provisions in Section 14526.2.)
  83. 14527.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. )

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    Participation in an adult day health care program is voluntary, and participants may stop at any time.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. ) ## 14527. Participation in an adult day health care program shall be voluntary. The participant may end the participation at any time. However, an adult day health center shall not otherwise terminate the provision of adult day health services to any participant unless approved by the state department. No provider may employ, or contract for, persons specifically for the sole purpose of solicitation of eligible participants. A provider shall not use false advertising or false statements to induce participants. No solicitation of participants shall include the granting or offering of any monetary or other valuable consideration for participation. All informational material for potential participants prepared by the provider shall have the prior approval of the department. (Added by Stats. 1977, Ch. 1066.)
  84. 14528.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. )

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    Adult day health providers must conduct a multidisciplinary assessment before accepting someone into the program.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. ) ## 14528. Before acceptance into the program, all adult day health providers shall conduct a multidisciplinary assessment directed towards ascertaining the individual’s pathological diagnosis, physical disability, functional ability, psychological status, and social and physical environment. (Added by Stats. 1977, Ch. 1066.)
  85. 14528.1.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. )

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    This section assigns responsibility for a participant’s medical care to the personal health care provider and requires the adult day health care center to help the participant establish that provider relationship.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. ) ## 14528.1. (a) The personal health care provider, as defined in Section 14552.3, shall have and retain responsibility for the participant’s medical care. (b) If the participant does not have a personal health care provider during the initial assessment process to determine eligibility for adult day health care, the adult day health care center staff physician may conduct the initial history and physical for the participant. (c) The adult day health care center shall make all reasonable efforts to assist the participant in establishing a relationship with a personal health care provider. (d) If the adult day health care center is unable to locate a personal health care provider for the participant, or if the participant refuses to establish a relationship with a personal health care provider, the adult day health care center shall do both of the following: (1) Document the lack of personal health care provider relationship in the participant’s health record. (2) Continue to document all efforts taken to assist the participant in establishing a relationship with a personal health care provider. (e) (1) A personal physician for one or more of an adult day health care center’s enrolled participants may serve as the adult day health care staff physician. (2) When a personal physician serves as the staff physician, the physician shall have a personal care services arrangement with the adult day health care center that meets the criteria set forth in Section 1395nn(e)(3)(A) of Title 42 of the United States Code. (3) A personal care physician, an adult day health care staff physician, or an immediate family member of the personal care physician or adult day health care staff physician, shall comply with ownership interest restrictions as provided under Section 654.2 of the Business and Professions Code. (Amended by Stats. 2008, Ch. 648, Sec. 9. Effective January 1, 2009.)
  86. 14529.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. )

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    Adult day health care assessment teams must include specified members, perform an initial assessment, reassess care plans at least twice a year, and provide or develop follow-up therapy or maintenance services when needed.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. ) ## 14529. (a) The multidisciplinary health team conducting an assessment shall consist of at least the individual’s personal physician or a staff physician, or both, a registered nurse, and a social worker. (b) For the initial assessment, the multidisciplinary health team shall also include a physical therapist and an occupational therapist. In addition, when the need is identified by a physician or nurse, qualified consultants with skills in recreational therapy, speech language pathology, or dietary assessment shall serve as team members. (c) The multidisciplinary team described in subdivision (b) shall conduct an initial assessment. At the time of reassessment, if an individual plan of care has been developed by the physical therapist or the occupational therapist, they shall reassess the participant to determine any ongoing or different needs for physical therapy or occupational therapy services. If it is determined that no further physical therapy or occupational therapy is needed, the physical therapist and the occupational therapist shall not be required to sign the treatment plan. For further reassessments, the nurse or physician shall determine if the physical therapist or occupational therapist is needed. (d) The assessment team shall: (1) Determine the medical, psychosocial, and functional status of each participant. (2) Develop an individualized plan of care, including goals, objectives, and services designed to meet the needs of the person, which shall be signed by each member of the multidisciplinary team, except that the signature of only one physician member of the team shall be required. (3) At least biannually reassess the participant’s individualized plan care and make any necessary adjustments to the plan. (4) If the initial assessment or any subsequent reassessment shows that restorative therapy is needed, acute rehabilitative treatment shall be provided by the appropriate licensed or certified personnel. (5) If the initial assessment or any subsequent reassessment shows that restorative therapy is not needed, the multidisciplinary team shall determine whether the participant requires maintenance program services and if the team finds that the participant requires these services, the multidisciplinary team shall develop an individual maintenance program as part of the plan of care. (Amended by Stats. 1991, Ch. 985, Sec. 5.)
  87. 1453.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 2. Trauma-Informed Diversion Programs for Indian Children [1452 - 1453] ( Article 2 added by Stats. 2018, Ch. 36, Sec. 33. )

    Verify source ↗

    The board must reserve 3% of Youth Reinvestment Grant Program funds for Indian tribes, through an application process, once funds are appropriated. Priority goes to diversion programs for Indian children with specified high-need indicators. Indian tribes may apply on a regional basis and may receive the aggregate funds they would have received as separate jurisdictions.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 2. Trauma-Informed Diversion Programs for Indian Children [1452 - 1453] ( Article 2 added by Stats. 2018, Ch. 36, Sec. 33. ) ## 1453. (a) The board shall allocate 3 percent of funds for the Youth Reinvestment Grant Program, upon appropriation of funds pursuant to Section 1450, to Indian tribes through an application process for the purpose of implementing diversion programs for Indian children that use trauma-informed, community-based, and health-based interventions. (b) Funding priority shall be given to diversion programs that address the needs of Indian children who experience the following: (1) High rates of juvenile arrests. (2) High rates of suicide. (3) High rates of alcohol and substance abuse. (4) Average high school graduation rates that are lower than 75 percent. (c) Indian tribes may apply for funding under this article on a regional efforts basis and receive the aggregate amount of funds that they would have received if awarded as independent jurisdictions. (Added by Stats. 2018, Ch. 36, Sec. 33. (AB 1812) Effective June 27, 2018.)
  88. 14530.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    Providers must give participants a written service statement, and the statement must be signed and kept in the participant’s file.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 2. Eligibility, Participation, and Discharge [14525 - 14530] ( Article 2 added by Stats. 1977, Ch. 1066. ) ## 14530. (a) Individual plans of care shall be submitted to the department. Services for each participant shall be provided as specified in the individual plan of care approved pursuant to Section 14526. (b) Individual monthly service reports shall be submitted to the department. (c) Each provider shall supply a written statement to the participant explaining what services will be provided and specifying the scheduled days of attendance. This statement, which shall be known as the participation agreement, shall be signed by the participant and a provider representative and retained in the participant’s file. (Amended by Stats. 2001, Ch. 681, Sec. 14. Effective January 1, 2002.)
  89. 1454.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 3. Trauma-Informed Diversion Programs for Minors [1454 - 1455] ( Article 3 added by Stats. 2018, Ch. 36, Sec. 33. )

    Verify source ↗

    The board must allocate and distribute Youth Reinvestment Grant Program funds to local jurisdictions, and recipients must meet grant, match, and service-provider conditions.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 3. Trauma-Informed Diversion Programs for Minors [1454 - 1455] ( Article 3 added by Stats. 2018, Ch. 36, Sec. 33. ) ## 1454. (a) The board shall allocate 94 percent of funds for the Youth Reinvestment Grant Program, upon appropriation of funds pursuant to Section 1450, to local jurisdictions, including a county, city, or city and county, through a competitive grant process for the purpose of implementing trauma-informed diversion programs for minors. (b) The board shall distribute a grant under this article pursuant to all of the following conditions: (1) A local jurisdiction shall be awarded no less than fifty thousand dollars ($50,000) and no more than one million dollars ($1,000,000). (2) (A) A local jurisdiction shall provide at least a 25-percent match to the grant that it receives pursuant to this article. Funds used to provide the 25-percent match amount may include a combination of federal, other state, local, or private funds. (B) Notwithstanding subparagraph (A), a local jurisdiction may provide less than a 25-percent match, but at least a 10-percent match, to the grant if the local jurisdiction is identified by the board as high need with low or no local infrastructure for diversion programming. (3) (A) Ten percent of the funds shall be distributed to a lead public agency to coordinate with local law enforcement agencies, social services agencies, and nonprofit organizations on implementation of diversion programs and alternatives to incarceration and involvement with the juvenile justice system. (B) Ninety percent of the funds shall pass through the lead public agency to community-based organizations, that are nongovernmental and not local law enforcement agencies, to deliver services in underserved communities with high rates of juvenile arrests. (4) Highest need is identified based on both of the following: (A) Jurisdictions with high rates of juvenile arrests for misdemeanors and status offenses. (B) Jurisdictions with racial or ethnic disparities on the basis of disproportionately high rates of juvenile arrests. (5) (A) Services shall be community based, located in communities of local jurisdictions with the highest need. (B) Services shall be evidence based or research supported, trauma informed, culturally relevant, and developmentally appropriate. (C) Direct service providers who receive funding from a grant pursuant to this article shall be nongovernmental and not law enforcement or probation entities. (D) Direct service providers shall have experience effectively serving at-risk youth populations. (E) Services shall include all of the following: (i) Diversion programs and alternatives to arrest, incarceration, and formal involvement with the juvenile justice system. (ii) Educational services, including academic and vocational services. (iii) Mentoring services. (iv) Behavioral health services. (v) Mental health services. (c) Local jurisdictions may apply for funding under this article on a regional efforts basis and receive the aggregate amount of funds that they would have received if awarded as independent jurisdictions. (Amended by Stats. 2019, Ch. 497, Sec. 299. (AB 991) Effective January 1, 2020.)
  90. 1455.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 3. Trauma-Informed Diversion Programs for Minors [1454 - 1455] ( Article 3 added by Stats. 2018, Ch. 36, Sec. 33. )

    Verify source ↗

    The board must oversee and administer the grant program and perform specified support, tracking, funding, reporting, and evaluation duties.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 3. Trauma-Informed Diversion Programs for Minors [1454 - 1455] ( Article 3 added by Stats. 2018, Ch. 36, Sec. 33. ) ## 1455. (a) The board shall be responsible for administration oversight and accountability of the grant program under this article, in coordination with the California Health and Human Services Agency and the State Department of Education. (b) The board, in collaboration with partner agencies, shall perform all of the following duties: (1) Provide guidance to applicant and recipient local jurisdictions, including guidance regarding available federal, state, and local funds for the purposes of braiding and matching funds. (2) Support data collection and analysis to identify and target jurisdictions with the highest need and to measure program outcomes and impacts. (3) Track funding allocations and disbursements in accordance with the applicant’s proposed plans. (4) (A) Secure or set aside sufficient funds to contract with a research firm or university to conduct a statewide evaluation of the grant program and its outcomes over a three-year grant period. (B) The board shall make available on its Internet Web site a report of grantees, projects, and outcomes at the state and local levels upon completion of the three-year period. (C) The board and collaborating agencies shall assist the research firm or university by providing relevant, existing data for the purposes of tracking outcomes. Measures may include, but are not limited to, any of the following: (i) Reductions in law enforcement responses to minors for low-level offenses, court caseloads and processing, days the minors spend in detention, placement of minors in congregate care, school and placement disruptions, and facility staff turnover. (ii) Improvement in the health and well-being of the minors, school and community stability, educational attainment, and employment opportunities. (iii) Projected state and local cost savings as a result of the diversion programming. (Added by Stats. 2018, Ch. 36, Sec. 33. (AB 1812) Effective June 27, 2018.)
  91. 14550.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    Adult day health care centers must provide specified onsite services, including rehabilitation, medical, nursing, nutrition, psychiatric or psychological, social work, recreation, transportation, and emergency policies.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. ) ## 14550. Adult day health care centers shall offer, and shall provide directly on the premises, at least the following services: (a) Rehabilitation services, including the following: (1) Occupational therapy as an adjunct to treatment designed to restore impaired function of patients with physical or mental limitations. (2) Physical therapy appropriate to meet the needs of the patient. (3) Speech therapy for participants with speech or language disorders. (b) Medical services supervised by either the participant’s personal physician or a staff physician, or both, which emphasize prevention treatment, rehabilitation, and continuity of care and also provide for maintenance of adequate medical records. To the extent otherwise permitted by law, medical services may be provided by nurse practitioners, as defined in Section 2835 of the Business and Professions Code, operating within the existing scope of practice, or under standardized procedures pursuant to Section 2725 of the Business and Professions Code, or by registered nurses practicing under standardized procedures pursuant to Section 2725 of the Business and Professions Code. (c) Nursing services, including the following: (1) Nursing services rendered by a professional nursing staff, who periodically evaluate the particular nursing needs of each participant and provide the care and treatment that is indicated. (2) Self-care services oriented toward activities of daily living and personal hygiene, such as toileting, bathing, and grooming. (d) Nutrition services, including the following: (1) The program shall provide a minimum of one meal per day which is of suitable quality and quantity as to supply at least one-third of the daily nutritional requirement, unless the participant declines the meal or medical contraindications exist, as documented in the participant’s health record, that prohibit the ingestion of the meal at the adult day health care center. Additionally, special diets and supplemental feedings shall be available if indicated. (2) Dietary counseling and nutrition education for the participant and his or her family shall be a required adjunct of such service. Dietary counseling and nutrition education may be provided by a professional registered nurse, unless the participant is receiving a special diet prescribed by a physician, or a nurse determines that the services of a registered dietician are necessary. (e) Psychiatric or psychological services which include consultation and individual assessment by a psychiatrist, clinical psychologist, or a psychiatric social worker, when indicated, and group or individual treatment for persons with diagnosed mental, emotional, or behavioral problems. (f) Social work services to participants and their families to help with personal, family, and adjustment problems that interfere with the effectiveness of treatment. (g) Planned recreational and social activities suited to the needs of the participants and designed to encourage physical exercise, to prevent deterioration, and to stimulate social interaction. (h) Transportation service for participants, when needed, to and from their homes utilizing specially equipped vehicles to accommodate participants’ needs. The transportation service may only exceed one hour when necessary to ensure regular and planned attendance at the adult day health care center and when there is documentation in the participant’s health record that there is no medical contraindication. (i) Written policies and procedures for dealing with natural disaster and emergency situations. (Amended by Stats. 2008, Ch. 648, Sec. 10. Effective January 1, 2009.)
  92. 14550.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    Adult day health care centers must provide specified core services to each participant during attendance, and must provide one meal per day unless the participant declines or a documented medical contraindication applies.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. ) ## 14550.5. Adult day health care centers shall offer, and provide directly on the premises, in accordance with the participant’s individual plan of care, and subject to authorization pursuant to Section 14526, the following core services to each participant during each day of the participant’s attendance at the center: (a) One or more of the following professional nursing services: (1) Observation, assessment, and monitoring of the participant’s general health status and changes in his or her condition, risk factors, and the participant’s specific medical, cognitive, or mental health condition or conditions upon which admission to the adult day health care center was based. (2) Monitoring and assessment of the participant’s medication regimen, administration and recording of the participant’s prescribed medications, and intervention, as needed, based upon the assessment and the participant’s reactions to his or her medications. (3) Oral or written communication with the participant’s personal health care provider, other qualified health care or social service provider, or the participant’s family or other caregiver, regarding changes in the participant’s condition, signs, or symptoms. (4) Supervision of the provision of personal care services for the participant, and assistance, as needed. (5) Provision of skilled nursing care and intervention, within scope of practice, to participants, as needed, based upon an assessment of the participant, his or her ability to provide self-care while at the adult day health care center, and any health care provider orders. (b) One or both of the following core personal care services or social services: (1) One or both of the following personal care services: (A) Supervision of, or assistance with, activities of daily living or instrumental activities of daily living. (B) Protective group supervision and interventions to assure participant safety and to minimize the risk of injury, accident, inappropriate behavior, or wandering. (2) One or more of the following social services provided by the adult day health care center social worker or social worker assistant: (A) Observation, assessment, and monitoring of the participant’s psychosocial status. (B) Group work to address psychosocial issues. (C) Care coordination. (c) At least one of the following therapeutic activities provided by the adult day health care center activity coordinator or other trained adult day health care center personnel: (1) Group or individual activities to enhance the social, physical, or cognitive functioning of the participant. (2) Facilitated participation in group or individual activities for those participants whose frailty or cognitive functioning level precludes them from active participation in scheduled activities. (d) One meal per day of attendance, in accordance with Section 54331 of Title 22 of the California Code of Regulations, unless the participant declines the meal or medical contraindications exist, as documented in the participant’s health record, that prohibit the ingestion of the meal. (Amended by Stats. 2008, Ch. 648, Sec. 11. Effective January 1, 2009. Repealed as of date prescribed in Section 14550.6. After repeal, see related provisions in Section 14550.6.)
  93. 14550.6.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    Adult day health care centers must provide specified core services to each participant each day on the premises, subject to the participant’s care plan and authorization requirements.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. ) ## 14550.6. Adult day health care centers shall offer, and provide directly on the premises, in accordance with the participant’s individual plan of care, and subject to authorization pursuant to Section 14526.2, the following core services to each participant during each day of the participant’s attendance at the center: (a) One or more of the following professional nursing services: (1) Assessment and monitoring of the participant’s general health status and changes in his or her condition, risk factors, and the participant’s specific medical, cognitive, or mental health condition or conditions upon which admission to the adult day health care center was based. (2) Monitoring and assessment of the participant’s medication regimen, administration and recording of the participant’s prescribed medications, and intervention, as needed, based upon professional assessment of the participant’s reactions to his or her medications. (3) Oral or written communication with the participant’s personal health care provider, other qualified health care or social service provider, or the participant’s family or other caregiver, regarding changes in the participant’s condition, signs, or symptoms. (4) Provision of skilled nursing care and intervention, within scope of practice, to participants, as needed, based upon an assessment of the participant, his or her ability to provide self-care while at the adult day health care center, and any health care provider orders. (b) Personal care services or social services, or both, needed to address the person’s individual needs for benefits as required by Section 14525.1, as follows: (1) Protective group supervision and interventions to ensure participant safety and to minimize the risk of injury, accident, inappropriate behavior, or wandering. (2) Assessment, and monitoring of the participant’s psychosocial status provided by the adult day health care center social worker or social worker assistant. (3) Group work to address psychosocial issues. (c) At least one of the following therapeutic activities provided by the adult day health care center activity coordinator or other trained adult day health care center personnel: (1) Group or individual activities to enhance the social, physical, or cognitive functioning of the participant. (2) Facilitated participation in group or individual activities for those participants whose frailty or cognitive functioning level precludes them from active participation in scheduled activities. (d) One meal per day of attendance, in accordance with Section 54331 of Title 22 of the California Code of Regulations, unless the participant declines the meal or medical contraindications exist, as documented in the participant’s health record, that prohibit the ingestion of the meal. (e) This section shall only be implemented to the extent permitted by federal law. (f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement the provisions of this section by means of all-county letters, provider bulletins, or similar instructions without taking further regulatory action. (g) Upon the date of execution of the declaration described under subdivision (g) of Section 14525.1, this section shall become operative and Section 14550.5 shall become inoperative and on that date is repealed. (Added by Stats. 2009, 4th Ex. Sess., Ch. 5, Sec. 56. Effective July 28, 2009. Section operative on date prescribed in subd. (g).)
  94. 14551.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    Adult day health care programs may provide certain additional services, including podiatric, optometric, dental, and other department-approved services.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. ) ## 14551. The following additional services may also be provided: (a) Podiatric services provided or arranged for, or under direction of, the supervising physician. (b) Optometric screening and advice for low-vision cases by a licensed ophthalmologist or optometrist. (c) Dental screening for the purpose of apprising the participant of the necessity of regular or emergency dental care. (d) Such other services within the concept and objectives of adult day health care as may be approved by the department. (Amended by Stats. 1978, Ch. 429.)
  95. 14552.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    A provider seeking adult day health care certification must meet listed licensing, staffing, service, rights, language-access, and capacity standards.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. ) ## 14552. In order to obtain certification as a provider of adult day health care under this chapter and Chapter 7 (commencing with Section 14000), the following standards shall be met: (a) The provider shall have met all other requirements of licensure as an adult day health care center pursuant to Chapter 3.3 (commencing with Section 1570) of Division 2 of the Health and Safety Code. (b) The provider shall comply with requirements of this chapter regarding program and scope of services. (c) The provider shall have appropriate licensed personnel. (d) The provider shall employ required personnel for furnishing of required services pursuant to Section 14550 consistent with commonly accepted professional standards. (e) The provider shall afford to each participant all rights, including the right to be free from harm and abuse, identified in the rules and regulations adopted pursuant to Section 1580 of the Health and Safety Code. (f) A provider serving a substantial number of participants of a particular racial or ethnic group, or participants whose primary language is not English, shall employ staff who can meet the cultural and linguistic needs of the participant population. (g) A provider shall have organizational and administrative capacity to provide services under the provisions of this chapter. (Amended by Stats. 2004, Ch. 797, Sec. 2. Effective January 1, 2005.)
  96. 14552.2.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    An adult day health care center’s program plan must describe its philosophy, objectives, services, staffing, training, and related sample care materials, and the section applies only when funding is available.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. ) ## 14552.2. (a) “Program plan” means a written description of the adult day health care center’s philosophy, objectives, and processes for providing required services to the participant populations. (b) The program plan shall include any of the following elements, as requested by the California Department of Aging, and shall be submitted as required in Section 14574.1: (1) The total number of participants the center proposes to serve, or currently serves, daily. (2) A profile of the participant population the center proposes to serve, or currently serves, that includes a description of the specific medical, social, and other needs of each population. (3) A description of the specific program elements and services that addresses the medical, social, and other needs of each participant population that the center proposes to serve, or currently serves, as specified in paragraph (2). “Program elements” means the components of an adult day health care program, as specified in Section 14550. (4) A description of the specialized professional and program staff that will provide, or currently provide, the adult day health care center’s program services, as specified in paragraph (3), and that staff’s responsibilities. The plan shall demonstrate that the adult day health care center is organized and staffed to carry out the requirements as specified in the regulations adopted pursuant to Section 1580 of the Health and Safety Code. (5) An in-service training plan for each center staff member to commence within the first six months of employment. The training plan shall address, at a minimum, the specific medical, social, and other needs of each participant population the center proposes to serve, as specified in paragraph (2). (6) A sample individual plan of care for each specialty population the adult day health care center proposes to serve, or currently serves, and a sample of a one-week schedule of daily program services for each sample individual plan of care. The individual plan of care shall demonstrate the specific medical, social, and other needs of each participant population the adult day health center proposes to serve. (7) A plan for a behavior modification program if such a program will be used as a basic intervention for meeting the needs of a special population, such as persons with developmental disabilities or persons with mental disabilities. (c) This section shall be implemented only to the extent funds are made available for the purposes of this section in the annual Budget Act or another statute. (d) The implementation of the program plan requirements does not require adoption of regulations pursuant to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). (Added by Stats. 2004, Ch. 797, Sec. 3. Effective January 1, 2005.)
  97. 14552.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    The department may impose a one-year moratorium on certifying and enrolling new adult day health care centers into Medi-Cal.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. ) ## 14552.5. Pursuant to Section 14043.46, the department may implement a one-year moratorium on the certification and enrollment into the Medi-Cal program of new adult day health care centers. (Added by Stats. 2004, Ch. 228, Sec. 26.1. Effective August 16, 2004.)
  98. 14553.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    Adult day health care providers must create written policies and procedures, get department approval, and share review information with the department unless an interagency agreement says otherwise.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. ) ## 14553. An adult day health care provider shall establish written policies and procedures, which shall have prior approval of the department, unless otherwise specified in an interagency agreement entered into pursuant to Section 1572 of the Health and Safety Code, for continuously reviewing the quality of care, performance of all personnel, the utilization of services and facilities, and costs. Information derived from the review shall be made available to the department, unless otherwise specified in an interagency agreement entered into pursuant to Section 1572 of the Health and Safety Code. (Amended by Stats. 2001, Ch. 681, Sec. 18. Effective January 1, 2002.)
  99. 14553.1.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    An adult day health care center’s policies and procedures must include staffing backup and service-continuity provisions.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. ) ## 14553.1. The adult day health care center’s policies and procedures shall include provisions for the following: (a) Designating the staff who will serve in the required positions during a short-term absence or short-term vacancy, as defined in subdivision (o) of Section 1570.7 of the Health and Safety Code, of required staff. (b) Providing coverage for required staff in the event of a long-term absence or long-term vacancy, as defined in subdivision (k) of Section 1570.7 of the Health and Safety Code. (c) Ensuring continuity of services for participants during staff absences. (Added by Stats. 2008, Ch. 648, Sec. 12. Effective January 1, 2009.)
  100. 14554.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    An adult day health care provider must keep a complete standard medical record for each participant, including subcontractor treatment records, following department specifications and any additional specifications from the California Department of Aging.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. ) ## 14554. The adult day health care provider shall maintain a complete standard medical record for each participant, including records of treatment rendered by a subcontractor, according to specifications established by the department and as may be further specified by the California Department of Aging. (Amended by Stats. 2001, Ch. 681, Sec. 19. Effective January 1, 2002.)
  101. 14555.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    Adult day health care providers must have a grievance procedure, and participants may use it to submit grievances.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 3. Services and Standards [14550 - 14555] ( Article 3 added by Stats. 1977, Ch. 1066. ) ## 14555. Each adult day health care provider shall establish a grievance procedure under which participants may submit their grievances. Such procedure shall be approved by the department prior to the approval of the certification. The department shall establish standards for such procedures to insure adequate consideration and rectification of participant grievances. A provider shall make written findings of fact in the case of each grievance processed, a copy of which shall be transmitted to the participant. If the Medi-Cal participant has an unresolved grievance, the fair hearing provided in Chapter 7 (commencing with Section 10950) of Part 2 of this division shall be available to resolve all grievances regarding care and administration by the adult day health care provider. The findings and recommendations of the department, based on the decision of the hearing officer, shall be binding upon the adult day health care provider. (Amended by Stats. 1998, Ch. 151, Sec. 16. Effective January 1, 1999.)
  102. 1456.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 4. Trauma-Informed Diversion Programs for Youth [1456 - 1459] ( Article 4 added by Stats. 2019, Ch. 584, Sec. 3. )

    Verify source ↗

    This article applies to Youth Reinvestment Grant Program grants starting in fiscal year 2019–20, except grants to Indian tribes under Article 2.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 4. Trauma-Informed Diversion Programs for Youth [1456 - 1459] ( Article 4 added by Stats. 2019, Ch. 584, Sec. 3. ) ## 1456. Notwithstanding any other law, and except for grants provided to Indian tribes under Article 2 (commencing with Section 1452), commencing with the 2019–20 fiscal year and each fiscal year thereafter, this article shall apply to grants provided under the Youth Reinvestment Grant Program. (Added by Stats. 2019, Ch. 584, Sec. 3. (AB 1454) Effective January 1, 2020.)
  103. 1457.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 4. Trauma-Informed Diversion Programs for Youth [1456 - 1459] ( Article 4 added by Stats. 2019, Ch. 584, Sec. 3. )

    Verify source ↗

    This section defines key terms used in the article, including applicant, area of high need, board, diversion program, local governmental entity, and nonprofit organization.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 4. Trauma-Informed Diversion Programs for Youth [1456 - 1459] ( Article 4 added by Stats. 2019, Ch. 584, Sec. 3. ) ## 1457. For purposes of this article, the following definitions apply: (a) “Applicant” means a nonprofit organization or local governmental entity. (b) “Area of high need” means either of the following: (1) A city or a ZIP Code with rates of youth arrests that are higher than the county average, based on available arrest data, as described by the applicant. (2) A city or a ZIP Code with racial or ethnic disparities in youth arrests that are higher than their representation in the county population, as described by the applicant. (c) “Board” means the Board of State and Community Corrections. (d) “Diversion program” means a program that promotes positive youth development by relying on responses that prevent a young person’s involvement or further involvement in the justice system. Diversion programs, which may follow a variety of different models, aim to divert youth from justice system engagement at the earliest possible point. Departments or agencies that may refer youth to diversion programs include, but are not limited to, schools, service organizations, police, probation, or prosecutors. (e) “Local governmental entity” means a local government agency, including, but not limited to, a county child welfare agency, county probation department, county behavioral health department, county public health department, school district, or county office of education. (f) “Nonprofit organization” means a private, community-based organization that is exempt from taxation pursuant to Section 501(c)(3) or 501(c)(4) of the Internal Revenue Code, and that is nongovernmental and does not carry out any law enforcement duties. (Added by Stats. 2019, Ch. 584, Sec. 3. (AB 1454) Effective January 1, 2020.)
  104. 14570.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    The department must adopt rules and regulations on quality of care and payment for services under this chapter, and the director must create a separate organizational entity for the Adult Day Health Care Medi-Cal program.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. ) ## 14570. (a) The department shall adopt all necessary rules and regulations providing for quality of care and payment for services rendered under this chapter pursuant to Chapter 7 (commencing with Section 14000). All regulations heretofore adopted by the department pursuant to this chapter, and that are in effect immediately preceding the operative date of the amendment of this section enacted by the Legislature during the 1977–78 Regular Session, shall remain in effect and shall be fully enforceable unless and until readopted, amended, or repealed by the director. (b) The director shall establish a distinct organizational entity within the department that shall have primary responsibility for the Adult Day Health Care Medi-Cal program. This entity shall coordinate and direct all departmental activities required by this chapter. (Amended by Stats. 2001, Ch. 681, Sec. 20. Effective January 1, 2002.)
  105. 14571.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    The department must create and use a rate methodology for adult day health care, set reimbursement rules for assessments, require direct billing, and establish utilization controls.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. ) ## 14571. The department, in consultation with the California Association for Adult Day Services, shall develop a rate methodology. The methodology shall take into consideration all allowable costs associated with providing adult day health care services. Once a methodology has been approved by the department, it shall be the basis of future annual rate reviews. Payment shall be for services provided in accordance with an approved individual plan of care. Billing shall be submitted directly to the department. Additionally, the department shall establish a separately billable and reasonable rate of reimbursement for the initial assessment that takes into account the intensity of services and the skill level of the health professionals required to conduct the mandated three-day assessment of new participant needs and living environment. Subsequent assessments, as needed or required, shall be billed at a lesser amount. The department shall establish utilization controls for assessment days to ensure the appropriate use of assessment and reassessment activity. Nothing in this section shall preclude the department from entering into specific prospective budgeting and reimbursement agreements with providers. (Amended by Stats. 2006, Ch. 691, Sec. 8. Effective January 1, 2007.)
  106. 14571.1.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    The Legislature states that adult day health care is an important part of home- and community-based long-term care, that certain skilled services should be billed separately, and that reimbursement should be fair and equitable.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. ) ## 14571.1. The Legislature finds and declares all of the following: (a) Adult day health care is a necessary component in achieving an integrated home- and community-based long-term care system consistent with the principles of the decision of the United States Supreme Court in Olmstead v. L.C. by Zimring (1999) 527 U.S. 581. (b) The federal Centers for Medicare and Medicaid Services has directed the State of California to segregate certain skilled services from the all-inclusive per diem rate currently in use for adult day health care centers and to bill for those services using separate billing codes and reimbursement rates. (c) The reimbursement methodology for adult day health care services that is established by the department should provide for fair and equitable reimbursement to adult day health care centers for services that are provided to each participant. (Added by Stats. 2006, Ch. 691, Sec. 9. Effective January 1, 2007.)
  107. 14571.2.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    The department must set a prospective reimbursement methodology and limit for adult day health care services, and adult day health care centers must file annual cost reports.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. ) ## 14571.2. (a) Subject to the provisions of this section, the department shall establish, effective August 1, 2012, a reimbursement methodology and a reimbursement limit for adult day health care services on a prospective cost basis for services that are provided to each participant, pursuant to his or her individual plan of care. The prospective reimbursement methodology shall be determined by the department after consultation with the California Association for Adult Day Services and other interested stakeholders. (b) The following definitions shall apply for purposes of this section: (1) “Daily core services” means the services described in Section 14550.5. (2) “Separately billable services” means services designated by the department, after consultation with the California Association for Adult Day Services, and shall include, but not be limited to, the following: (A) Physical therapy services. (B) Occupational therapy services. (C) Speech and language pathology services. (D) Mental health services. (E) Registered dietician services. (F) Transportation services. (c) The prospective reimbursement methodology for the daily core services provided by each adult day health care center shall be determined by the department based on the reasonable cost of providing all of the adult day health care services included within the core services and adjusted to the particular rate year. Services and costs included in the calculation of the daily core services rate shall include, but not be limited to, all of the following: (1) Fixed or capital-related costs representing depreciation, leases and rentals, interest, leasehold improvements, and other amortization. (2) Labor costs other than those for the separately billable services, including direct and indirect labor and contracted staff hours required by law or regulation. (3) All other costs exclusive of fixed or capital-related costs, leases or rentals, interest, leasehold improvements, and other amortization. (4) Add-ons, adjustments, and audit adjustments determined annually in the calculation of the core rate to allow for changes specified in subdivision (h), until those changes are reflected in the cost report. (5) Cost components required to comply with licensing and certification laws and regulations. (d) (1) The daily reimbursement rates for the separately billable services shall be determined based upon the reasonable cost of providing each service, how each of the individual billable services is defined, and which professional is providing the service, subject to the scope of his or her license. These reimbursement rates shall not exceed the Medi-Cal rates for the same service on file at the time the service is rendered. (2) In establishing the total reimbursement limit, direct patient care labor costs may be paid at a specified discrete percentile to ensure maintenance of quality of care. (e) The department shall determine a reimbursement limit applicable to each adult day health center peer group established pursuant to subdivision (m), taking into account total overall average costs per day of attendance for providing the entire array of adult day health care services, including the daily core services and the separately billable services. The department shall determine a reimbursement limit applicable to each adult day health care center peer group established pursuant to subdivision (m) based on cost containment principles applied to other acute care and long-term care providers. (f) By July 1, 2010, the department shall develop, after consultation with the California Association for Adult Day Services, all of the following: (1) An adult day health care center cost report meeting the requirements of subdivision (j) and a list of individual components to be included in the core rate calculation. (2) The methodology and documentation necessary to establish the reimbursement rate for the separately billable services. (3) The reimbursement rates for transportation services. Payments for transportation services shall be subject to the limit on the daily reimbursement and shall be reimbursed whether the center provides transportation directly, by use of contracted transportation, or both. The department shall review methodologies for payment for transportation services. The review of payment methodologies shall include a survey of other states’ adult day health care transportation systems, and transportation reports or expert consultation relevant to nonemergency medical transportation services in the community. (g) (1) By January 1, 2011, the department shall facilitate the training of providers in collaboration with the California Association for Adult Day Services. The adult day health care centers shall be trained in the all of the following elements: (A) The use of the modified cost report, supplemental reports, and the accounting and reporting manual. (B) Plan of care documentation required to support the separately billable rate components. (C) Medical necessity and eligibility requirements and documentation. (2) By January 1, 2011, the department, after consultation with the California Association for Adult Day Services, shall establish facility peer groupings as specified in subdivision (m). (h) By July 1, 2011, the department, after consultation with the California Association for Adult Day Services, shall establish a methodology for calculation of the reimbursement limit, rates for the daily core services, and applicable percentiles limiting specific cost categories within the core rate. (i) (1) By March 30, 2012, a preliminary estimate of the reimbursement limit, the reimbursement rate for individual adult health care services, and separately billable services shall be established and provided to the California Association for Adult Day Services and other interested stakeholders. The department shall allow an appropriate stakeholder comment period following this action. (2) The information supplied to all interested stakeholders in paragraph (1) shall be compared to what would have been paid under the rate methodology in effect for the 2011–12 fiscal year. (3) Based on the rate comparisons, a methodology to provide for a multiyear phase in of the new prospective payment may be implemented. (4) At the time of implementation, no adult day health care center’s payment shall be decreased by more than 10 percent below the rate paid in the rate year immediately preceding the first year that the rate methodology prescribed in this section is implemented. In the second and third rate years, no adult day health care center reimbursement rate shall be decreased by more than 10 percent below the adult day health care center’s reimbursement rate on file at the time of the application of the next year’s reimbursement rate. (j) (1) The department, with input from the California Association for Adult Day Services and all interested stakeholders, shall develop the cost reporting form and determine the costs that are to be included and excluded from the annual cost reporting methodology. (2) Cost reporting shall be consistent with Section 1861 of the federal Social Security Act (42 U.S.C. Sec. 1395x) and Part 413 of Title 42 of the Code of Federal Regulations. (3) Cost reporting shall include itemization of the costs of all adult day health care services such that information necessary to determine costs associated with the core bundle of services and each of the separately billable services can be collected. (4) The cost report or supplemental report to the cost report, as determined by the frequency the data will be required for calculation of the core rate, shall collect staffing level and salary data for all direct and indirect patient care staff, arranged through either employment or contract. (5) All adult day health care centers participating in the Medi-Cal program shall maintain books and records according to generally accepted accounting principles and the uniform accounting systems adopted by the state, and shall submit annual cost reports directly to the department. (k) (1) The department may exclude any cost report or portion thereof that it deems to be inaccurate, incomplete, or unrepresentative, consistent with the policies established in paragraph (2) of subdivision (j). For facilities that fail to file cost reports with the department pursuant to this section, the department shall reimburse those facilities at 10 percent below the lowest reimbursement limit established in the facility’s peer group pursuant to subdivision (d). (2) Cost report data shall be validated by using comparisons to salary surveys and health industry administrative data maintained by the Office of Statewide Health Planning and Development and other state agencies. If cost report data is not statistically valid for a given peer group, survey statistics shall be used as a proxy to substitute for the cost report data. (3) Cost report data for any adult day health care center that has closed or is no longer a Medi-Cal participating facility shall be excluded from the rate calculation. (4) The specific process for maintaining cost data and submitting cost reports shall be developed after consultation with the California Association for Adult Day Services. (l) Field audits shall be performed by the department in accordance with all of the following laws and regulations: (1) Section 1861 of the Social Security Act (42 U.S.C. Sec. 1395x) and Title XVIII of the Social Security Act (42 U.S.C. Sec. 1395 et seq.). (2) Sections 413.9, 433.32, and 483.10 of, Part 413 of, Title 42 of the Code of Federal Regulations. (3) Centers for Medicare and Medicaid Services Publication 15-1 (federal Department of Health and Human Services Manual). (4) Chapter 5 (commencing with Section 54001) of Division 3 of, and Chapter 10 (commencing with Section 78001) of Division 5 of, Title 22 of the California Code of Regulations. (5) Sections 14170 and 14171. (6) Relevant portions of the California Medicaid State Plan. (m) (1) In accordance with field audit requirements, adult day health care centers shall be placed in a minimum of three designated peer groupings. Each adult day health care center in each of the designated peer groupings shall be audited on an annual basis. (2) If for any reason a field audit was not performed, the average audit adjustment of the peer grouping shall be applied. (3) The peer groupings shall include, at minimum, geographic differences and size of facility. The need for additional groupings shall be periodically reevaluated to ensure that the peer groupings remain relevant on a statewide basis. (4) The department shall analyze and evaluate the data obtained through peer grouping analysis in order to determine if additional peer groupings or data elements are necessary for refinement of the peer groupings. (5) After analyzing the data pursuant to paragraph (4), the department may increase the number of peer groupings or change the criteria to reflect pertinent factors affecting peer grouping costs. (n) (1) An audit adjustment or adjustments, either specific to an adult day health care center or by peer grouping, reflecting the difference between reported and audited costs and participant days for field audited centers, shall be applied to all adult day health care centers for purposes of establishing the core services reimbursement rate and the reimbursement limit for the following rate year. Audit adjustments shall include all of the following: (A) The results of settled appeals. The department shall consider only the findings of audit appeal reports that are issued more than 180 days prior to the beginning of the new rate year. (B) In the case of peer grouping audit adjustments, audited costs shall be modified by a factor reflecting share-of-cost overpayments and share-of-cost underpayments. (C) The results of federal audits, when reported to the state, shall be applied in determining audit adjustments. (D) (i) An adjustment or adjustments to reported costs of adult day health care centers shall be made to reflect changes in state or federal laws and regulations that would affect those costs, including increases in the minimum wage or increases in minimum staffing requirements. (ii) The costs described in clause (i) shall be reflected as an add-on to the new rate or rates. (iii) To the extent not prohibited by federal law or regulations, add-ons to the rate or rates shall continue until those costs are included in cost reports used to set the new rate or rates. (2) Adjusted costs shall be divided into categories and treated as follows: (A) Fixed or capital-related costs shall include costs that represent depreciation, leases and rentals, interest, leasehold improvements, and other amortization. No update shall be applied. (B) Property taxes, where identified, shall be updated at a rate of 2 percent annually. (C) Labor costs, which shall be defined as a ratio of salary, wage, and benefits costs to the total costs of each adult day health care center, shall be updated based upon the labor study conducted by the department and using industry-specific wage data as reported by the adult day health care centers. The separately billable services shall be updated by applying the median market-based rate specific to the specialty service category. (D) All other costs shall include all other costs less fixed or capital-related costs, property taxes, and labor costs. This cost category shall be updated using the California Consumer Price Index. (3) Prior to the implementation of this methodology, the department shall take measures to ensure appropriate training of state audit staff. (o) The department shall provide updates on the rate methodology to the appropriate fiscal and policy committees of the Legislature. The appropriation for services paid under this rate methodology shall be included in the annual Budget Act. (p) Adult day health care centers may appeal findings that result in an adjustment to the rate or rates pursuant to Section 14171 and to Article 1.5 (commencing with Section 51016) of Chapter 3 of Division 3 of Title 22 of the California Code of Regulations. (q) (1) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department shall implement this section by means of a provider bulletin or similar instruction without taking regulatory action. By August 1, 2015, the department shall adopt regulations in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. (2) The department shall notify and consult with interested stakeholders in implementing, interpreting, or making specific the provisions described in this section. (r) The department shall implement this section only to the extent that federal financial participation is obtained. (s) The department may file a state plan amendment to implement the requirements of this section. Immediately upon filing any such state plan amendment, the department shall provide the fiscal committees of the Legislature with a copy of the state plan amendment. (Amended by Stats. 2009, Ch. 165, Sec. 3. (SB 117) Effective January 1, 2010.)
  108. 14571.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. )

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    Federally qualified health centers must be reimbursed using a prospective payment system rate for adult day health care services.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. ) ## 14571.5. Federally qualified health centers shall be reimbursed on a prospective payment system rate basis pursuant to Section 14132.100 for the provision of adult day health care services. (Added by Stats. 2006, Ch. 691, Sec. 11. Effective January 1, 2007.)
  109. 14572.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. )

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    Adult day health care providers cannot receive Medi-Cal reimbursement unless they are licensed and currently certified, with a limited exception for providers meeting specified conditions.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. ) ## 14572. (a) No Medi-Cal reimbursement shall be made for a service rendered by an adult day health care provider that does not have a license as an adult day health care center or that does not have currently effective Medi-Cal certification pursuant to this chapter. (b) Notwithstanding subdivision (a), Medi-Cal certification shall be granted as of the date of licensure with respect to, and reimbursement shall be made for, a service rendered on or after that date if the provider meets all of the following requirements: (1) Is exempt from the moratorium imposed on the certification and enrollment of new adult day health care centers pursuant to paragraph (5) of subdivision (b) of Section 14043.46. (2) Meets all certification requirements for adult day health care centers, and is enrolled as a Medi-Cal provider. (3) Provides services in compliance with the requirements of this chapter as of the date the center began providing services to beneficiaries. (Amended by Stats. 2006, Ch. 74, Sec. 70. Effective July 12, 2006.)
  110. 14573.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. )

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    Adult day health care providers must submit a renewal report before certification renewal, and the department must review renewal applications before approval.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. ) ## 14573. (a) Initial Medi-Cal certification for adult day health care providers shall expire 12 months from the date of issuance. The director shall specify any date he or she determines is reasonably necessary because of the record of the applicant and to carry out the purposes of this chapter, but not more than 24 months from the date of issuance, when renewal of the certification shall expire. The certification may be extended for periods of not more than 60 days if the department determines it to be necessary. (b) Before certification renewal the provider shall submit with the application for renewal a report according to department specifications that includes an analysis of income and expenditures, continued demonstrated community need, services, participant statistics and outcome, and adherence to policies and procedures. (c) Prior to approving renewal of Medi-Cal certification, the California Department of Aging shall conduct a financial review and onsite medical and management reviews. The reviews shall be conducted by a team of persons with appropriate technical skills. The management review shall be performed by the entity responsible for directing and coordinating the program, as specified in the interagency agreement entered into pursuant to Section 1572 of the Health and Safety Code. (d) Where the director determines that the public interests would be served thereby, a public hearing may be held on any renewal application subject to this section. The findings of the departmental program and licensing reviews and the provider’s annual evaluation report shall be presented at the hearing. (Amended by Stats. 2004, Ch. 797, Sec. 4. Effective January 1, 2005.)
  111. 14574.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. )

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    The director must terminate Medi-Cal certification for an adult day health care provider if the provider is out of compliance, and must give reasonable notice before doing so.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. ) ## 14574. (a) The director shall terminate the Medi-Cal certification of any adult day health care provider at any time if he or she finds the provider is not in compliance with standards prescribed by this chapter or Chapter 7 (commencing with Section 14000) or regulations adopted pursuant to these chapters. The director shall give reasonable notice of his or her intention to terminate the certification to the provider and participants in the center. The notice shall state the effective date of, and the reason for, the termination. (b) The California Department of Aging and the department shall coordinate proceedings to deny an application for certification, to terminate or suspend certification, or to revoke or suspend licensure to the extent appropriate to ensure consistency and uniformity. (c) The provider shall have the right to appeal the department’s decision made pursuant to Section 14123. (d) This section is not applicable to denials of initial certification made pursuant to a moratorium imposed in accordance with Section 14043.46 of the Welfare and Institutions Code. (Amended by Stats. 2011, Ch. 119, Sec. 7. (SB 91) Effective July 25, 2011.)
  112. 14574.1.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. )

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    Adult day health care centers must be inspected at least every two years, and the director may designate inspectors. If serious deficiencies create a risk to participants, the department or California Department of Aging may act immediately. Providers can dispute enrollment-related actions, and the dispute must be handled promptly.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. ) ## 14574.1. (a) Every adult day health care center shall be periodically inspected and evaluated for quality of care by a representative or representatives designated by the director, unless otherwise specified in the interagency agreement entered into pursuant to Section 1572 of the Health and Safety Code. Inspections shall be conducted prior to the expiration of certification, but at least every two years, and as often as necessary to ensure the quality of care being provided. As resources permit, an inspection may be conducted prior to, as well as within, the first 90 days of operation. (b) If, as a result of the inspection, the department or the California Department of Aging, as specified in the interagency agreement, determines that the adult day health care center has serious deficiencies that pose a risk to the health and safety of the participants, the department or the California Department of Aging, as specified in the interagency agreement, may immediately take any of the following actions, including, but not limited to: (1) Require a plan of correction, including as requested, a program plan pursuant to Section 14552.2. (2) Limit participant enrollment. (3) Prohibit new participant enrollment. (c) The provider shall have the right to dispute an action taken under paragraphs (2) and (3) of subdivision (b). The department or the California Department of Aging, as specified in the interagency agreement, shall accept, consider, and resolve disputes filed pursuant to this subdivision in a timely manner. The dispute resolution process shall be determined by the California Department of Aging in consultation with the department. (d) The director shall ensure that public records accurately reflect the current status of any potential actions including the resolution of disputes. (Amended by Stats. 2004, Ch. 797, Sec. 5. Effective January 1, 2005.)
  113. 14575.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. )

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    Adult day health care providers must keep a department-approved accounting and reporting system, submit annual cost reports, and retain supporting records; the department and California Department of Aging have related approval and audit powers.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. ) ## 14575. Each adult day health care provider shall maintain a uniform accounting and reporting system as developed by the department, in consultation with the provider. The department shall implement a uniform cost accounting system and train providers in this system by July 1, 1987. The California Department of Aging, in coordination with the department may approve an alternative cost accounting system where the provider demonstrates the ability to report comparable and reliable data. The provider shall submit annual cost reports to the department, unless otherwise specified in an interagency agreement entered into pursuant to Section 1572 of the Health and Safety Code, no later than five months after the close of the licensee’s fiscal year. The report shall be submitted in the format prescribed by the state. Each facility shall maintain, for a period of four years following the submission of annual cost reports, financial and statistical records of the period covered by the cost reports which are accurate and in sufficient detail to substantiate the cost data reported. These records shall be made available to state or federal representatives upon request. The department, unless otherwise specified in an interagency agreement entered into pursuant to Section 1572 of the Health and Safety Code, may request a financial review performed by an independent certified public accountant as part of the provider’s annual cost report. All certified financial statements shall be filed with the department within a period no later than three months after the department’s request. The department, unless otherwise specified in an interagency agreement entered into pursuant to Section 1572 of the Health and Safety Code, may require a limited or complete certified public accountant audit when the monitoring activities carried out pursuant to Section 14573 reveal significant financial management deficiencies. (Amended by Stats. 2001, Ch. 681, Sec. 25. Effective January 1, 2002.)
  114. 14576.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. )

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    Adult day health care providers must give the department additional information and reports the department considers necessary, unless an interagency agreement says otherwise.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. ) ## 14576. Each adult day health care provider shall furnish to the department, unless otherwise specified by the interagency agreement entered into pursuant to Section 1572 of the Health and Safety Code, all additional information and reports that the department may find necessary in performing its functions under this chapter. The information and reports shall include, but not be limited to, any statistical information regarding utilization of services, individual treatment plans and individual service reports, costs of health care, and administration the department may require. (Amended by Stats. 2001, Ch. 681, Sec. 26. Effective January 1, 2002.)
  115. 14577.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. )

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    Subcontracts for reimbursable services must follow department regulations, be written, and be sent to the department for approval before taking effect.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 4. Administration [14570 - 14577] ( Article 4 added by Stats. 1977, Ch. 1066. ) ## 14577. All subcontracts for services reimbursable under this chapter shall be entered into pursuant to regulations of the department. All subcontracts shall be in writing, and a copy shall be transmitted to the department for approval prior to taking effect. Each subcontract submitted to the department for approval shall contain the amount of compensation or other consideration which the subcontractor will receive under the terms of the subcontract with the adult day health care provider. However, this section shall not apply to employment contracts of salaried employees of an adult day health care licensee. All subcontracts to provide health care benefits, including emergency services, shall include a specification that services will be provided to participants to meet the needs of the participants based upon the plans of care. All subcontracts to provide any of the basic services specified in Section 14550 through subcontractors, shall meet all of the qualifications required by, or pursuant to, this chapter as appropriate for the services which the subcontractors are required to perform. Each subcontract shall require that the subcontractor make all of its books and records pertaining to the goods or services furnished under the terms of the subcontract available for inspection, examination, or copying by the department during normal working hours at the subcontractor’s principal place of business, or at such other place in the state as the department shall designate. Subcontracts between an adult day health care provider and a subcontractor shall be public records and shall be kept on file and be available at the center. The names of the officers and stockholders of the subcontractor shall also be kept on file and be available as public records at the center. (Amended by Stats. 1998, Ch. 151, Sec. 19. Effective January 1, 1999.)
  116. 1458.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 4. Trauma-Informed Diversion Programs for Youth [1456 - 1459] ( Article 4 added by Stats. 2019, Ch. 584, Sec. 3. )

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    The board must allocate youth diversion grant funds through a competitive process and impose specific grant conditions, including matching funds and program/service requirements.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 4. Trauma-Informed Diversion Programs for Youth [1456 - 1459] ( Article 4 added by Stats. 2019, Ch. 584, Sec. 3. ) ## 1458. (a) The board shall allocate funds appropriated pursuant to Section 1450 through a competitive grant process for the purpose of implementing trauma-informed diversion programs for youth. (b) The board shall distribute a grant under this article pursuant to all of the following conditions: (1) A local governmental entity or nonprofit organization shall be awarded no less than fifty thousand dollars ($50,000) and no more than two million dollars ($2,000,000). (2) (A) An applicant shall provide at least a 25-percent cash or in-kind match to the grant that it receives pursuant to this article. Funds used to provide the 25-percent match amount may include a combination of federal, other state, local, or private funds. (B) Notwithstanding subparagraph (A), an applicant entity may provide less than a 25-percent match, but at least a 10-percent cash or in-kind match, to the grant if the applicant identifies the service area as high need with low or no local infrastructure for diversion programming. (3) Ninety percent of the funds awarded to a local government entity shall pass through to community-based organizations to deliver services in underserved communities with high rates of youth arrests, as described by the applicant. (4) (A) Services shall be community based, located in communities of local jurisdictions with high needs. (B) Services shall be evidence based or research supported, trauma informed, culturally relevant, and developmentally appropriate. (C) Direct service providers who receive funding from a grant pursuant to this article shall be nongovernmental and not law enforcement or probation entities. (D) Direct service providers shall have experience effectively serving at-risk youth populations. (E) Diversion programs shall include alternatives to arrest, incarceration, and formal involvement with the juvenile justice system. Diversion programs shall also include one or more of the following: (i) Educational services, including academic and vocational services. (ii) Mentoring services. (iii) Behavioral health services. (iv) Mental health services. (c) Multiple applicants may apply for funding under this article on a regional basis in a single application and receive the aggregate amount of funds that they would have received if awarded as independent applicants. (Added by Stats. 2019, Ch. 584, Sec. 3. (AB 1454) Effective January 1, 2020.)
  117. 14585.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 5. Conflict of Interest [14585 - 14588] ( Article 5 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    This section defines “state officer or employee” for this article and requires the director to adopt regulations further defining which employees are covered.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 5. Conflict of Interest [14585 - 14588] ( Article 5 added by Stats. 1977, Ch. 1066. ) ## 14585. For purposes of this article, “state officer or employee” means a Member of Congress representing the State of California; a Member of the Legislature; a secretary of a state agency and those members of the secretary’s staff who hold policymaking positions; those members of the Governor’s staff who hold policymaking positions; an administrative aide or committee consultant of the Legislature; the appointive or civil service employee of the highest class or grade in each department, system, program, section, or other administrative subdivision of the department and the California Department of Aging, as defined in regulations adopted by those departments; any other employee in the department and the California Department of Aging who has any responsibility for the negotiation and development, or management of Medi-Cal contracts of an adult day health care center certified under the provisions of this chapter. The director shall adopt regulations further delineating the class of employees covered by this section. (Amended by Stats. 1998, Ch. 151, Sec. 20. Effective January 1, 1999.)
  118. 14586.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 5. Conflict of Interest [14585 - 14588] ( Article 5 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    An adult day health center cannot get Medi-Cal certification approved or renewed if certain connected people have governance or ownership roles in a contracting entity.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 5. Conflict of Interest [14585 - 14588] ( Article 5 added by Stats. 1977, Ch. 1066. ) ## 14586. No Medi-Cal certification for an adult day health center shall be approved or renewed pursuant to this chapter if a state officer or employee, or the spouse or a minor child of a state officer or employee, is a member of the board of directors, board of trustees, executive committee or other governing board or committee, the principal officer, a shareholder in the case of a corporation, or a partner in the case of a partnership, in any entity contracting with an adult day health center to provide services reimbursable pursuant to this chapter. (Added by Stats. 1977, Ch. 1066.)
  119. 14587.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 5. Conflict of Interest [14585 - 14588] ( Article 5 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    Medi-Cal certification for an adult day health center may not be approved or renewed if a state officer or employee has a direct financial interest in the subcontractor.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 5. Conflict of Interest [14585 - 14588] ( Article 5 added by Stats. 1977, Ch. 1066. ) ## 14587. No Medi-Cal certification for an adult day health center shall be approved or renewed if any state officer or employee has a direct financial interest in such a subcontractor. For the purposes of this section, “direct financial interest” means the ownership of common stock, preferred stock, warrants, options, partnership interests, and debt instruments if convertible to equity investments in a subcontractor specified in this section. A convertible debt includes bonds, notes, debentures, and mortages. As used in this section, “direct financial interest” also includes such financial interest of a spouse or a minor child of a state officer or employee in any business entity or in real property held for income or gain. (Added by Stats. 1977, Ch. 1066.)
  120. 14588.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 5. Conflict of Interest [14585 - 14588] ( Article 5 added by Stats. 1977, Ch. 1066. )

    Verify source ↗

    A Medi-Cal certification for an adult day health center cannot be approved or renewed if a state officer or employee, or that person’s spouse or minor child, provides legal solicitation or management services to the center or shares in income from those services.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 5. Conflict of Interest [14585 - 14588] ( Article 5 added by Stats. 1977, Ch. 1066. ) ## 14588. No Medi-Cal certification for an adult day health center shall be approved or renewed if a state officer or employee, or the spouse or a minor child of a state officer or employee, provides legal solicitation or management services to the adult day health center or shares in the income or any remuneration derived from the providing of legal or management services to an adult day health center. (Added by Stats. 1977, Ch. 1066.)
  121. 14589.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 6. Cessation of Adult Day Health Care and Assistance with Transition from Adult Day Health Care Services to Other Services [14589 - 14590] ( Article 6 added by Stats. 2011, Ch. 3, Sec. 104. )

    Verify source ↗

    The Legislature states that the department should obtain federal approval to eliminate Adult Day Health Care as an optional Medi-Cal benefit.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 6. Cessation of Adult Day Health Care and Assistance with Transition from Adult Day Health Care Services to Other Services [14589 - 14590] ( Article 6 added by Stats. 2011, Ch. 3, Sec. 104. ) ## 14589. (a) The Legislature finds and declares the following: (1) During times of economic crisis, it is crucial to find areas within the program where efficiencies can be achieved while continuing to provide community-based services that support independence. (2) Adult Day Health Care (ADHC) has been vulnerable to fraud and, despite attempts to curtail and prevent fraud, including, but not limited to, a moratorium on new facilities and onsite treatment authorization request review, fraud continues in this area. (3) The state has added services and programs to enable vulnerable populations to remain in the community, including, but not limited to, the Money Follows the Person project, California’s Section 1115(a) Comprehensive Medi-Cal Demonstration Project Waiver: a Bridge to Reform, and services and supports, including day programs, provided under the Lanterman Developmental Disabilities Services Act (Division 4.5 (commencing with Section 4500)). It also continues to explore opportunities to add additional services and programs to help individuals remain in the community, including, but not limited to, pilot projects to better meet the health care needs of individuals dually eligible for both Medicare and Medicaid, and exploring the Community First Choice Option as a Medi-Cal benefit. (4) There are alternative services to meet the needs of Medi-Cal beneficiaries utilizing ADHC, including in-home supportive services, physical, occupational, and speech therapies, nonemergency medical transportation, and home health services. (b) Therefore, it is the intent of the Legislature for the department to obtain federal approval to eliminate ADHC as an optional Medi-Cal benefit. (Amended by Stats. 2012, Ch. 162, Sec. 225. (SB 1171) Effective January 1, 2013.)
  122. 14589.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 6. Cessation of Adult Day Health Care and Assistance with Transition from Adult Day Health Care Services to Other Services [14589 - 14590] ( Article 6 added by Stats. 2011, Ch. 3, Sec. 104. )

    Verify source ↗

    Adult day health care is excluded from Medi-Cal coverage, and the department may implement this section through guidance letters or similar instructions.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 6. Cessation of Adult Day Health Care and Assistance with Transition from Adult Day Health Care Services to Other Services [14589 - 14590] ( Article 6 added by Stats. 2011, Ch. 3, Sec. 104. ) ## 14589.5. (a) Notwithstanding any other provision of law related to the Medi-Cal program or to adult day health care, adult day health care is excluded from coverage under the Medi-Cal program. (b) This section shall only be implemented to the extent permitted by federal law. (c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement the provisions of this section by means of all-county letters, provider bulletins, or similar instructions, without taking further regulatory action. (d) This section shall be implemented on the first day of the first calendar month following 90 days after the effective date of the act that adds this section or on the first day of the first calendar month following 60 days after the date the department secures all necessary federal approvals to implement this section, whichever is later. (Added by Stats. 2011, Ch. 3, Sec. 104. (AB 97) Effective March 24, 2011. Implementation is on date prescribed in subd. (d).)
  123. 1459.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 4. Trauma-Informed Diversion Programs for Youth [1456 - 1459] ( Article 4 added by Stats. 2019, Ch. 584, Sec. 3. )

    Verify source ↗

    The board must oversee the grant program, support data collection and analysis, require grantees to provide outcomes, reserve up to $250,000 for a statewide evaluation, publish a report online within 180 days after each grant cycle, and help the evaluator with existing data.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 1. DELINQUENTS AND WARDS OF THE JUVENILE COURT [100 - 1459] ( Part 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 5. Youth Reinvestment Grant Program [1450 - 1459] ( Chapter 5 added by Stats. 2018, Ch. 36, Sec. 33. ) ## ARTICLE 4. Trauma-Informed Diversion Programs for Youth [1456 - 1459] ( Article 4 added by Stats. 2019, Ch. 584, Sec. 3. ) ## 1459. The board shall be responsible for administration oversight and accountability of the grant program under this article and shall perform both of the following duties: (a) Support grantee data collection and analysis and require grantees to provide outcomes of the funded programs. (b) (1) Set aside up to two hundred fifty thousand dollars ($250,000) of funds appropriated for purposes of the grant program, exclusive of the funds set aside for administrative costs to the board pursuant to subdivision (c) of Section 1450, to contract with a research firm or university to conduct a statewide evaluation of the grant program and its outcomes over a three-year grant period. (2) The board shall make available on its internet website a report of grantees, projects, and outcomes at the state and local levels within 180 days of completion of the grant cycle. (3) The board shall assist the research firm or university by providing relevant, existing data for the purposes of tracking outcomes. Measures may include, but are not limited to, any of the following: (A) Reductions in law enforcement responses to youth for low-level offenses, court caseloads and processing, days the youth spend in detention, placement of youth in congregate care, school and placement disruptions, and facility staff turnover. (B) Improvement in the health and well-being of the youth, school and community stability, educational attainment, and employment opportunities. (C) Projected state and local cost savings as a result of the diversion programming. (Added by Stats. 2019, Ch. 584, Sec. 3. (AB 1454) Effective January 1, 2020.)
  124. 14590.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 6. Cessation of Adult Day Health Care and Assistance with Transition from Adult Day Health Care Services to Other Services [14589 - 14590] ( Article 6 added by Stats. 2011, Ch. 3, Sec. 104. )

    Verify source ↗

    The department must run a short-term transition program, adult day health care centers must send participant records to the department, and some implementing contracts and instructions are exempt from normal procurement and rulemaking steps.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.7. Adult Day Health Care Programs [14520 - 14590] ( Heading of Chapter 8.7 renumbered from Chapter 8.5 (as added by Stats. 1977, Ch. 1066) by Stats. 1978, Ch. 429. ) ## ARTICLE 6. Cessation of Adult Day Health Care and Assistance with Transition from Adult Day Health Care Services to Other Services [14589 - 14590] ( Article 6 added by Stats. 2011, Ch. 3, Sec. 104. ) ## 14590. (a) As a result of the enactment of this article to eliminate adult day health care as an optional benefit under the Medi-Cal program, the department shall implement a short-term program to fund organizations to assist individuals receiving ADHC services to transition to other Medi-Cal services, social services, and respite programs, or to provide social activities and respite assistance for individuals who were receiving ADHC services at the time the services were eliminated. The goal of this funding is to minimize the risk of institutionalization by identifying needed services available in the community and providing beneficiaries assistance in accessing those services. (b) To ensure a smooth transition, adult day health care centers shall provide relevant participant information, including the most recent copy of a participant’s individual plan of care, to the department. Final Medi-Cal payment to adult day health care centers is contingent upon the provision of participants’ individual plan of care and all documentation supporting that individual plan of care, including medical records, to the grantee. Failure to provide documents under this section is grounds for a temporary withhold of payment to the adult day health care center under the process established pursuant to Section 14107.11. (c) To implement this section, the department may contract with public or private entities and utilize existing health care service provider enrollment and payment mechanisms, including the Medi-Cal program’s fiscal intermediary. Contracts entered into for the purposes of implementing this article, including any contract amendments, system changes pursuant to a change order, and any project or system development notices, may be developed using a competitive process established by the department and shall be exempt from Chapter 5.6 (commencing with Section 11545) of Part 1 of Division 3 of Title 2 of the Government Code, Article 4 (commencing with Section 19130) of Chapter 5 of Part 2 of Division 5 of Title 2 of the Government Code, and the Public Contract Code, and any associated policies, procedures, or regulations under those provisions, and shall be exempt from review or approval by any division of the Department of General Services and the California Technology Agency. A contract may provide for periodic advance payments for services to be performed. (d) Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the department may implement this article through provider bulletins or similar instructions without taking regulatory action. (e) Implementation of the short-term program to assist individuals receiving ADHC services to transition to other Medi-Cal services, social services, and respite programs, or to provide social activities and respite assistance for individuals who were receiving ADHC services at the time the services were eliminated, is subject to an appropriation in the annual Budget Act. (Added by Stats. 2011, Ch. 3, Sec. 104. (AB 97) Effective March 24, 2011.)
  125. 14591.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.75. Program of All-Inclusive Care for the Elderly [14591 - 14594] ( Chapter 8.75 repealed and added by Stats. 2011, Ch. 367, Sec. 19. )

    Verify source ↗

    This section states legislative findings about the need for community-based, cost-effective long-term care services for frail elderly people and the success of the PACE model.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.75. Program of All-Inclusive Care for the Elderly [14591 - 14594] ( Chapter 8.75 repealed and added by Stats. 2011, Ch. 367, Sec. 19. ) ## 14591. The Legislature finds and declares all of the following: (a) Community-based services to the frail elderly are often uncoordinated, fragmented, inappropriate, or insufficient to meet the needs of frail elderly who are at risk of institutionalization, often resulting in unnecessary placement in nursing homes. (b) Steadily increasing health care costs for the frail elderly provide incentive to develop programs providing quality services at reasonable costs. (c) Capitated “risk-based” financing provides an alternative to the traditional fee-for-service payment system by providing a fixed, per capita monthly payment for a package of health care services and requiring the provider to assume financial responsibility for cost overruns. (d) On Lok Senior Health Services began as a federal and state demonstration program in 1973 to test whether comprehensive community-based services could be provided to the frail elderly at no greater cost than nursing home care. (e) Since 1983, On Lok Senior Health Services of San Francisco has successfully provided a comprehensive package of services and operated within a cost-effective, capitated risk-based financing system. (f) Recognizing On Lok’s success, Congress passed legislation in 1986 and 1987 encouraging the expansion of capitated long-term care programs by permitting federal Medicare and Medicaid waivers to be granted indefinitely to On Lok and authorizing the federal Centers for Medicare and Medicaid Services (CMS) to grant waivers in up to 10 new sites throughout the nation in order to replicate the On Lok model. (g) In response, the Legislature authorized the State Department of Health Care Services to seek a waiver to contract with up to 10 demonstration projects to develop risk-based, long-term care pilot programs modeled upon On Lok Senior Health Services. (h) The demonstration projects authorized by the Legislature proved to be successful at providing comprehensive, community-based services to frail elderly individuals at no greater cost than providing nursing home care. (i) In 1997, Congress passed the Balanced Budget Act of 1997 (Public Law 105-33) authorizing states to offer PACE program services as optional services under the state’s Medicaid state plan. (j) Based upon the success of the demonstration projects in California, the state is now providing community-based, risk-based, and capitated long-term care services under the PACE program as optional services under California’s Medi-Cal State Plan. (Added by Stats. 2011, Ch. 367, Sec. 19. (AB 574) Effective January 1, 2012.)
  126. 14592.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.75. Program of All-Inclusive Care for the Elderly [14591 - 14594] ( Chapter 8.75 repealed and added by Stats. 2011, Ch. 367, Sec. 19. )

    Verify source ↗

    This section creates the PACE program, exempts certain PACE-only clinics and agencies from licensure, and requires them to follow operating standards and cooperate with oversight.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.75. Program of All-Inclusive Care for the Elderly [14591 - 14594] ( Chapter 8.75 repealed and added by Stats. 2011, Ch. 367, Sec. 19. ) ## 14592. (a) For purposes of this chapter, “PACE organization” means an entity as defined in Section 460.6 of Title 42 of the Code of Federal Regulations. (b) The director shall establish the California Program of All-Inclusive Care for the Elderly (PACE program) to provide community-based, risk-based, and capitated long-term care services as optional services under the state’s Medi-Cal State Plan and under contracts entered into between the federal Centers for Medicare and Medicaid Services, the department, and PACE organizations, meeting the requirements of the Balanced Budget Act of 1997 (Public Law 105-33) and any other applicable law or regulation. (c) A primary care clinic, as defined in paragraph (1) of subdivision (b) of Section 1200 of the Health and Safety Code, an adult day health care center, as defined in subdivision (b) of Section 1570.7 of the Health and Safety Code, or a home health agency, as defined in subdivision (a) of Section 1727 of the Health and Safety Code, that exclusively serves PACE participants, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations, is exempt from licensure by the State Department of Public Health. A primary care clinic, an adult day health care center, or a home health agency that exclusively serves PACE participants shall be overseen and regulated by the department. (1) A primary care clinic, adult day health care center, or home health agency approved by the department pursuant to this section to operate exclusively as part of a PACE organization may provide services to individuals who are being assessed for eligibility to enroll in the PACE program for not more than 60 calendar days after an individual submits an application for enrollment. (2) If the department determines that a primary care clinic, adult day health care center, or home health agency approved to operate exclusively as part of a PACE organization has provided services to individuals other than those enrolled in the PACE program, or who are being assessed for eligibility pursuant to paragraph (1), the clinic, adult day health care center, or home health agency shall apply for licensure with the State Department of Public Health. A primary care clinic, adult day health care center, or home health agency required to obtain licensure from the State Department of Public Health pursuant to this paragraph shall apply for the license not later than 60 calendar days following the determination by the department described in this paragraph. The clinic, adult day health care center, or home health agency shall not accept any new participants in the PACE program until licensure is obtained. (3) This subdivision shall become operative only if the director determines, and communicates that determination in writing to the State Department of Public Health, that operating standards compliance programs consistent with subdivisions (d) and (e) have been established for implementation of this section. A primary care clinic, adult day health care center, or home health agency, as defined in this subdivision, shall remain under the oversight and regulatory authority of the State Department of Public Health until the director communicates their written determination to the State Department of Public Health. (d) In order to provide services to PACE participants, PACE organizations exempt from licensure pursuant to this section shall be in compliance with all of the operating standards: (1) A primary care clinic that exclusively serves PACE participants, or that also serves individuals who are being assessed for eligibility to enroll in a PACE program for not more than 60 calendar days after an individual submits an application for enrollment, shall be in compliance with the clinic operating standards set forth in Chapter 1 (commencing with Section 1200) of Division 2 of the Health and Safety Code, except as modified by the department, to meet the needs of PACE participants or those individuals being assessed. (2) An adult day health care center that exclusively serves PACE participants, or that also serves individuals who are being assessed for eligibility to enroll in a PACE program for not more than 60 calendar days after an individual submits an application for enrollment, shall be in compliance with the center operating standards set forth in Chapter 3.3 (commencing with Section 1570) of Division 2 of the Health and Safety Code, except as modified by the department, to meet the needs of PACE participants or those individuals being assessed. (3) A home health agency that exclusively serves PACE participants, or that also serves individuals who are being assessed for eligibility to enroll in a PACE program for not more than 60 calendar days after an individual submits an application for enrollment, shall be in compliance with the agency operating standards set forth in Chapter 8 (commencing with Section 1725) of Division 2 of the Health and Safety Code, except as modified by the department, to meet the needs of PACE participants or those individuals being assessed. (e) A PACE organization exempt from licensure pursuant to this section shall cooperate with the department’s evaluation, oversight, and ongoing monitoring and shall comply with the operating standards, as described in subdivision (d). The PACE organization’s cooperation shall include, but shall not be limited to, all of the following: (1) Permitting the department or its agent immediate access to inspect any physical locations involved with the PACE organization’s services. (2) Immediately providing the department or its agent with copies of any requested records regarding the PACE organization and services offered to PACE participants. (3) Immediately providing the department or its agent with requested information regarding the PACE organization’s operations. (f) (1) Before approving an adult day health care center that exclusively serves PACE participants, or that also serves individuals who are being assessed for eligibility to enroll in a PACE program for not more than 60 calendar days after an individual submits an application for enrollment, the department shall obtain a criminal record clearance for the administrator, program director, and fiscal officer of the proposed adult day health care center. The department shall obtain the criminal record clearances each time these positions are to be filled. The adult day health care center facility shall not allow a newly hired administrator, program director, or fiscal officer to have direct contact with clients or residents of the facility before completion of the criminal record clearance set forth in this subdivision. (2) The criminal record clearance shall require the administrator, program director, and fiscal officer to submit electronic fingerprint images and related information required by the Department of Justice to the Department of Justice, for the purpose of obtaining information as to the existence and content of a record of state or federal convictions, state or federal arrests, and state or federal arrests for which the Department of Justice establishes that the person is free on bail or on their recognizance pending trial or appeal. (3) When received, the Department of Justice shall transmit fingerprint images and related information received pursuant to this section to the Federal Bureau of Investigation for the purpose of obtaining a federal criminal history records check. The Department of Justice shall review the information returned from the Federal Bureau of Investigation and compile and disseminate a response to the department. (4) The Department of Justice shall provide a state-level or federal-level criminal offender record information search response to the department pursuant to paragraph (1) of subdivision (p) of Section 11105 of the Penal Code. (5) The department shall request from the Department of Justice subsequent notification service, as provided pursuant to Section 11105.2 of the Penal Code, for persons described in paragraph (1). (6) The persons described in paragraph (1) shall be responsible for any costs associated with transmitting the electronic fingerprint images. The Department of Justice shall charge a fee sufficient to cover the cost of processing the request described in this subdivision. (7) A criminal record clearance shall be complete when the department has obtained the person’s criminal offender record information search response from the Department of Justice and has determined that the person is not disqualified from engaging in the activity for which clearance is required. (8) Notwithstanding any other law, the department may provide an individual with a copy of their state-level or federal-level criminal offender record information search response as provided to the department by the Department of Justice if the department has denied a criminal background clearance based on that response and the individual makes a written request to the department for a copy specifying an address to which it is to be sent. The state-level or federal-level criminal offender record information search response shall not be modified or altered from its form or content as provided by the Department of Justice and shall be provided to the address specified by the individual in the written request. The department shall retain a copy of the individual’s written request and the response and date provided. (g) (1) To qualify for approval as a home health agency that exclusively serves PACE participants, or that also serves individuals who are being assessed for eligibility to enroll in a PACE program for not more than 60 calendar days after an individual submits an application for enrollment, the following persons shall submit electronic fingerprint images and related information required by the Department of Justice to the Department of Justice for the furnishing of the person’s criminal record to the department, at the person’s expense as provided in paragraph (6), for the purpose of obtaining information as to the existence and content of a record of state or federal convictions, state or federal arrests, and state or federal arrests for which the Department of Justice establishes that the person is free on bail or on their recognizance pending trial or appeal: (A) The owner or owners of a private agency if the owners are individuals. (B) If the owner of a private agency is a corporation, partnership, or association, an individual with a 10 percent or greater interest in that corporation, partnership, or association. (C) The administrator. (2) A facility shall not allow a newly hired administrator, program director, or fiscal officer to have direct contact with clients or residents of the facility before completion of the criminal record clearance process set forth in this subdivision. (3) When received, the Department of Justice shall transmit fingerprint images and related information received pursuant to this section to the Federal Bureau of Investigation for the purpose of obtaining a federal criminal history records check. The Department of Justice shall review the information returned from the Federal Bureau of Investigation and compile and disseminate a response to the department. (4) The Department of Justice shall provide a state-level or federal-level criminal offender record information search response to the department pursuant to paragraph (1) of subdivision (p) of Section 11105 of the Penal Code. (5) The department shall request from the Department of Justice subsequent notification service, as provided pursuant to Section 11105.2 of the Penal Code, for persons described in paragraph (1). (6) The persons described in paragraphs (1) and (2) shall be responsible for any costs associated with transmitting the electronic fingerprint images. The fee to cover the processing costs of the Department of Justice, not including the costs associated with capturing or transmitting the fingerprint images and related information, shall not exceed thirty-two dollars ($32) per submission. (7) A criminal record clearance shall be complete when the department has obtained the person’s criminal offender record information search response from the Department of Justice and has determined that the person is not disqualified from engaging in the activity for which clearance is required. (h) The department may refuse to enter into, or may terminate, a contract with a PACE organization exempt from licensure pursuant to this section, based on the PACE organization’s failure to comply with the operating standards as described in subdivision (d), or based on the PACE organization’s failure to cooperate as described in subdivision (e). (i) If a PACE organization exempt from licensure pursuant to this section fails to comply with subdivision (c), (d), (e), (f), or (g), the department may require the PACE organization to submit a corrective action plan to bring the PACE organization into compliance with the requirements of those subdivisions. If the department approves the corrective action plan, the PACE organization shall complete the corrective action plan to the satisfaction of the department. If the PACE organization fails to satisfactorily complete the corrective action plan within the time specified by the department, the department may take other action as specified in the PACE organization’s contract with the department. (j) For purposes of implementing this section, the department may enter into exclusive or nonexclusive contracts, or may amend existing contracts, on a bid or negotiated basis. Contracts entered into or amended pursuant to this subdivision shall be exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code and Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and shall be exempt from the review or approval of any division of the Department of General Services. (k) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of letters, bulletins, or other similar instructions, without taking regulatory action. (l) This section shall be implemented only to the extent any necessary federal approvals are obtained and federal financial participation is available. (m) The department shall implement the amendments made to this section by the act that added this subdivision no later than January 1, 2021, but only to the extent any necessary federal approvals are obtained and federal financial participation is available. (n) (1) The department shall establish an administrative fee to be paid by each PACE organization exempt from licensure upon enrollment as a PACE provider, and annually thereafter, in an amount necessary to pay for reasonable costs of implementing and administering subdivisions (c) to (l), inclusive. (2) (A) The fee described in this subdivision shall not be greater than the corresponding fee or fees otherwise imposed on a primary care clinic, home health agency, or adult day health care center pursuant to laws and regulations relating to licensing and regulation by the State Department of Public Health. (B) It is the intent of the Legislature that the fee described in this subdivision is not an additional cost to a PACE organization because PACE organizations exempt from licensure are not subject to fees otherwise imposed for purposes of licensing and regulation by the State Department of Public Health. (C) All fees paid to, and received by, the department pursuant to this subdivision shall be deposited in the State Treasury and shall be credited to a special fund that is hereby created as the PACE Oversight Fund of the State Department of Health Care Services. Moneys deposited in this fund shall be expended by the department for the purposes of implementing and administering subdivisions (c) to (l), inclusive, upon appropriation by the Legislature. No surplus in the PACE Oversight Fund of the State Department of Health Care Services shall be deposited in, or transferred to, the General Fund or any other fund. (o) The amendments made to this section by the act that added this subdivision shall be supported entirely by federal funds and special funds, unless otherwise specified in statute or unless specifically appropriated from the General Fund in the annual Budget Act or other enacted legislation. (Amended by Stats. 2021, Ch. 554, Sec. 12. (SB 823) Effective January 1, 2022.)
  127. 14593.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.75. Program of All-Inclusive Care for the Elderly [14591 - 14594] ( Chapter 8.75 repealed and added by Stats. 2011, Ch. 367, Sec. 19. )

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    The department may contract for the PACE program and must set capitation rates at at least 95% of estimated fee-for-service cost; it also must seek federal flexibility and some contracts may be nonbid and exempt from a Public Contract Code chapter.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.75. Program of All-Inclusive Care for the Elderly [14591 - 14594] ( Chapter 8.75 repealed and added by Stats. 2011, Ch. 367, Sec. 19. ) ## 14593. (a) (1) The department may enter into contracts with public or private organizations for implementation of the PACE program, and also may enter into separate contracts with PACE organizations, to fully implement the single state agency responsibilities assumed by the department in those contracts, Section 14132.94, and any other state requirement found necessary by the department to provide comprehensive community-based, risk-based, and capitated long-term care services to California’s frail elderly. (2) The department may enter into separate contracts as specified in paragraph (1) with up to 15 PACE organizations. This paragraph shall become inoperative upon federal approval of a capitation rate methodology, pursuant to subdivision (n) of Section 14301.1. (b) The requirements of the PACE model, as provided for pursuant to Section 1894 (42 U.S.C. Sec. 1395eee) and Section 1934 (42 U.S.C. Sec. 1396u-4) of the federal Social Security Act, shall not be waived or modified. The requirements that shall not be waived or modified include all of the following: (1) The focus on frail elderly qualifying individuals who require the level of care provided in a nursing facility. (2) The delivery of comprehensive, integrated acute and long-term care services. (3) The interdisciplinary team approach to care management and service delivery. (4) Capitated, integrated financing that allows the provider to pool payments received from public and private programs and individuals. (5) The assumption by the provider of full financial risk. (6) The provision of a PACE benefit package for all participants, regardless of source of payment, that shall include all of the following: (A) All Medicare-covered items and services. (B) All Medicaid-covered items and services, as specified in the state’s Medicaid plan. (C) Other services determined necessary by the interdisciplinary team to improve and maintain the participant’s overall health status. (c) Sections 14002, 14005.12, 14005.17, and 14006 shall apply when determining the eligibility for Medi-Cal of a person receiving the services from an organization providing services under this chapter. (d) Provisions governing the treatment of income and resources of a married couple, for the purposes of determining the eligibility of a nursing-facility certifiable or institutionalized spouse, shall be established so as to qualify for federal financial participation. (e) (1) The department shall establish capitation rates paid to each PACE organization at no less than 95 percent of the fee-for-service equivalent cost, including the department’s cost of administration, that the department estimates would be payable for all services covered under the PACE organization contract if all those services were to be furnished to Medi-Cal beneficiaries under the fee-for-service Medi-Cal program provided for pursuant to Chapter 7 (commencing with Section 14000). (2) This subdivision shall be implemented only to the extent that federal financial participation is available. (3) This subdivision shall become inoperative upon federal approval of a capitation rate methodology, pursuant to subdivision (n) of Section 14301.1. (f) Contracts under this chapter may be on a nonbid basis and shall be exempt from Chapter 2 (commencing with Section 10290) of Part 2 of Division 2 of the Public Contract Code. (g) (1) Notwithstanding subdivision (b), and only to the extent federal financial participation is available, the department, in consultation with PACE organizations, shall seek increased federal regulatory flexibility from the federal Centers for Medicare and Medicaid Services to modernize the PACE program, which may include, but is not limited to, addressing all of the following: (A) Composition of PACE interdisciplinary teams (IDT). (B) Use of community-based physicians. (C) Marketing practices. (D) Development of a streamlined PACE waiver process. (2) This subdivision shall be operative upon federal approval of a capitation rate methodology pursuant to subdivision (n) of Section 14301.1. (Amended (as amended by Stats. 2016, Ch. 30, Sec. 34) by Stats. 2017, Ch. 52, Sec. 77. (SB 97) Effective July 10, 2017.)
  128. 14594.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.75. Program of All-Inclusive Care for the Elderly [14591 - 14594] ( Chapter 8.75 repealed and added by Stats. 2011, Ch. 367, Sec. 19. )

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    PACE organizations may not require in-person contact or restrict the service setting before paying for telehealth-covered services, subject to contract terms, and they cannot be read as authorized to require telehealth when the provider says it is not appropriate.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.75. Program of All-Inclusive Care for the Elderly [14591 - 14594] ( Chapter 8.75 repealed and added by Stats. 2011, Ch. 367, Sec. 19. ) ## 14594. (a) For the purposes of this section, the definitions in subdivision (a) of Section 2290.5 of the Business and Professions Code shall apply. (b) It is the intent of the Legislature to recognize the practice of telehealth as a legitimate means by which an individual may receive health care services from a health care provider without in-person contact with the health care provider. (c) No PACE organization shall require that in-person contact occur between a health care provider and a patient before payment is made for the covered services appropriately provided through telehealth, subject to the terms and conditions of the contract entered into between the enrollee or subscriber and the PACE organization, and between the PACE organization and its participating providers or provider groups. (d) No PACE organization shall limit the type of setting where services are provided for the patient or by the health care provider before payment is made for the covered services appropriately provided through telehealth, subject to the terms and conditions of the contract entered into between the enrollee or subscriber and the PACE organization, and between the PACE organization and its participating providers or provider groups. (e) Notwithstanding any other provision, this section shall not be interpreted to authorize a PACE organization to require the use of telehealth when the health care provider has determined that it is not appropriate. (Added by Stats. 2012, Ch. 782, Sec. 14. (AB 1733) Effective January 1, 2013.)
  129. 14600.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 1. General Provisions [14600 - 14601] ( Article 1 added by Stats. 1981, Ch. 102, Sec. 133. )

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    The state must develop alternative methods for managing Medi-Cal care to make the most of limited public resources.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 1. General Provisions [14600 - 14601] ( Article 1 added by Stats. 1981, Ch. 102, Sec. 133. ) ## 14600. The Legislature finds and declares that expenditure demands on health service costs at the federal, state, and local level, now, and will in the foreseeable future, exceed available public resources. In order to live within fiscal constraints, the state must develop alternative methods of managing Medi-Cal care that utilizes resources to the maximum advantage of people requiring public medical assistance. The purposes of the program alternatives described in this chapter are to provide limited implementation and experimentation prior to statewide enactment of these alternative approaches to funding and management of health care services. (Added by Stats. 1981, Ch. 102, Sec. 133. Effective June 28, 1981.)
  130. 14601.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 1. General Provisions [14600 - 14601] ( Article 1 added by Stats. 1981, Ch. 102, Sec. 133. )

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    This section defines “Department” as the State Department of Health Services and “Director” as the State Director of Health Services for this chapter.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 1. General Provisions [14600 - 14601] ( Article 1 added by Stats. 1981, Ch. 102, Sec. 133. ) ## 14601. As used in this chapter: (a) “Department” means State Department of Health Services. (b) “Director” means State Director of Health Services. (Added by Stats. 1981, Ch. 102, Sec. 133. Effective June 28, 1981.)
  131. 14610.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. )

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    This section defines key terms used in the article about negotiated hospital rates.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. ) ## 14610. As used in this article: (a) “Rate” means the rate of reimbursement per unit of service which is agreed to by the department and a hospital. (b) “Unit of service” means an inpatient day, a case, a discharge or admission, an episode, or any other measure of service which is a basis for reimbursement agreed to by a hospital and the department. (c) “Commission” means the California Health Facilities Commission. (d) “Private entity” means any private organization with appropriate experience and expertise to negotiate Medi-Cal hospital reimbursement rates on behalf of the state. (Added by Stats. 1981, Ch. 102, Sec. 133. Effective June 28, 1981.)
  132. 14611.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. )

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    The Legislature states its intent to create a method for reimbursing hospitals for Medi-Cal inpatient and outpatient services on a prospectively negotiated contract basis.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. ) ## 14611. It is the intention of the Legislature to enact a method for reimbursing hospitals for inpatient and outpatient services provided to Medi-Cal beneficiaries on a prospectively negotiated contractual basis. The provisions of this article are intended to develop and test alternatives for contractually arranging for the payment and delivery of such services which will become the basis for a permanent contracting system. (Added by Stats. 1981, Ch. 102, Sec. 133. Effective June 28, 1981.)
  133. 14612.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. )

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    The Legislature says any alternatives developed and tested under this article should align with stated hospital-care objectives.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. ) ## 14612. The Legislature further intends that the alternatives developed and tested pursuant to the provisions of this article shall be consistent with the following objectives: (a) Providing reasonable access to all levels and types of hospital care by beneficiaries. (b) Providing reasonable geographical access to hospital care by beneficiaries. (c) Promoting efficiency and economy in the delivery of hospital care. (d) Fairness to the contracting hospitals. (Added by Stats. 1981, Ch. 102, Sec. 133. Effective June 28, 1981.)
  134. 14613.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. )

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    The department must develop at least three alternative methods for reimbursing hospitals for Medi-Cal inpatient and outpatient services on a prospectively negotiated rate basis.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. ) ## 14613. (a) The department shall develop at least three alternative methods of reimbursing hospitals for providing inpatient and outpatient hospital services to Medi-Cal beneficiaries on a prospectively negotiated rate basis. Each method shall provide for prospectively negotiating rates for such care. Each method shall require the hospital to agree to provide a minimal number of units of service at the negotiated rate. (b) The department shall consult with associations and other appropriate representatives of the hospital industry. The department shall make every reasonable effort to develop at least one alternative for prospectively negotiating hospital rates which is supported by such representatives of the hospital industry. (c) The department shall consult with the commission regarding the development of at least one alternative for prospectively negotiating hospital rates. The department may enter into an interagency agreement with the commission for the development of such an alternative. (Added by Stats. 1981, Ch. 102, Sec. 133. Effective June 28, 1981.)
  135. 14614.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. )

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    Alternative reimbursement methods must be designed to cut administrative costs, encourage hospital participation in Medi-Cal, support outpatient care where possible, and help hospitals reduce costs.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. ) ## 14614. Each alternative method for prospectively negotiated rate reimbursement developed pursuant to this article shall do the following: (a) Reduce administrative cost to the department and to hospitals. (b) Provide incentives to hospitals to participate in the Medi-Cal program, including prospective interim payments, unless the parties agree otherwise. (c) Provide incentives to hospitals to provide services on an outpatient basis wherever possible. (d) Provide incentives to hospitals to reduce their costs. (Added by Stats. 1981, Ch. 102, Sec. 133. Effective June 28, 1981.)
  136. 14616.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. )

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    The department may test certain hospital rate negotiation alternatives after notifying the Joint Legislative Budget Committee and waiting at least 30 days.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. ) ## 14616. Not sooner than 30 days after providing notification to the Joint Legislative Budget Committee, the department may implement on a test basis any of the alternatives for prospective hospital rate negotiations which have been reported to the Legislature pursuant to Section 14614. The department may enter into an interagency agreement with the commission, or contract with a private entity, for implementing any such alternative. In testing alternatives, the department shall attempt to obtain participation by hospitals representing various sizes, types, ownership, and geographic locations. The department may not discriminate against hospitals wishing to participate on the basis of any of the characteristics described in the immediately preceding sentence. (Added by Stats. 1981, Ch. 102, Sec. 133. Effective June 28, 1981.)
  137. 14617.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. )

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    Hospitals are not required by this article to participate in a prospectively negotiated rate test as a condition of Medi-Cal participation.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. ) ## 14617. Nothing in this article shall be construed to require that hospitals participate in a prospectively negotiated rate test, as provided by this article, as a condition of participation in the Medi-Cal program. (Added by Stats. 1981, Ch. 102, Sec. 133. Effective June 28, 1981.)
  138. 14619.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. )

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    For the 1981–82 fiscal year, the Controller may move funds among specified Budget Act items when needed to implement this article.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. ) ## 14619. For the 1981–82 fiscal year, the Controller may transfer such funds among Items 426-001-001, 426-001-890, 426-101-001, and 426-101-890 of the Budget Act of 1981 as are necessary to implement the provisions of this article. (Added by Stats. 1981, Ch. 102, Sec. 133. Effective June 28, 1981.)
  139. 14620.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. )

    Verify source ↗

    Implementation of negotiated hospital rates is allowed only after the pilot study is completed, after June 30, 1983, and only if both stated conditions are met.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 2. Negotiated Hospital Rates [14610 - 14620] ( Article 2 added by Stats. 1981, Ch. 102, Sec. 133. ) ## 14620. Authority to implement negotiated hospital rates after the completion of the pilot study and after June 30, 1983, shall be contingent on both of the following: (a) A special Budget Act item, following the submission by the State Department of Health Services of a final report which evaluates the results of the projects conducted under the provisions of this article. (b) Enactment of legislation specifying the negotiated hospital rate program. (Added by Stats. 1981, Ch. 102, Sec. 133. Effective June 28, 1981.)
  140. 14680.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 5. Mental Health Managed Care [14680 - 14685.1] ( Article 5 heading added by Stats. 1995, Ch. 91, Sec. 187. )

    Verify source ↗

    The section says mental health plans should be developed for Medi-Cal specialty mental health services, with guidelines consistent with federal law and the department’s guidelines.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 5. Mental Health Managed Care [14680 - 14685.1] ( Article 5 heading added by Stats. 1995, Ch. 91, Sec. 187. ) ## 14680. (a) The Legislature finds and declares that there is a need to establish a standard set of guidelines that governs the provision of managed Medi-Cal specialty mental health services at the local level, consistent with federal law. (b) Therefore, in order to ensure quality and continuity, and to efficiently utilize mental health services under the Medi-Cal program, there shall be developed mental health plans for the provision of those services that are consistent with guidelines established by the department. The guidelines shall be consistent with federal Medicaid requirements and the approved Medicaid state plan and waivers to ensure full and timely federal reimbursement to mental health plans for services that are rendered and reimbursed consistent with federal Medicaid requirements. (c) It is the intent of the Legislature that mental health plans be developed and implemented regardless of whether other systems of Medi-Cal managed care are implemented. (d) It is further the intent of the Legislature that Sections 14681 to 14685, inclusive, shall not be construed to mandate the participation of counties in Medi-Cal managed mental health care plans. (e) This section shall become operative on July 1, 2012. (Amended (as added by Stats. 2011, Ch. 651, Sec. 10) by Stats. 2012, Ch. 34, Sec. 236. (SB 1009) Effective June 27, 2012. Section operative July 1, 2012, by its own provisions.)
  141. 14681.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 5. Mental Health Managed Care [14680 - 14685.1] ( Article 5 heading added by Stats. 1995, Ch. 91, Sec. 187. )

    Verify source ↗

    The department must make sure Medi-Cal managed care contracts include a process for screening, referral, and coordination for medically necessary specialty mental health care services.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 5. Mental Health Managed Care [14680 - 14685.1] ( Article 5 heading added by Stats. 1995, Ch. 91, Sec. 187. ) ## 14681. The department shall ensure that all contracts for Medi-Cal managed care include a process for screening, referral, and coordination with any mental health plan established, of medically necessary specialty mental health care services. (Amended by Stats. 2012, Ch. 34, Sec. 237. (SB 1009) Effective June 27, 2012. Operative July 1, 2012, by Sec. 254 of Ch. 34.)
  142. 14682.1.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 5. Mental Health Managed Care [14680 - 14685.1] ( Article 5 heading added by Stats. 1995, Ch. 91, Sec. 187. )

    Verify source ↗

    The department must create and carry out mental health plans for Medi-Cal beneficiaries, convene a steering committee, and may structure that process.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 5. Mental Health Managed Care [14680 - 14685.1] ( Article 5 heading added by Stats. 1995, Ch. 91, Sec. 187. ) ## 14682.1. (a) The State Department of Health Care Services shall be designated as the state agency responsible for development, consistent with the requirements of Section 4060, and implementation of, mental health plans for Medi-Cal beneficiaries. (b) The department shall convene a steering committee for the purpose of providing advice and recommendations on the transition and continuing development of the Medi-Cal mental health managed care systems pursuant to subdivision (a). The committee shall include work groups to advise the department of major issues to be addressed in the managed mental health care plan, as well as system transition and transformation issues pertaining to the delivery of mental health care services to Medi-Cal beneficiaries, including services to children provided through the Early and Periodic Screening, Diagnosis, and Treatment Program. (c) The committee shall consist of diverse representatives of concerned and involved communities, including, but not limited to, beneficiaries, their families, providers, mental health professionals, substance use disorder treatment professionals, statewide representatives of health care service plans, representatives of the California Behavioral Health Planning Council, public and private organizations, county behavioral health directors, and others as determined by the department. The department has the authority to structure this steering committee process in a manner that is conducive for addressing issues effectively, and for providing a transparent, collaborative, meaningful process to ensure a more diverse and representative approach to problem-solving and dissemination of information. (Amended by Stats. 2017, Ch. 511, Sec. 32. (AB 1688) Effective January 1, 2018.)
  143. 14683.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 5. Mental Health Managed Care [14680 - 14685.1] ( Article 5 heading added by Stats. 1995, Ch. 91, Sec. 187. )

    Verify source ↗

    The department must ensure mental health plans include screening, referral, coordination, outreach, and quality/access standards, with extra coordination for Medi-Cal eligible children.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 5. Mental Health Managed Care [14680 - 14685.1] ( Article 5 heading added by Stats. 1995, Ch. 91, Sec. 187. ) ## 14683. The department shall ensure all of the following: (a) That mental health plans include a process for screening, referral, and coordination with other necessary services, including, but not limited to, health, housing, and vocational rehabilitation services. For Medi-Cal eligible children, the mental health plans shall also provide coordination with education programs and any necessary medical or rehabilitative services, including, but not limited to, those provided under the California Children’s Services Program (Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code) and the Child Health and Disability Prevention Program (Article 6 (commencing with Section 124025) of Chapter 3 of Part 2 of Division 106 of the Health and Safety Code), and those provided by a fee-for-service provider or a Medi-Cal managed care plan. This subdivision shall not be construed to establish any higher level of service from a county than is required under existing law. The mental health plan shall not be liable for the failure of other agencies responsible for the provision of nonmental health services to provide those services or to participate in coordination efforts. (b) That mental health plans include a system of outreach to enable Medi-Cal beneficiaries and providers to participate in and access Medi-Cal specialty mental health services under the plans, consistent with existing law. (c) That standards for quality and access developed by the department in consultation with the steering committee established pursuant to Section 14682.1 are included in mental health plans serving Medi-Cal beneficiaries. (Amended by Stats. 2012, Ch. 34, Sec. 240. (SB 1009) Effective June 27, 2012. Operative July 1, 2012, by Sec. 254 of Ch. 34.)
  144. 14684.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 5. Mental Health Managed Care [14680 - 14685.1] ( Article 5 heading added by Stats. 1995, Ch. 91, Sec. 187. )

    Verify source ↗

    Mental health plans under Medi-Cal must follow listed guidelines for funding, planning, service delivery, monitoring, and culturally competent care.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 5. Mental Health Managed Care [14680 - 14685.1] ( Article 5 heading added by Stats. 1995, Ch. 91, Sec. 187. ) ## 14684. (a) Notwithstanding any other provision of state law, and to the extent permitted by federal law, mental health plans, whether administered by public or private entities, shall be governed by the following guidelines: (1) State and federal Medi-Cal funds identified for the diagnosis and treatment of mental illness shall be used solely for those purposes. Administrative costs incurred by counties for activities necessary for the administration of the mental health plan shall be clearly identified and shall be reimbursed in a manner consistent with federal Medicaid requirements and the approved Medicaid state plan and waivers. Administrative requirements shall be based on and limited to federal Medicaid requirements and the approved Medicaid state plan and waivers, and shall not impose costs exceeding funds available for that purpose. (2) The development of the mental health plan shall include a public planning process that includes a significant role for Medi-Cal beneficiaries, family members, mental health advocates, providers, and public and private contract agencies. (3) The mental health plan shall include appropriate standards relating to quality, access, and coordination of services within a managed system of care, and costs established under the plan, and shall provide opportunities for existing Medi-Cal providers to continue to provide services under the mental health plan, as long as the providers meet those standards. (4) Continuity of care for current recipients of services shall be ensured in the transition to managed mental health care. (5) Medi-Cal covered specialty mental health services shall be provided in the beneficiary’s home community, or as close as possible to the beneficiary’s home community. Pursuant to the objectives of the rehabilitation option described in subdivision (a) of Section 14021.4, mental health services may be provided in a facility, a home, or other community-based site. (6) Medi-Cal beneficiaries whose mental or emotional condition results or has resulted in functional impairment, as defined by the department, shall be eligible for covered specialty mental health services. Emphasis shall be placed on adults with serious and persistent mental illness and children with serious emotional disturbances, as defined by the department. (7) Mental health plans shall provide specialty mental health services to eligible Medi-Cal beneficiaries, including both adults and children. Specialty mental health services include Early and Periodic Screening, Diagnosis, and Treatment Services to eligible Medi-Cal beneficiaries under the age of 21 pursuant to 42 U.S.C. Section 1396d(a)(4)(B) of Title 42 of the United States Code. (8) Each mental health plan shall include a mechanism for monitoring the effectiveness of, and evaluating accessibility and quality of, services available. The plan shall utilize and be based upon state-adopted performance outcome measures and shall include review of individual service plan procedures and practices, a beneficiary satisfaction component, and a grievance system for beneficiaries and providers. (9) Each mental health plan shall provide for culturally competent and age-appropriate services, to the extent feasible. The mental health plan shall assess the cultural competency needs of the program. The mental health plan shall include, as part of the quality assurance program required by Section 14725, a process to accommodate the significant needs with reasonable timeliness. The department shall provide demographic data and technical assistance. Performance outcome measures shall include a reliable method of measuring and reporting the extent to which services are culturally competent and age-appropriate. (b) This section shall become operative on July 1, 2012. (Amended (as added by Stats. 2011, Ch. 651, Sec. 12) by Stats. 2012, Ch. 34, Sec. 241. (SB 1009) Effective June 27, 2012. Section operative July 1, 2012.)
  145. 14684.1.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 5. Mental Health Managed Care [14680 - 14685.1] ( Article 5 heading added by Stats. 1995, Ch. 91, Sec. 187. )

    Verify source ↗

    The department must create and run a second-level appeals process for treatment authorization disputes between mental health plans and hospitals.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 5. Mental Health Managed Care [14680 - 14685.1] ( Article 5 heading added by Stats. 1995, Ch. 91, Sec. 187. ) ## 14684.1. (a) The department shall establish a process for second level treatment authorization request appeals to review and resolve disputes between mental health plans and hospitals. (b) When the department establishes an appeals process, the department shall comply with all of the following: (1) The department shall review appeals initiated by hospitals and render decisions on appeals based on findings that are the result of a review of supporting documents submitted by mental health plans and hospitals. (2) If the department upholds a mental health plan denial of payment of a hospital claim, a review fee shall be assessed on the provider. (3) If the department reverses a mental health plan denial of payment of a hospital claim, a review fee shall be assessed on the mental health plan. (4) If the department decision regarding a mental health plan denial of payment upholds the claim in part and reverses the claim in part, the department shall prorate the review fee between the parties accordingly. (c) The amount of the review fees shall be calculated and adjusted annually. The methodology and calculation used to determine the fee amounts shall result in an aggregate fee amount that, in conjunction with any other outside source of funding for this function, may not exceed the aggregate annual costs of providing second level treatment authorization request reviews. (d) Fees collected by the department shall be retained by the department and used to offset administrative and personnel services costs associated with the appeals process. (e) The department may use the fees collected, in conjunction with other available appropriate funding for this function, to contract for the performance of the appeals process function. (Amended by Stats. 2012, Ch. 34, Sec. 242. (SB 1009) Effective June 27, 2012. Operative July 1, 2012, by Sec. 254 of Ch. 34.)
  146. 14685.1.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 5. Mental Health Managed Care [14680 - 14685.1] ( Article 5 heading added by Stats. 1995, Ch. 91, Sec. 187. )

    Verify source ↗

    Section 14685 is repealed on November 7, 2012, if Section 36 has been added to Article XIII of the California Constitution by that date.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.8. Medi-Cal Management: Alternative Methods [14600 - 14685.1] ( Chapter 8.8 added by Stats. 1981, Ch. 102, Sec. 133. ) ## ARTICLE 5. Mental Health Managed Care [14680 - 14685.1] ( Article 5 heading added by Stats. 1995, Ch. 91, Sec. 187. ) ## 14685.1. Section 14685 is hereby repealed on November 7, 2012, if Section 36 has been added to Article XIII of the California Constitution as of that date. (Added by Stats. 2012, Ch. 34, Sec. 244. (SB 1009) Effective June 27, 2012.)
  147. 14700.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

    Verify source ↗

    The section transfers Medi-Cal specialty mental health administration from the State Department of Mental Health to the State Department of Health Care Services, with transition planning and continued enforcement of existing regulations and orders.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14700. (a) (1) It is the intent of the Legislature to transfer to the State Department of Health Care Services, no later than July 1, 2012, the state administration of Medi-Cal specialty mental health managed care, the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program, and applicable functions related to federal Medicaid requirements, from the State Department of Mental Health. (2) It is further the intent of the Legislature for this transfer to occur in an efficient and effective manner, with no unintended interruptions in service delivery to clients and families. This transfer is intended to do all of the following: (A) Improve access to culturally appropriate community-based mental health services, including a focus on client recovery, social rehabilitation services, and peer support. (B) Effectively integrate the financing of services, including the receipt of federal funds, to more effectively provide services. (C) Improve state accountabilities and outcomes. (D) Provide focused, high-level leadership for behavioral health services within the state administrative structure. (b) Effective July 1, 2012, the state administrative functions for the operation of Medi-Cal specialty mental health managed care, the EPSDT Program, and applicable functions related to federal Medicaid requirements, that were performed by the State Department of Mental Health shall be transferred to the State Department of Health Care Services. This state administrative transfer shall conform to a state administrative transition plan provided to the fiscal and applicable policy committees of the Legislature as soon as feasible, but no later than October 1, 2011. This state administrative transition plan may also be updated by the Governor and provided to all fiscal and applicable policy committees of the Legislature upon its completion, but no later than May 15, 2012. (c) All regulations and orders concerning Medi-Cal specialty mental health managed care and the EPSDT Program shall remain in effect and shall be fully enforceable unless and until readopted, amended, or repealed by the State Department of Health Care Services, or until they expire by their own terms. (Added by Stats. 2011, Ch. 29, Sec. 20. (AB 102) Effective June 29, 2011. Conditionally inoperative as provided in Section 14721.)
  148. 14701.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

    Verify source ↗

    The department must create a transition plan for transferring specified Medi-Cal mental health programs, and it must hold stakeholder meetings and consult with stakeholders on the plan.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14701. (a) The State Department of Health Care Services, in collaboration with the State Department of State Hospitals and the California Health and Human Services Agency, shall create a state administrative and programmatic transition plan, either as one comprehensive transition plan or separately, to guide the transfer of the Medi-Cal specialty mental health managed care and the EPSDT Program to the State Department of Health Care Services effective July 1, 2012. (b) (1) Commencing no later than July 15, 2011, the State Department of Health Care Services, together with the State Department of State Hospitals, shall convene a series of stakeholder meetings and forums to receive input from clients, family members, providers, counties, and representatives of the Legislature concerning the transition and transfer of Medi-Cal specialty mental health managed care and the EPSDT Program. This consultation shall inform the creation of a state administrative transition plan and a programmatic transition plan that shall include, but is not limited to, the following components: (A) The plan shall ensure that it is developed in a way that continues access and quality of service during and immediately after the transition, preventing any disruption of services to clients and family members, providers and counties, and others affected by this transition. (B) A detailed description of the state administrative functions currently performed by the State Department of Mental Health regarding Medi-Cal specialty mental health managed care and the EPSDT Program. (C) Explanations of the operational steps, timelines, and key milestones for determining when and how each function or program will be transferred. These explanations shall also be developed for the transition of positions and staff serving Medi-Cal specialty mental health managed care and the EPSDT Program, and how these will relate to, and align with, positions at the State Department of Health Care Services. The State Department of Health Care Services and the California Health and Human Services Agency shall consult with the Department of Human Resources in developing this aspect of the transition plan. (D) A list of any planned or proposed changes or efficiencies in how the functions will be performed, including the anticipated fiscal and programmatic impacts of the changes. (E) A detailed organization chart that reflects the planned staffing at the State Department of Health Care Services in light of the requirements of subparagraphs (A) to (C), inclusive, and includes focused, high-level leadership for behavioral health issues. (F) A description of how stakeholders were included in the various phases of the planning process to formulate the transition plans and a description of how their feedback will be taken into consideration after transition activities are underway. (2) The State Department of Health Care Services, together with the State Department of State Hospitals and the California Health and Human Services Agency, shall convene and consult with stakeholders at least twice following production of a draft of the transition plans and before submission of transition plans to the Legislature. Continued consultation with stakeholders shall occur in accordance with the requirement in subparagraph (F) of paragraph (1). (Amended by Stats. 2014, Ch. 71, Sec. 200. (SB 1304) Effective January 1, 2015. Conditionally inoperative as provided in Section 14721.)
  149. 14702.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

    Verify source ↗

    This section defines “Department” and “Director” for this chapter.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14702. For purposes of this chapter, the following definitions shall apply: (a) “Department” means the State Department of Health Care Services. (b) “Director” means the Director of Health Care Services. (Added by Stats. 2012, Ch. 34, Sec. 245. (SB 1009) Effective June 27, 2012. Conditionally inoperative as provided in Section 14721.)
  150. 14703.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

    Verify source ↗

    Contracts made under this chapter are exempt from two specified Public Contract Code requirements.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14703. Contracts entered into pursuant to this chapter shall be exempt from the requirements of Chapter 1 (commencing with Section 10100) and Chapter 2 (commencing with section 10290) of Part 2 of Division 2 of the Public Contract Code. (Added by Stats. 2012, Ch. 34, Sec. 246. (SB 1009) Effective June 27, 2012. Conditionally inoperative as provided in Section 14721.)
  151. 14704.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

    Verify source ↗

    Certain Medi-Cal specialty mental health regulations or orders stay in force and remain enforceable until the department readopts, amends, repeals them, or they expire on their own.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14704. A regulation or order concerning Medi-Cal specialty mental health services adopted by the State Department of Mental Health pursuant to Division 5 (commencing with Section 5000), as in effect preceding the effective date of this section, shall remain in effect and shall be fully enforceable, unless and until the readoption, amendment, or repeal of the regulation or order by the department, or until it expires by its own terms. (Added by Stats. 2012, Ch. 34, Sec. 247. (SB 1009) Effective June 27, 2012. Conditionally inoperative as provided in Section 14721.)
  152. 14705.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    Counties must provide specialty mental health services for Medi-Cal beneficiaries, verify eligibility through mental health plans, meet Medi-Cal reimbursement requirements, and certify public expenditures before seeking federal reimbursement.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14705. (a) (1) This section shall apply to specialty mental health services provided by counties to Medi-Cal eligible individuals. Counties shall provide services to Medi-Cal beneficiaries and seek the maximum federal reimbursement possible for services rendered to persons with mental illnesses. (2) To the extent permitted under federal law and Section 5892, funds distributed to the counties from the Mental Health Subaccount, the Mental Health Equity Subaccount, and the Vehicle License Collection Account of the Local Revenue Fund, funds from the Mental Health Account and the Behavioral Health Subaccount of the Local Revenue Fund 2011, funds from the Behavioral Health Services Fund, and any other funds from which the Controller makes distributions to the counties may be used to pay for services provided by these funds that the counties can then certify as public expenditures in order to achieve the maximum federal reimbursement possible for services pursuant to this chapter. (3) The standards and guidelines for the administration of specialty mental health services to Medi-Cal eligible persons shall be consistent with federal Medicaid requirements, as specified in the approved Medicaid state plan and waivers to ensure full and timely federal reimbursement to counties for services that are rendered and claimed consistent with federal Medicaid requirements. (b) With regard to each person receiving specialty mental health services from a mental health plan, the mental health plan shall verify whether the person is Medi-Cal eligible and, if determined to be Medi-Cal eligible, the person shall be referred when appropriate to a facility, clinic, or program that is certified for Medi-Cal reimbursement. (c) With regard to county operated facilities, clinics, or programs for which claims are submitted to the department for Medi-Cal reimbursement for specialty mental health services to Medi-Cal eligible individuals, the county shall ensure that all requirements necessary for Medi-Cal reimbursement for these services are complied with, including, but not limited to, utilization review and the submission of yearend cost reports by December 31 following the close of the fiscal year. (d) Counties shall certify to the state that they have incurred public expenditures prior to requesting the reimbursement of federal funds. (Amended by Stats. 2024, Ch. 40, Sec. 73. (SB 159) Effective June 29, 2024. Operative January 1, 2025, pursuant to Sec. 85 of Stats. 2024, Ch. 40. Conditionally inoperative as provided in Section 14721.)
  153. 14705.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    Facilities or agencies providing local specialty mental health services must send a written certification to the county mental health director within 30 days after a patient is admitted or first gets services, stating whether the patient is presumed eligible for Medi-Cal specialty mental health services.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14705.5. Each public or private facility or agency providing local specialty mental health services pursuant to a county performance contract plan shall make a written certification within 30 days after a patient is admitted to the facility as a patient or first given services by such a facility or agency, to the local mental health director of the county, stating whether or not each of these patients is presumed to be eligible for specialty mental health services under the Medi-Cal program. (Added by renumbering Section 5719 by Stats. 2012, Ch. 34, Sec. 153. (SB 1009) Effective June 27, 2012. Operative July 1, 2012, by Sec. 254 of Ch. 34. Conditionally inoperative as provided in Section 14721.)
  154. 14705.7.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    Mental health plans may contract with providers on a negotiated net amount basis, but negotiated net amounts or rates may not be included in contracts between the state and mental health plans for specialty mental health services. Reimbursement for plans with certified public expenditures must follow federal Medicaid upper-payment-limit requirements.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14705.7. Mental health plans may contract with providers on a negotiated net amount basis in the same manner as set forth in Section 5705. Negotiated net amounts or rates shall not be in contracts between the state and mental health plans for specialty mental health services. Reimbursement to mental health plans that have certified public expenditures shall be consistent with federal Medicaid requirements for calculating upper payment limits, as specified in the approved Medicaid state plan and waivers. (Added by renumbering Section 5716 by Stats. 2012, Ch. 34, Sec. 150. (SB 1009) Effective June 27, 2012. Conditionally inoperative as provided in Section 14721.)
  155. 14706.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    The department must investigate and audit certain claims and reimbursements for specialty mental health services, and it determines the amount of related federal fund payments or repayments through its existing appeals process.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14706. (a) The department shall have responsibility for conducting investigations and audits of claims and reimbursements for expenditures for specialty mental health services provided by mental health plans to Medi-Cal eligible individuals. (b) The amount of the payment or repayment of federal funds in accordance with audit findings pertaining to Medi-Cal specialty mental health services shall be determined by the department pursuant to the existing administrative appeals process of the department. (Added by renumbering Section 5722 by Stats. 2012, Ch. 34, Sec. 157. (SB 1009) Effective June 27, 2012. Operative July 1, 2012, by Sec. 254 of Ch. 34. Conditionally inoperative as provided in Section 14721.)
  156. 14707.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    The department must use federal audit appeal processes for federal audit exceptions unless it decides, with the County Behavioral Health Directors Association of California, that the appeals are not cost beneficial.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14707. (a) In the case of federal audit exceptions, the department shall follow federal audit appeal processes unless the department, in consultation with the County Behavioral Health Directors Association of California, determines that those appeals are not cost beneficial. (b) Whenever there is a final federal audit exception against the state resulting from expenditure of federal funds by individual counties, the department may offset federal reimbursement and request the Controller’s office to offset the distribution of funds to the counties from the Mental Health Subaccount, the Mental Health Equity Subaccount, and the Vehicle License Collection Account of the Local Revenue Fund, funds from the Mental Health Account and the Behavioral Health Subaccount of the Local Revenue Fund 2011, and any other mental health realignment funds from which the Controller makes distributions to the counties by the amount of the exception. The department shall provide evidence to the Controller that the county has been notified of the amount of the audit exception no less than 30 days before the offset is to occur. The department shall involve the appropriate counties in developing responses to any draft federal audit reports that directly impact the county. (Amended by Stats. 2015, Ch. 455, Sec. 56. (SB 804) Effective January 1, 2016. Conditionally inoperative as provided in Section 14721.)
  157. 14707.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    The department must create and update a plan for an EPSDT mental health performance outcome system, consult stakeholders, and report the plan and implementation proposals to the Legislature by set deadlines.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14707.5. (a) It is the intent of the Legislature to develop a performance outcome system for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) mental health services that will improve outcomes at the individual and system levels and will inform fiscal decisionmaking related to the purchase of services. (b) The State Department of Health Care Services, in collaboration with the California Health and Human Services Agency and in consultation with the Behavioral Health Services Oversight and Accountability Commission, shall create a plan for a performance outcome system for EPSDT mental healthservices provided to eligible Medi-Cal beneficiaries under the age of 21 pursuant to 42 U.S.C. Section 1396d(a)(4)(B). (1) (A) Commencing no later than September 1, 2012, the department shall convene a stakeholder advisory committee comprised of representatives of child and youth clients, family members, providers, counties, and the Legislature. (B) This consultation shall inform the creation of a plan for a performance outcome system for EPSDT mental health services. (2) In developing a plan for a performance outcomes system for EPSDT mental health services, the department shall consider the following objectives, among others: (A) High-quality and accessible EPSDT mental health services for eligible children and youth, consistent with federal law. (B) Information that improves practice at the individual, program, and system levels. (C) Minimization of costs by building upon existing resources to the fullest extent possible. (D) Reliable data that is collected and analyzed in a timely fashion. (3) At a minimum, the plan for a performance outcome system for EPSDT mental health services shall consider evidence-based models for performance outcome systems, such as the Child and Adolescent Needs and Strengths (CANS), federal requirements, including the review by the External Quality Review Organization (EQRO), and timelines for implementation at the provider, county, and state levels. (c) The State Department of Health Care Services shall provide the performance outcomes system plan, including milestones and timelines, for EPSDT mental health services described in subdivision (a) to all fiscal committees and appropriate policy committees of the Legislature no later than October 1, 2013. (d) The State Department of Health Care Services shall propose how to implement the performance outcomes system plan for EPSDT mental health services described in subdivision (a) no later than January 10, 2014. (e) (1) (A) Commencing no later than February 1, 2014, the department shall convene a stakeholder advisory committee comprised of advocates for, and representatives of, child and youth clients, family members, managed care health plans, providers, counties, and the Legislature. (B) The committee shall develop methods to routinely measure, assess, and communicate program information regarding informing, identifying, screening, assessing, referring, and linking Medi-Cal eligible beneficiaries to mental health services and supports. (C) The committee shall also review health plan screenings for mental health, health plan referrals to Medi-Cal fee-for-service providers, and health plan referrals to county mental health plans, among others. (D) The committee shall make recommendations to the department regarding performance and outcome measures that will contribute to improving timely access to appropriate care for Medi-Cal eligible beneficiaries. (2) The department shall incorporate into the performance outcomes system established pursuant to this section the screenings and referrals described in this subdivision, including milestones and timelines, and shall provide an updated performance outcomes system plan to all fiscal committees and the appropriate policy committees of the Legislature no later than October 1, 2014. (3) The department shall propose how to implement the updated performance systems outcome plan described in paragraph (2) no later than January 10, 2015. (f) This section shall become operative on January 1, 2025, if amendments to the Mental Health Services Act are approved by the voters at the March 5, 2024, statewide primary election. (Repealed (in Sec. 113) and added by Stats. 2023, Ch. 790, Sec. 114. (SB 326) Effective October 12, 2023. Operative January 1, 2025, by its own provisions. Conditionally inoperative as provided in Section 14721.)
  158. 14707.7.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    The department must consult stakeholders, produce and update specialty mental health performance reports, publish them online, send them to the Legislature, and avoid reporting demographic data that could identify individuals.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14707.7. (a) It is the intent of the Legislature to build upon performance outcomes system reports the department has developed pursuant to Section 14707.5 and the Special Terms and Conditions of the Medi-Cal Specialty Mental Health Services Waiver, as approved pursuant to Section 1915(b) of the federal Social Security Act (42 U.S.C. Sec. 1396n(b)), in order to provide data to inform strategies to reduce mental health disparities. (b) (1) Commencing no later than January 15, 2018, and as needed thereafter, the department shall consult with stakeholders, including, but not limited to, subject-matter experts who represent providers, consumer advocates, consumers, family members, counties, and the Legislature, to inform the updates to the performance outcomes reports for specialty mental health that the department developed pursuant to Section 14707.5 and the Special Terms and Conditions of the Medi-Cal Specialty Mental Health Services Waiver. The stakeholder consultation shall continuously inform the development of performance outcome and disparities reduction measures. (2) In building upon the performance outcomes reports for specialty mental health services, the department shall also consider both of the following objectives, among others: (A) High-quality, culturally and linguistically competent, and accessible specialty mental health services for all eligible beneficiaries, consistent with federal law. (B) Strategies to reduce mental health disparities. (3) The performance outcomes reports for specialty mental health services shall also consider the Special Terms and Conditions of the Medi-Cal Specialty Mental Health Services Waiver, as approved pursuant to Section 1915(b) of the federal Social Security Act (42 U.S.C. Sec. 1396n(b)) and the Medicaid Managed Care Quality Rating System. (4) In order to identify mental health disparities, at a minimum, the performance outcomes reports for specialty mental health services shall be produced using existing data collected by the state, stratified by both the statewide and county levels in the following areas: (A) Access, such as timely access to services, including waiting time to assessment and waiting time to first appointment. (B) Language capacity and language access. (C) Quality. (D) Utilization and penetration. (5) (A) Data required pursuant to paragraph (4) shall be stratified by age, sex, gender identity, race, ethnicity, primary language, sexual orientation, and any other data elements for which there is peer-reviewed evidence to assess performance outcomes related to mental health disparities. (B) The department shall not report any demographic data under paragraph (4) or this paragraph that would permit identification of individuals. (6) (A) The department shall publish the performance outcomes reports based on available data for specialty mental health services described in this section on the department’s Internet Web site by December 31, 2018. The department shall also provide the performance outcomes reports to the Legislature by December 31, 2018. (B) Commencing January 1, 2019, and annually thereafter, the department shall update the performance outcomes reports for specialty mental health and shall post the updated reports on the department’s Internet Web site. (7) Commencing January 1, 2019, the department shall consult, as needed, with the stakeholders specified in paragraph (1) to do both of the following: (A) Incorporate additional components into the performance outcomes reports, including, but not limited to, components concerning the reduction of mental health disparities, such as timely access to services, language access, and quality and utilization measures, relating to mental health services obtained through Medi-Cal managed care plans. (B) Make recommendations for statewide quality improvement and efforts to reduce mental health disparities based on information reported in the performance outcomes reports. (8) Upon completion of the activities specified in paragraph (7), the department shall consult with stakeholders on an as-needed basis. (9) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this subdivision by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action. (Added by Stats. 2017, Ch. 550, Sec. 1. (AB 470) Effective January 1, 2018. Conditionally inoperative as provided in Section 14721.)
  159. 14708.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    Counties may use certified public expenditures to claim certain costs above state maximum rates, but only under specified conditions and using local funds only for the excess portion.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14708. (a) For purposes of federal reimbursement to counties that have certified to the state that they have incurred certified public expenditures, the reimbursement amounts shall be consistent with federal Medicaid requirements for calculating federal upper payment limits, as specified in the approved Medicaid state plan and waivers. (b) If the reimbursement methodology utilizes federal upper payment limits and the total cost of services exceeds the state maximum rates in effect for the 2011–12 fiscal year, a county may use certified public expenditures to claim the costs of services that exceed the state maximum rates, up to the federal upper payment limits. If a county chooses to claim costs that exceed the state maximum rates with certified public expenditures, the county shall use only local funds, and not state funds, to claim the portion of the costs over the state maximum rates. As a condition of receiving reimbursement up to the federal upper payment limits, a county shall enter into and maintain an agreement with the department implementing this subdivision. (c) Notwithstanding this section, in the event that a health facility has entered into a negotiated rate agreement pursuant to Article 2.6 (commencing with Section 14081) of Chapter 7 of Part 4 of Division 9, the facility’s rates shall be governed by that agreement. (d) This section shall become operative on July 1, 2012. (Added by renumbering Section 5720 (as added by Stats. 2011, Ch. 651, Sec. 4) by Stats. 2012, Ch. 34, Sec. 155. (SB 1009) Effective June 27, 2012. Section operative July 1, 2012, by its own provisions. Conditionally inoperative as provided in Section 14721.)
  160. 14709.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    Clinics providing Medi-Cal specialty mental health services must be certified if they want reimbursement for those medical assistance mental health services.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14709. The provisions of subdivision (a) of Section 14000 shall not be construed to prevent providers of specialty mental health services pursuant to this chapter from also being providers of medical assistance mental health services for the purposes of Chapter 7 (commencing with Section 14000). Clinics providing Medi-Cal specialty mental health services pursuant to this chapter shall be required to be certified as a condition to reimbursement for providing those medical assistance mental health services. (Added by renumbering Section 5723 by Stats. 2012, Ch. 34, Sec. 158. (SB 1009) Effective June 27, 2012. Operative July 1, 2012, by Sec. 254 of Ch. 34. Conditionally inoperative as provided in Section 14721.)
  161. 14710.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    The section requires certain service-related fees to be deducted from service costs, restricts use of private charitable donations, and lets a mental health plan contract for retention of unanticipated funds only if those funds are used for specified specialty mental health services.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14710. Except as otherwise provided in this section, in determining the amounts which may be paid, fees paid by persons receiving services or fees paid on behalf of persons receiving services by the federal government, by the Medi-Cal program set forth in Chapter 7 (commencing with Section 14000), and by other public or private sources, shall be deducted from the costs of providing services. However, a mental health plan may negotiate a contract that permits a specialty mental health care provider to retain unanticipated funds above the budgeted contract amount, provided that the unanticipated revenues are utilized for the specialty mental health services specified in the contract. If a provider is permitted by contract to retain unanticipated revenues above the budgeted amount, the specialty mental health provider shall specify the services funded by those revenues in the yearend cost report submitted to the mental health plan. A mental health plan shall not permit the retention of any fees paid by private resources on behalf of Medi-Cal beneficiaries without having those fees deducted from the costs of providing services. Whenever feasible, persons with mental illness who are eligible for specialty mental health services under the Medi-Cal program shall be treated in a facility approved for reimbursement in that program. General unrestricted or undesignated private charitable donations and contributions made to charitable or nonprofit organizations shall not be considered as “fees paid by persons” or “fees paid on behalf of persons receiving services” under this section and the contributions shall not be applied in determining the amounts to be paid. These unrestricted contributions shall not be used in part or in whole to defray the costs or the allocated costs of the Medi-Cal program. (Added by renumbering Section 5721 by Stats. 2012, Ch. 34, Sec. 156. (SB 1009) Effective June 27, 2012. Operative July 1, 2012, by Sec. 254 of Ch. 34. Conditionally inoperative as provided in Section 14721.)
  162. 14711.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    The department must develop a Medi-Cal reimbursement methodology with specified federal consultation and approval constraints, and administrative costs are capped at 15 percent of direct client service costs.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14711. (a) The department shall develop, in consultation with the County Behavioral Health Directors Association of California, a reimbursement methodology for use in the Medi-Cal claims processing and interim payment system that maximizes federal funding and utilizes, as much as practicable, federal Medicaid and Medicare reimbursement principles. The department shall work with the federal Centers for Medicare and Medicaid Services in the development of the methodology required by this section. (b) Reimbursement amounts developed through the methodology required by this section shall be consistent with federal Medicaid requirements and the approved Medicaid state plan and waivers. (c) Administrative costs shall be claimed separately in a manner consistent with federal Medicaid requirements and the approved Medicaid state plan and waivers and shall be limited to 15 percent of the total actual cost of direct client services. (d) The cost of performing quality assurance and utilization review activities shall be reimbursed separately and shall not be included in administrative cost. (e) The reimbursement methodology established pursuant to this section shall be based upon certified public expenditures, which encourage economy and efficiency in service delivery. (f) The reimbursement amounts established for direct client services pursuant to this section shall be based on increments of time for all noninpatient services. (g) The reimbursement methodology shall not be implemented until it has received any necessary federal approvals. (h) This section shall become operative on July 1, 2012. (Amended by Stats. 2015, Ch. 455, Sec. 57. (SB 804) Effective January 1, 2016. Conditionally inoperative as provided in Section 14721.)
  163. 14712.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    The department must run Medi-Cal managed mental health care through contracts with mental health plans, and counties have duties tied to contracting, notice, and shared fiscal responsibility.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14712. (a) Notwithstanding any other state law, the department shall implement managed mental health care for Medi-Cal beneficiaries through contracts with mental health plans. Mental health plans may include individual counties, counties acting jointly, or an organization or nongovernmental entity determined by the department to meet mental health plan standards. A contract may be exclusive and may be awarded on a geographic basis. (b) Two or more counties acting jointly may agree to deliver or subcontract for the delivery of specialty mental health services subject to the approval by the department. The agreement may encompass all or any portion of the specialty mental health services provided pursuant to this chapter. This agreement shall not relieve the individual counties of fiscal responsibility for providing these services. Any agreement between counties shall delineate each county’s responsibilities and fiscal liability for overpayments. (c) (1) The department shall contract with a county or counties acting jointly for the delivery of specialty mental health services to each county’s eligible Medi-Cal beneficiary population. If a county decides not to contract with the department, does not renew its contract, or is unable to meet the standards set by the department, the county shall inform the department of this decision in writing. (2) If the county is unwilling to contract for the delivery of specialty mental health services, the department shall ensure that specialty mental health services are provided to Medi-Cal beneficiaries. (3) If the department or county determines that the county is unable to adequately provide specialty mental health services, or that the county does not meet the standards of a mental health plan, the department shall ensure that specialty mental health services are provided to Medi-Cal beneficiaries. (4) The department may contract with qualifying individual counties, counties acting jointly, or other qualified entities approved by the department for the delivery of specialty mental health services in any county that is unable or unwilling to contract with the department. The county may not subsequently contract to provide specialty mental health services under this chapter unless the department elects to contract with the county. (d) If a county does not contract with the department or other department-approved entity to provide specialty mental health services, the department shall work with the Department of Finance and the Controller to sequester funds from the county that is unable or unwilling to contract in accordance with Section 30027.10 of the Government Code. (Amended by Stats. 2019, Ch. 465, Sec. 11. (AB 1642) Effective January 1, 2020. Conditionally inoperative as provided in Section 14721.)
  164. 14713.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    The department and mental health plans must comply with applicable federal and state requirements. If a mental health plan is found noncompliant with certain chapters, the department may impose sanctions and plans of correction.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14713. (a) The department and mental health plans shall comply with all applicable federal laws, regulations, and the guidelines, standards, and requirements specified in the state plan, waiver, and mental health plan contract, and, except as provided in this chapter, all applicable state statutes and regulations. (b) If the department determines that a mental health plan has failed to comply with the requirements of Chapter 7 (commencing with Section 14000), Chapter 8 (commencing with Section 14200), Chapter 8.8 (commencing with Section 14600), or this chapter, the department may impose sanctions and plans of correction pursuant to Section 14197.7. (c) If federal requirements that affect this chapter are changed, it is the intent of the Legislature that state requirements be revised to comply with those changes. (Amended by Stats. 2019, Ch. 465, Sec. 12. (AB 1642) Effective January 1, 2020. Conditionally inoperative as provided in Section 14721.)
  165. 14714.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    This section sets contract and oversight rules for mental health plans serving Medi-Cal beneficiaries, including who bears financial risk, when services may be transferred, renewal and termination rules, notice requirements, and possible exemptions.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14714. (a) (1) Except as otherwise specified in this chapter, a contract entered into pursuant to this chapter shall include a provision that the mental health plan contractor shall bear the financial risk for the cost of providing medically necessary specialty mental health services to Medi-Cal beneficiaries. (2) If the mental health plan is not administered by a county, the mental health plan shall not transfer the obligation for any specialty mental health services to Medi-Cal beneficiaries to the county. The mental health plan may purchase services from the county. The mental health plan shall establish mutually agreed-upon protocols with the county that clearly establish conditions under which beneficiaries may obtain non-Medi-Cal reimbursable services from the county. Additionally, the plan shall establish mutually agreed-upon protocols with the county for the conditions of transfer of beneficiaries who have lost Medi-Cal eligibility to the county for care under Part 2 (commencing with Section 5600), Part 3 (commencing with Section 5800), and Part 4 (commencing with Section 5850) of Division 5. (3) The mental health plan shall be financially responsible for ensuring access and a minimum required scope of benefits and services, consistent with state and federal requirements, to Medi-Cal beneficiaries who are residents of that county regardless of where the beneficiary resides, except as provided for in Section 14717.1 or 14717.2. The department shall require that the same definition of medical necessity be used, and the minimum scope of benefits offered by each mental health plan be the same, except to the extent that prior federal approval is received and is consistent with state and federal laws. (b) (1) Any contract entered into pursuant to this chapter may be renewed if the mental health plan continues to meet the requirements of this chapter, regulations promulgated pursuant to this chapter, and the terms and conditions of the contract. Failure to meet these requirements shall be cause for nonrenewal of the contract. The department may base the decision to renew on timely completion of a mutually agreed-upon plan of correction of any deficiencies, submissions of required information in a timely manner, or other conditions of the contract. (2) If the contract is not renewed based on the reasons specified in paragraph (1), the department shall notify the Department of Finance, the fiscal and policy committees of the Legislature, and the Controller of the amounts to be sequestered from the Mental Health Subaccount, the Mental Health Equity Account, and the Vehicle License Fee Collection Account of the Local Revenue Fund and the Mental Health Account and the Behavioral Health Subaccount of the Local Revenue Fund 2011, and the Controller shall sequester those funds in the Behavioral Health Subaccount pursuant to Section 30027.10 of the Government Code. Upon this sequestration, the department shall use the funds in accordance with Section 30027.10 of the Government Code. (c) (1) The obligations of the mental health plan shall be changed only by contract or contract amendment. (2) Notwithstanding paragraph (1), the mental health plan shall comply with federal and state requirements, including the applicable sections of the state plan and waiver. (3) A change may be made during a contract term or at the time of contract renewal, when there is a change in obligations required by federal or state law, or when required by a change in the interpretation or implementation of any law or regulation. (4) To the extent permitted by federal law, either the department or the mental health plan may request that contract negotiations be reopened during the course of a contract due to substantial changes in the cost of covered benefits that result from an unanticipated event. (d) The department shall immediately terminate a contract when the director finds that there is an immediate threat to the health and safety of Medi-Cal beneficiaries. Termination of the contract for other reasons shall be subject to reasonable notice of the department’s intent to take that action and notification to affected beneficiaries. The plan may request a hearing by the Office of Administrative Hearings and Appeals. (e) A mental health plan may terminate its contract in accordance with the contract. The mental health plan shall provide written notice to the department at least 180 days before the termination or nonrenewal of the contract. (f) Upon the request of the director, the Director of the Department of Managed Health Care may exempt a mental health plan from the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code). These exemptions may be subject to conditions the director deems appropriate. This section does not impair or diminish the authority of the Director of the Department of Managed Health Care under the Knox-Keene Health Care Service Plan Act of 1975, nor does it reduce or otherwise limit the obligation of a mental health plan contractor licensed as a health care service plan to comply with the requirements of the Knox-Keene Health Care Service Plan Act of 1975, and the rules of the Director of the Department of Managed Health Care promulgated under the Knox-Keene Health Care Service Plan Act of 1975. The director, in consultation with the Director of the Department of Managed Health Care, shall analyze the appropriateness of licensure or application of applicable standards of the Knox-Keene Health Care Service Plan Act of 1975. (g) The department shall provide oversight to the mental health plans to ensure quality, access, cost efficiency, and compliance with data and reporting requirements. At a minimum, the department shall monitor, through a method independent of any agency of the mental health plan contractor, the level and quality of services provided, expenditures pursuant to the contract, and conformity with federal and state law. (h) County employees implementing or administering a mental health plan act in a discretionary capacity when they determine whether or not to admit a person for care or to provide any level of care pursuant to this chapter. (i) If a county discontinues operations as the mental health plan, the department shall approve any new mental health plan. The new mental health plan shall give reasonable consideration to affiliation with nonprofit community mental health agencies that were under contract with the county and that meet the mental health plan’s quality and cost efficiency standards. (j) This chapter does not modify, alter, or increase the obligations of counties as otherwise limited and defined in Chapter 3 (commencing with Section 5700) of Part 2 of Division 5. The county’s maximum obligation for services to persons ineligible for Medi-Cal shall be no more than the amount of funds remaining in the mental health subaccount pursuant to Sections 17600, 17601, 17604, 17605, and 17609 after fulfilling the Medi-Cal contract obligations. (Amended by Stats. 2022, Ch. 402, Sec. 1. (AB 1051) Effective January 1, 2023. Conditionally inoperative as provided in Section 14721.)
  166. 14715.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    The department must require certain mental health plans and Medi-Cal managed care plans to sign an MOU, and the MOU must include notice-handling and response timelines.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14715. (a) (1) The department shall require any mental health plan that provides Medi-Cal specialty mental health services to enter into a memorandum of understanding with any Medi-Cal managed care plan that provides Medi-Cal health services to some of the same Medi-Cal recipients served by the mental health plan. The memorandum of understanding shall comply with applicable regulations. (2) For purposes of this section, a “Medi-Cal managed care plan” means any prepaid health plan or Medi-Cal managed care plan contracting with the department to provide services to enrolled Medi-Cal beneficiaries under Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200), or Part 4 (commencing with Section 101525) of Division 101 of the Health and Safety Code. (b) The department shall require the memorandum of understanding to include both of the following: (1) A process or entity to be designated by the local mental health plan to receive notice of actions, denials, or deferrals from the Medi-Cal managed care plan, and to provide any additional information requested in the deferral notice as necessary for a medical necessity determination. (2) A requirement that the local mental health plan respond by the close of the business day following the day the deferral notice is received. (c) This section shall apply to any contracts entered into, amended, modified, extended, or renewed on or after January 1, 2001. (Amended by Stats. 2019, Ch. 465, Sec. 13. (AB 1642) Effective January 1, 2020. Conditionally inoperative as provided in Section 14721.)
  167. 14716.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    Local mental health plans must set up a procedure to ensure foster children placed outside their county of adjudication can access outpatient specialty mental health services, and the department must collect statistics on access.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14716. (a) Each local mental health plan shall establish a procedure to ensure access to outpatient specialty mental health services, as required by the Early Periodic Screening and Diagnostic Treatment program standards, for any child in foster care who has been placed outside his or her county of adjudication. (b) The procedure required by subdivision (a) may be established through one or more of the following: (1) The establishment of, and federal approval, if required, of, a statewide system or procedure. (2) An arrangement between local mental health plans for reimbursement for services provided by a mental health plan other than the mental health plan in the county of adjudication and designation of an entity to provide additional information needed for approval or reimbursement. This arrangement shall not require providers who are already credentialed or certified by the mental health plan in the beneficiary’s county of residence to be credentialed or certified by, or to contract with, the mental health plan in the county of adjudication. (3) Arrangements between the mental health plan in the county of adjudication and mental health providers in the beneficiary’s county of residence for authorization of, and reimbursement for, services. This arrangement shall not require providers credentialed or certified by, and in good standing with, the mental health plan in the beneficiary’s county of residence to be credentialed or certified by the mental health plan in the county of adjudication. (c) The department shall collect and keep statistics that will enable the department to compare access to outpatient specialty mental health services by foster children placed in their county of adjudication with access to outpatient specialty mental health services by foster children placed outside of their county of adjudication. (Added by renumbering Section 5777.6 by Stats. 2012, Ch. 34, Sec. 177. (SB 1009) Effective June 27, 2012. Operative July 1, 2012, by Sec. 254 of Ch. 34. Conditionally inoperative as provided in Section 14721.)
  168. 14717.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    The department and the California Health and Human Services Agency must create and use standardized mental health contracts, authorization procedures, and documentation forms for certain foster children, and some related reporting and coordination duties apply.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14717. (a) In order to facilitate the receipt of medically necessary specialty mental health services by a foster child who is placed outside his or her county of original jurisdiction, the department shall take all of the following actions: (1) On or before July 1, 2008, create all of the following items, in consultation with stakeholders, including, but not limited to, the California Institute for Mental Health, the Child and Family Policy Institute of California, the County Behavioral Health Directors Association of California, and the California Alliance of Child and Family Services: (A) A standardized contract for the purchase of medically necessary specialty mental health services from organizational providers when a contract is required. (B) A standardized specialty mental health service authorization procedure. (C) A standardized set of documentation standards and forms, including, but not limited to, forms for treatment plans, annual treatment plan updates, day treatment intensive and day treatment rehabilitative progress notes, and treatment authorization requests. (2) On or before January 1, 2009, use the standardized items as described in paragraph (1) to provide medically necessary specialty mental health services to a foster child who is placed outside his or her county of original jurisdiction, so that organizational providers who are already certified by a mental health plan are not required to be additionally certified by the mental health plan in the county of original jurisdiction. (3) (A) On or before January 1, 2009, use the standardized items described in paragraph (1) to provide medically necessary specialty mental health services to a foster child placed outside his or her county of original jurisdiction to constitute a complete contract, authorization procedure, and set of documentation standards and forms, so that no additional documents are required. (B) Authorize a county mental health plan to be exempt from subparagraph (A) and have an addendum to a contract, authorization procedure, or set of documentation standards and forms, if the county mental health plan has an externally placed requirement, such as a requirement from a federal integrity agreement, that would affect one of these documents. (4) Following consultation with stakeholders, including, but not limited to, the California Institute for Mental Health, the Child and Family Policy Institute of California, the County Behavioral Health Directors Association of California, the California State Association of Counties, and the California Alliance of Child and Family Services, require the use of the standardized contracts, authorization procedures, and documentation standards and forms as specified in paragraph (1) in the 2008–09 state-county mental health plan contract and each state-county mental health plan contract thereafter. (5) The mental health plan shall complete a standardized contract, as provided in paragraph (1), if a contract is required, or another mechanism of payment if a contract is not required, with a provider or providers of the county’s choice, to deliver approved specialty mental health services for a specified foster child, within 30 days of an approved treatment authorization request. (b) The California Health and Human Services Agency shall coordinate the efforts of the department and the State Department of Social Services to do all of the following: (1) Participate with the stakeholders in the activities described in this section. (2) During budget hearings in 2008 and 2009, report to the Legislature regarding the implementation of this section and subdivision (c) of Section 14716. (3) On or before July 1, 2008, establish the following, in consultation with stakeholders, including, but not limited to, the County Behavioral Health Directors Association of California, the California Alliance of Child and Family Services, and the County Welfare Directors Association of California: (A) Informational materials that explain to foster care providers how to arrange for specialty mental health services on behalf of the beneficiary in their care. (B) Informational materials that county child welfare agencies can access relevant to the provision of services to children in their care from the out-of-county local mental health plan that is responsible for providing those services, including, but not limited to, receiving a copy of the child’s treatment plan within 60 days after requesting services. (C) It is the intent of the Legislature to ensure that foster children who are adopted or placed permanently with relative guardians, and who move to a county outside their original county of residence, can access specialty mental health services in a timely manner. It is the intent of the Legislature to enact this section as a temporary means of ensuring access to these services, while the appropriate stakeholders pursue a long-term solution in the form of a change to the Medi-Cal Eligibility Data System that will allow these children to receive specialty mental health services through their new county of residence. (Amended by Stats. 2015, Ch. 455, Sec. 58. (SB 804) Effective January 1, 2016. Conditionally inoperative as provided in Section 14721.)
  169. 14717.1.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    This section sets rules for presumptive transfer of specialty mental health responsibility for certain foster children placed outside their county of original jurisdiction.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14717.1. (a) (1) For purposes of this section, “foster child” or “foster children” means a Medi-Cal eligible child or children younger than 21 years of age who have been placed into foster care by a county child welfare agency or a county probation department. (2) It is the intent of the Legislature to ensure that foster children who are placed outside of their county of original jurisdiction are able to access specialty mental health services in a timely manner, consistent with their individual strengths and needs and the requirements of federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services. (3) It is the further intent of the Legislature to overcome any barriers to care that may result when responsibility for providing or arranging for specialty mental health services to foster children who are placed outside of their county of original jurisdiction is retained by the county of original jurisdiction. (b) In order to facilitate the receipt of medically necessary specialty mental health services by a foster child who is placed outside of their county of original jurisdiction, the California Health and Human Services Agency shall coordinate with the department and the State Department of Social Services to take all of the following actions on or before July 1, 2017: (1) The department shall issue policy guidance on the conditions for, and exceptions to, presumptive transfer, as described in subdivisions (c) and (d), in consultation with the State Department of Social Services and with the input of stakeholders that include the County Welfare Directors Association of California, the Chief Probation Officers of California, the County Behavioral Health Directors Association of California, provider representatives, and family and youth advocates. (2) Policy guidance concerning the conditions for, and exceptions to, presumptive transfer shall ensure all of the following: (A) The transfer of responsibility improves access to specialty mental health care services consistent with the mental health needs of the foster child. (B) Presumptive transfer does not disrupt the continuity of care. (C) Conditions and exceptions are applied consistently statewide, giving due consideration to the varying capabilities of small, medium, and large counties. (D) Presumptive transfer can be waived only with an individualized determination that an exception applies. (E) A party to the case who disagrees with the presumptive transfer individualized exception determination made by the county placing agency pursuant to subdivision (d) is afforded an opportunity to request judicial review before a transfer or exception being finalized. (F) There is a procedure for expedited transfer within 48 hours of placement of the child outside of the county of original jurisdiction. (c) For purposes of this section, “presumptive transfer” means that absent any exceptions as established pursuant to this section, responsibility for providing or arranging for specialty mental health services shall promptly transfer from the county of original jurisdiction to the county in which the foster child resides, under either of the following conditions: (1) A foster child is placed in a county other than the county of original jurisdiction on or after July 1, 2017. (2) A foster child who resides in a county other than the county of original jurisdiction after June 30, 2017, and is not receiving specialty mental health services consistent with their mental health needs, requests transfer of responsibility. A foster child who resided in a county other than the county of original jurisdiction after June 30, 2017, and who continues to reside outside the county of original jurisdiction after December 31, 2017, shall have jurisdiction transferred no later than the child’s first regularly scheduled status review hearing conducted pursuant to Section 366 in the 2018 calendar year unless an exception described under subdivision (d) applies. (d) (1) On a case-by-case basis, and when consistent with the medical rights of children in foster care, presumptive transfer may be waived and the responsibility for the provision of specialty mental health services shall remain with the county of original jurisdiction if any of the exceptions described in paragraph (5) exist. (2) A request for waiver in a manner established by the department may be made by the foster child, the person or agency that is responsible for making mental health care decisions on behalf of the foster child, the county probation agency or the child welfare services agency with responsibility for the care and placement of the child, or any other interested party who owes a legal duty to the child involving the child’s health or welfare, as defined by the department. (3) The county probation agency or the child welfare services agency with responsibility for the care and placement of the child, in consultation with the child and their parent, the child and family team, as defined in paragraph (4) of subdivision (a) of Section 16501, if one exists, and other professionals who serve the child as appropriate, is responsible for determining whether waiver of the presumptive transfer is appropriate pursuant to the conditions and exceptions established under this section. The person who requested the exception, along with any other parties to the case, shall receive notice of the county agency’s determination. (4) The individual who requested the exception or any other party to the case who disagrees with the determination made by the county agency pursuant to paragraph (3) may request judicial review before the county’s determination becoming final. The court may set the matter for hearing and may confirm or deny the transfer of jurisdiction or application of an exception based on the best interest of the child. (5) Presumptive transfer may be waived under any of the following exceptions: (A) It is determined that the transfer would disrupt continuity of care or delay access to services provided to the foster child. (B) It is determined that the transfer would interfere with family reunification efforts documented in the individual case plan. (C) The foster child’s placement in a county other than the county of original jurisdiction is expected to last less than six months. (D) The foster child’s residence is within 30 minutes of travel time to the child’s established specialty mental health care provider in the county of original jurisdiction. (6) A waiver processed based on an exception to presumptive transfer shall be contingent upon the mental health plan in the county of original jurisdiction demonstrating an existing contract with a specialty mental health care provider, or the ability to enter into a contract, single case agreement, or other service payment mechanism within 30 days of the waiver decision, and the ability to deliver timely specialty mental health services directly to the foster child. That information shall be documented in the child’s case plan. (7) A request for waiver, the exceptions claimed as the basis for the request, a determination whether a waiver is determined to be appropriate under this section, and any objections to the determination shall be documented in the foster child’s case plan pursuant to Section 16501.1. (e) If the mental health plan in the county of original jurisdiction has completed an assessment of needed services for the foster child, the mental health plan in the county in which the foster child resides shall accept that assessment. The mental health plan in the county in which the foster child resides may conduct additional assessments if the foster child’s needs change or an updated assessment is needed to determine the child’s needs and identify the needed treatment and services to address those needs. (f) (1) Upon presumptive transfer, the mental health plan in the county in which the foster child resides shall assume responsibility for the authorization and provision of specialty mental health services and payments for services. The foster child transferred to the mental health plan in the county in which the foster child resides shall be considered part of the county of residence caseload for claiming purposes from the Behavioral Health Subaccount and the Behavioral Health Services Growth Special Account, both created pursuant to Section 30025 of the Government Code. (2) To support service delivery, continuity of care, and timely payment, the placing agency shall provide notification to the mental health plan that will be responsible for arranging and providing specialty mental health services for the foster child before placing a foster child out of county. The placing agency may complete these notifications through email. If notification before placement is not possible, the placing agency shall notify the appropriate mental health plan no later than three business days after making the out-of-county placement. (g) The State Department of Social Services and the department shall adopt regulations by July 1, 2027, to implement this section. Notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the State Department of Social Services and the department may implement and administer the changes made by this legislation through all-county letters, information notices, or similar written instructions until regulations are adopted. (h) (1) If the department determines it is necessary, it shall seek approval from the United States Department of Health and Human Services, federal Centers for Medicare and Medicaid Services before implementing this section. (2) If the department makes the determination that it is necessary to seek federal approval pursuant to paragraph (1), the department shall make an official request for approval from the federal government no later than January 1, 2017. (i) This section shall be implemented only if, and to the extent that, federal financial participation under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is available and all necessary federal approvals have been obtained. (j) Commencing July 1, 2024, in the case of placement of foster children in short-term residential therapeutic programs, community treatment facilities, or group homes, or in the case of admission of foster children to children’s crisis residential programs, this section shall apply only if the circumstances described in paragraph (1) or (2) of subdivision (b) of Section 14717.2 exist. (Amended by Stats. 2023, Ch. 42, Sec. 160. (AB 118) Effective July 10, 2023.)
  170. 14717.2.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    This section keeps a foster child’s county of original jurisdiction responsible for arranging and providing specialty mental health services when the child is placed out of county, unless specified exceptions apply.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14717.2. (a) (1) For purposes of this section, “foster child” or “foster children” means a Medi-Cal eligible child or children younger than 21 years of age who have been placed into foster care by a county child welfare agency or a county probation department. (2) It is the intent of the Legislature to ensure that foster children who are placed in community treatment facilities, group homes, or short-term residential therapeutic programs, or who are admitted to children’s crisis residential programs, outside of their county of original jurisdiction, are able to access specialty mental health services in a timely manner, consistent with their individual strengths and needs and the requirements of federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services. (3) The Legislature finds that because group home placements or short-term residential therapeutic program placements are intended to be short term, and because community treatment facility placements and children’s crisis residential program admissions are intended to be time-limited based on medical necessity, the responsibility for the provision of or arrangement for specialty mental health services for a foster child throughout the short-term or time-limited placement or admission shall remain with the county of original jurisdiction. (4) The Legislature intends that the placement of a foster child in a group home, community treatment facility, or short-term residential therapeutic program, or the admission of the child to a children’s crisis residential program outside of the county of original jurisdiction should not disrupt continuity of care or adversely impact timely payment to the provider of specialty mental health services. (b) Commencing July 1, 2024, a foster child’s county of original jurisdiction shall retain responsibility to arrange and provide specialty mental health services if the foster child is placed out of the county of original jurisdiction in a community treatment facility, group home, or short-term residential therapeutic program, or is admitted to a children’s crisis residential program, as these settings are defined in paragraph (8), (13), (18), or (21), respectively, of subdivision (a) of Section 1502 of the Health and Safety Code, unless either of the following circumstances exist: (1) The case plan for the foster child specifies that the child will transition to a less restrictive placement in the same county as the facility in which the child has been placed. (2) The placing agency determines, as informed by the child and family team, as defined in paragraph (4) of subdivision (a) of Section 16501, that the child will be negatively impacted if responsibility for providing or arranging for specialty mental health services is not transferred to the same county as the facility in which the child has been placed. The placing agency shall document the basis for making this determination in the child’s case record and may include in a child and family team meeting the mental health plan of the receiving county where the facility is located. It is the intent of the Legislature to encourage local coordination with the receiving county mental health plan. (c) If the circumstances in paragraph (1) or (2) of subdivision (b) exist, the process for presumptive transfer of responsibility for arranging and providing specialty mental health services set forth in Section 14717.1 shall apply. (d) (1) To support service delivery, continuity of care, and timely payment, the placing agency shall provide notification to the mental health plan that will be responsible for arranging and providing specialty mental health services for the foster child before placing a foster child out of county in a community treatment facility, group home, or short-term residential therapeutic program, or admitting a foster child to a children’s crisis residential program. The placing agency may complete these notifications through email. If notification before placement or admission is not possible, the placing agency shall notify the appropriate mental health plan no later than three business days after making the out-of-county placement. (2) Upon accepting placement or admission of a foster child, a group home, short-term residential therapeutic program, community treatment facility, or children’s crisis residential program may notify the mental health plan that will be responsible for arranging and providing specialty mental health services for the foster child that the foster child has been admitted to a children’s crisis residential program or placed in a group home, short-term residential therapeutic program, or community treatment facility. (e) If the circumstances in paragraph (1) or (2) of subdivision (b) exist at any point during the foster child’s placement or admission out of county, Section 14717.1 shall apply. (f) The placing agency shall document which mental health plan is responsible for providing or arranging for specialty mental health services. (g) (1) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department and the State Department of Social Services may implement, interpret, or make specific this section, in whole or in part, by means of plan or county letters, information notices, plan or provider bulletins, or similar written instructions, until regulations are adopted. (2) By July 1, 2027, the department and the State Department of Social Services shall adopt regulations to implement this section in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. (h) (1) If the department determines it is necessary, it shall seek approval from the United States Department of Health and Human Services, federal Centers for Medicare and Medicaid Services before implementing this section. (2) If the department makes the determination that it is necessary to seek federal approval pursuant to paragraph (1), the department shall make an official request for approval from the federal government no later than July 1, 2025. (i) This section shall be implemented only if, and to the extent that, federal financial participation under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) is available and all necessary federal approvals have been obtained. (Amended by Stats. 2023, Ch. 42, Sec. 161. (AB 118) Effective July 10, 2023.)
  171. 14717.25.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    For certain out-of-county foster children needing specialty mental health services, the county mental health plan and provider may use or create a payment contract, and the county plans must enter into a payment agreement within 30 days after notice if needed.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14717.25. (a) (1) For purposes of this section, “foster child” or “foster children” means a Medi-Cal eligible child or children younger than 21 years of age who have been placed into foster care by a county child welfare agency or a county probation department. (2) It is the intent of the Legislature to support timely payment to the provider for services to help ensure foster children placed out of county receive the care and treatment that they need. (b) If a foster child who needs to receive, or who is already receiving, specialty mental health services is placed out of county in a group home, community treatment facility, children’s crisis residential program, or short-term residential therapeutic program, and responsibility for providing and arranging for the child’s specialty mental health services is not transferred, in accordance with Sections 14717.1 and 14717.2, the mental health plan in the county of original jurisdiction and the specialty mental health services provider may choose one of the following options in order to ensure timely payment for specialty mental health services provided to the foster child: (1) Utilize an existing contract between the mental health plan in the county of original jurisdiction and the specialty mental health services provider for payment of services within a mutually agreed upon timeframe. (2) Establish a contract for payment of specialty mental health services for a foster child or multiple foster children for payment of services within a mutually agreed upon timeframe. (c) (1) If neither of the options described in paragraph (1) or (2) of subdivision (b) is available, and if the responsibility for arranging and providing specialty mental health services was not transferred, in accordance with Sections 14717.1 and 14717.2, payment for the specialty mental health services shall be made by the mental health plan in the county of original jurisdiction or through an agreement between the mental health plan in the county of residence and the mental health plan in the county of original jurisdiction. (2) The mental health plan in the county of original jurisdiction and the mental health plan in the county of residence shall enter into the agreement for payment of services within 30 days of notice, by either the placing agency or the placement provider, of the out-of-county placement. (Added by Stats. 2022, Ch. 402, Sec. 4. (AB 1051) Effective January 1, 2023.)
  172. 14717.26.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    The department and the State Department of Social Services must collect data about specialty mental health services for foster children placed outside their county, and the department must include that data in its performance dashboard.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14717.26. (a) For purposes of this section, “foster children” means Medi-Cal eligible children younger than 21 years of age who have been placed into foster care by a county child welfare agency or a county probation department. (b) The department and the State Department of Social Services shall collect data on the receipt of specialty mental health services by foster children who are placed outside of their county of original jurisdiction. These data shall be included in the department’s Medi-Cal specialty mental health services performance dashboard, in compliance with all applicable state and federal privacy and confidentiality laws, and shall contain all of the following statewide information: (1) The number of foster children placed out of county. (2) The number of foster children placed out of county who receive specialty mental health services. (3) For foster children placed out of county who receive specialty mental health services, the number of foster children for whom the county of original jurisdiction is responsible for providing or arranging for those services, and the number of foster children for whom the county of residence is responsible for that provision or arrangement. (Added by Stats. 2022, Ch. 402, Sec. 5. (AB 1051) Effective January 1, 2023.)
  173. 14717.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    An EQRO must conduct an annual mental health plan review, and the department and mental health plans must publish, review, share, and respond to foster-care-related Medi-Cal mental health data.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14717.5. (a) A mental health plan review shall be conducted annually by an external quality review organization (EQRO) pursuant to federal regulations at 42 C.F.R. 438.350 et seq. Commencing July 1, 2018, the review shall include specific data for Medi-Cal eligible minor and nonminor dependents in foster care, including all of the following: (1) The number of Medi-Cal eligible minor and nonminor dependents in foster care served each year. (2) Details on the types of mental health services provided to children, including prevention and treatment services. These types of services may include, but are not limited to, screenings, assessments, home-based mental health services, outpatient services, day treatment services or inpatient services, psychiatric hospitalizations, crisis interventions, case management, and psychotropic medication support services. (3) Access to, and timeliness of, mental health services, as described in Sections 1300.67.2, 1300.67.2.1, and 1300.67.2.2 of Title 28 of the California Code of Regulations and consistent with Section 438.206 of Title 42 of the Code of Federal Regulations, available to Medi-Cal eligible minor and nonminor dependents in foster care. (4) Quality of mental health services available to Medi-Cal eligible minor and nonminor dependents in foster care. (5) Translation and interpretation services, consistent with Section 438.10(c)(4) and (5) of Title 42 of the Code of Federal Regulations and Section 1810.410 of Title 9 of the California Code of Regulations, available to Medi-Cal eligible minor and nonminor dependents in foster care. (6) Performance data for Medi-Cal eligible minor and nonminor dependents in foster care. (7) Utilization data for Medi-Cal eligible minor and nonminor dependents in foster care. (8) Medication monitoring consistent with the child welfare psychotropic medication measures developed by the State Department of Social Services and any Healthcare Effectiveness Data and Information Set (HEDIS) measures related to psychotropic medications, including, but not limited to, the following: (A) Follow-Up Care for Children Prescribed Attention Deficit Hyperactivity Disorder Medication (HEDIS ADD). (B) Use of Multiple Concurrent Antipsychotics in Children and Adolescents (HEDIS APC). (C) Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (HEDIS APP). (D) Metabolic Monitoring for Children and Adolescents on Antipsychotics (HEDIS APM). (b) (1) The department shall post the EQRO data disaggregated by Medi-Cal eligible minor and nonminor dependents in foster care on the department’s Internet Web site in a manner that is publicly accessible. (2) The department shall review the EQRO data for Medi-Cal eligible minor and nonminor dependents in foster care. (3) If the EQRO identifies deficiencies in a mental health plan’s ability to serve Medi-Cal eligible minor and nonminor dependents in foster care, the department shall notify the mental health plan in writing of identified deficiencies. (4) The mental health plan shall provide a written corrective action plan to the department within 60 days of receiving the notice required pursuant to paragraph (3). The department shall notify the mental health plan of approval of the corrective action plan or shall request changes, if necessary, within 30 days after receipt of the corrective action plan. Final corrective action plans shall be made publicly available by, at minimum, posting on the department’s Internet Web site. (c) To the extent possible, the department shall, in connection with its duty to implement Section 14707.5, share with county boards of supervisors data that will assist in the development of mental health service plans, such as data described in federal regulations at 42 C.F.R. 438.350 et seq., in subdivision (c) of Section 16501.4 of this code, and in paragraph (1) of subdivision (a) of Section 1538.8 of the Health and Safety Code. (d) The department shall annually share performance outcome system data with county boards of supervisors for the purpose of informing mental health service plans. Performance outcome system data shared with county boards of supervisors shall include, but not be limited to, the following disaggregated data for Medi-Cal eligible minor and nonminor dependents in foster care: (1) The number of youth receiving specialty mental health services. (2) The racial distribution of youth receiving specialty mental health services. (3) The gender distribution of youth receiving specialty mental health services. (4) The number of youth, by race, with one or more specialty mental health service visits. (5) The number of youth, by race, with five or more specialty mental health service visits. (6) Utilization data for intensive home services, intensive care coordination, case management, therapeutic behavioral services, medication support services, crisis intervention, crisis stabilization, full-day intensive treatment, full-day treatment, full-day rehabilitation, and hospital inpatient days. (7) A unique count of youth receiving specialty mental health services who are arriving, exiting, and continuing with services. (e) The department shall ensure that the performance outcome system data metrics include disaggregated data for Medi-Cal eligible minor and nonminor dependents in foster care. These data shall be in a format that can be analyzed. (Amended by Stats. 2017, Ch. 561, Sec. 290. (AB 1516) Effective January 1, 2018.)
  174. 14718.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    This section governs reimbursement, claims, oversight, privacy limits, and appeals for Medi-Cal specialty mental health services.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14718. (a) This section shall be limited to specialty mental health services reimbursed to a mental health plan that certifies public expenditures subject to cost settlement or specialty mental health services reimbursed through the department’s fiscal intermediary. (b) The following provisions shall apply to matters related to specialty mental health services provided under the approved Medi-Cal state plan and the Specialty Mental Health Services Waiver, including, but not limited to, reimbursement and claiming procedures, reviews and oversight, and appeal processes for mental health plans (MHPs) and MHP subcontractors. (1) As determined by the department, the MHP shall submit claims for reimbursement to the Medi-Cal program for eligible services. (2) The department may offset the amount of any federal disallowance, audit exception, or overpayment against subsequent claims from the MHP. The department may offset the amount of any state disallowance, or audit exception or overpayment against subsequent claims from the mental health plan, through the 2010–11 fiscal year. This offset may be done at any time, after the department has invoiced or otherwise notified the mental health plan about the audit exception, disallowance, or overpayment. The department shall determine the amount that may be withheld from each payment to the mental health plan. The maximum withheld amount shall be 25 percent of each payment as long as the department is able to comply with the federal requirements for repayment of federal financial participation pursuant to Section 1903(d)(2) of the federal Social Security Act (42 U.S.C. Sec. 1396b(d)(2)). The department may increase the maximum amount when necessary for compliance with federal laws and regulations. (3) (A) Oversight by the department of the MHPs may include client record reviews of Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) specialty mental health services rendered by MHPs and MHP subcontractors under the Medi-Cal specialty mental health services waiver in addition to other audits or reviews that are conducted. (B) The department may contract with an independent, nongovernmental entity to conduct client record reviews. The contract awarded in connection with this section shall be on a competitive bid basis, pursuant to the Department of General Services contracting requirements, and shall meet both of the following additional requirements: (i) Require the entity awarded the contract to comply with all federal and state privacy laws, including, but not limited to, the federal Health Insurance Portability and Accountability Act (HIPAA; 42 U.S.C. Sec. 1320d et seq.) and its implementing regulations, the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code), and Section 1798.81.5 of the Civil Code. The entity shall be subject to existing penalties for violation of these laws. (ii) Prohibit the entity awarded the contract from using or disclosing client records or client information for a purpose other than the one for which the record was given. (iii) Prohibit the entity awarded the contract from selling client records or client information. (C) For purposes of this paragraph, the following terms shall have the following meanings: (i) “Client record” means a medical record, chart, or similar file, as well as other documents containing information regarding an individual recipient of services, including, but not limited to, clinical information, dates and times of services, and other information relevant to the individual and services provided and that evidences compliance with legal requirements for Medi-Cal reimbursement. (ii) “Client record review” means examination of the client record for a selected individual recipient for the purpose of confirming the existence of documents that verify compliance with legal requirements for claims submitted for Medi-Cal reimbursement. (D) The department shall recover overpayments of federal financial participation from MHPs within the timeframes required by federal law and regulation for repayment to the federal Centers for Medicare and Medicaid Services. (4) (A) The department, in consultation with mental health stakeholders, the County Behavioral Health Directors Association of California, and MHP subcontractor representatives, shall provide an appeals process that specifies a progressive process for resolution of disputes about claims or recoupments relating to specialty mental health services under the Medi-Cal specialty mental health services waiver. (B) The department shall provide MHPs and MHP subcontractors the opportunity to directly appeal findings in accordance with procedures that are similar to those described in Article 1.5 (commencing with Section 51016) of Chapter 3 of Subdivision 1 of Division 3 of Title 22 of the California Code of Regulations, until new regulations for a progressive appeals process are promulgated. When an MHP subcontractor initiates an appeal, it shall give notice to the MHP. The department shall propose a rulemaking package consistent with the department’s appeals process that is in effect on July 1, 2012, by no later than the end of the 2013–14 fiscal year. The reference in this subparagraph to the procedures described in Article 1.5 (commencing with Section 51016) of Chapter 3 of Subdivision 1 of Division 3 of Title 22 of the California Code of Regulations, shall only apply to those appeals addressed in this subparagraph. (C) The department shall develop regulations as necessary to implement this paragraph. (5) The department shall conduct oversight of utilization controls as specified in Section 14133. The MHP shall include a requirement in any subcontracts that all inpatient subcontractors maintain necessary licensing and certification. MHPs shall require that services delivered by licensed staff are within their scope of practice. Nothing in this chapter shall prohibit the MHPs from establishing standards that are in addition to the federal and state requirements, provided that these standards do not violate federal and state requirements and guidelines. (6) (A) Subject to federal approval and consistent with state requirements, the MHP may negotiate rates with providers of specialty mental health services. (B) Any excess in the distribution of funds over the expenditures for services by the mental health plan shall be spent for the provision of specialty mental health services and related administrative costs. (7) Nothing in this chapter shall limit the MHP from being reimbursed appropriate federal financial participation for any qualified services. To receive federal financial participation, the mental health plan shall certify its public expenditures for specialty mental health services to the department. (8) Notwithstanding Section 14115, claims for federal reimbursement for service pursuant to this chapter shall be submitted by MHPs within the timeframes required by federal Medicaid requirements and the approved Medicaid state plan and waivers. (9) The MHP shall use the fiscal intermediary of the Medi-Cal program of the State Department of Health Care Services for the processing of claims for inpatient psychiatric hospital services rendered in fee-for-service Medi-Cal hospitals. The department shall request the Controller to offset the distribution of funds to the counties from the Mental Health Subaccount, the Mental Health Equity Subaccount, or the Vehicle License Collection Account of the Local Revenue Fund, or funds from the Mental Health Account or the Behavioral Health Subaccount of the Local Revenue Fund 2011 for the nonfederal financial participation share for these claims. (c) Counties may set aside funds for self-insurance, audit settlement, and statewide program risk pools. The counties shall assume all responsibility and liability for appropriate administration of the funds. Special consideration may be given to small counties with a population of less than 200,000. This subdivision shall not make the state or department liable for mismanagement or loss of funds by the entity designated by counties under this subdivision. (d) The department shall consult with the County Behavioral Health Directors Association of California in February and September of each year to obtain data and methodology necessary to forecast future fiscal trends in the provision of specialty mental health services provided under the Medi-Cal specialty mental health services waiver, to estimate yearly specialty mental health services related costs, and to estimate the annual amount of federal funding participation to reimburse costs of specialty mental health services provided under the Medi-Cal specialty mental health services waiver. This shall include a separate presentation of the data and methodology necessary to forecast future fiscal trends in the provision of Early Periodic Screening, Diagnosis, and Treatment specialty mental health services provided under the Medi-Cal specialty mental health services waiver, to estimate annual EPSDT specialty mental health services related costs, and to estimate the annual amount of EPSDT specialty mental health services provided under the state Medi-Cal specialty mental health services waiver, including federal funding participation to reimburse costs of EPSDT. (e) When seeking federal approval for any federal Medicaid state plan amendment or waiver associated with Medi-Cal specialty mental health services, the department shall consult with staff of the Legislature, counties, providers, and other stakeholders in the development of the state plan amendment or waiver. (f) This section shall become operative on July 1, 2012. (Amended by Stats. 2015, Ch. 455, Sec. 59. (SB 804) Effective January 1, 2016. Conditionally inoperative as provided in Section 14721.)
  175. 14718.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    The Controller may use money from the Mental Health Managed Care Deposit Fund for loans to the General Fund, and interest must be paid on those loans.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14718.5. Notwithstanding any other law, including subdivision (b) of Section 16310 of the Government Code, the Controller may use the moneys in the Mental Health Managed Care Deposit Fund for loans to the General Fund as provided in Sections 16310 and 16381 of the Government Code. Interest shall be paid on all moneys loaned to the General Fund from the Mental Health Managed Care Deposit Fund. Interest payable shall be computed at a rate determined by the Pooled Money Investment Board to be the current earning rate of the fund from which loaned. This subdivision does not authorize any transfer that will interfere with the carrying out of the object for which the Mental Health Managed Care Deposit Fund was created. (Added by renumbering Section 5778.3 by Stats. 2012, Ch. 34, Sec. 180. (SB 1009) Effective June 27, 2012. Conditionally inoperative as provided in Section 14721.)
  176. 14721.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    The chapter applies only if the needed federal waivers are obtained, and the director must file a declaration confirming that waiver. The chapter becomes inoperative if the director files a declaration about certain county or funding conditions.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14721. (a) This chapter shall only be implemented to the extent that the necessary federal waivers are obtained. The director shall execute a declaration, to be retained by the director, that a waiver necessary to implement any provision of this chapter has been obtained. (b) This chapter shall become inoperative on the date that, and only if, the director executes a declaration, to be retained by the director, that more than 10 percent of all counties fail to become mental health plan contractors, and acceptable alternative contractors are not available, or if more than 10 percent of all funds allocated for Medi-Cal mental health services must be administered by the department because an acceptable plan is not available. (Added by renumbering Section 5780 by Stats. 2012, Ch. 34, Sec. 182. (SB 1009) Effective June 27, 2012. Operative July 1, 2012, by Sec. 254 of Ch. 34. Note: Termination clause applies to Chapter 8.9, comprising Sections 14700 to 14726.)
  177. 14722.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    A mental health plan may contract with a hospital for specialty mental health services for Medi-Cal beneficiaries, and the negotiated reimbursement rates are treated as payment in full, subject to third-party liability and patient share of costs.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14722. (a) Notwithstanding any other law, a mental health plan may enter into a contract for the provision of specialty mental health services for Medi-Cal beneficiaries with a hospital that provides for a per diem reimbursement rate for services that include room and board, routine hospital services, and all hospital-based ancillary services and that provides separately for the attending mental health professional’s daily visit fee. The payment of these negotiated reimbursement rates to the hospital by the mental health plan shall be considered payment in full for each day of inpatient psychiatric and hospital care rendered to a Medi-Cal beneficiary, subject to third-party liability and patient share of costs, if any. (b) This section shall not be construed to allow a hospital to interfere with, control, or otherwise direct the professional judgment of a physician and surgeon in a manner prohibited by Section 2400 of the Business and Professions Code or any other provision of law. (c) For purposes of this section, “hospital” means a hospital that submits reimbursement claims for Medi-Cal psychiatric inpatient hospital services through the Medi-Cal fiscal intermediary. (Added by renumbering Section 5781 by Stats. 2012, Ch. 34, Sec. 183. (SB 1009) Effective June 27, 2012. Operative July 1, 2012, by Sec. 254 of Ch. 34. Conditionally inoperative as provided in Section 14721.)
  178. 14723.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

    Verify source ↗

    Eligible public agencies may receive supplemental Medi-Cal reimbursement if they meet the section’s conditions, while the department must seek federal approval and cannot pay before approval.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14723. (a) Each eligible public agency, as described in subdivision (b), may, in addition to reimbursement or other payments that the agency would otherwise receive for Medi-Cal specialty mental health services, receive supplemental Medi-Cal reimbursement to the extent provided for in this section. (b) A public agency shall be eligible for supplemental reimbursement only if it is a county, city, or city and county and if, consistent with Section 14718 it provides as a mental health plan, or subcontracts for, specialty mental health services to Medi-Cal beneficiaries pursuant to the Medi-Cal Specialty Mental Health Consolidation Waiver (Number CA.17), as approved by the federal Centers for Medicare and Medicaid Services. (c) (1) Subject to paragraph (2), an eligible public agency’s supplemental reimbursement pursuant to this section shall be equal to the amount of federal financial participation received as a result of the claims submitted pursuant to paragraph (2) of subdivision (f). (2) Notwithstanding paragraph (1), in computing an eligible public agency’s reimbursement, in no instance shall the expenditures certified pursuant to paragraph (1) of subdivision (e), when combined with the amount received from other sources of payment and with reimbursement from the Medi-Cal program, including expenditures otherwise certified for purposes of claiming federal financial participation, exceed 100 percent of actual, allowable costs, as determined pursuant to California’s Medicaid State Plan, for the specialty mental health services to which the expenditure relates. Supplemental payment may be made on an interim basis until the time when actual, allowable costs are finally determined. (3) The supplemental Medi-Cal reimbursement provided by this section shall be distributed under a payment methodology based on specialty mental health services provided to Medi-Cal patients by each eligible public agency, on a per-visit basis, a per-procedure basis, a time basis, in one or more lump sums, or on any other federally permissible basis. The department shall seek approval from the federal Centers for Medicare and Medicaid Services for the payment methodology to be utilized, and shall not make any payment pursuant to this section prior to obtaining that federal approval. (d) (1) It is the intent of the Legislature in enacting this section to provide the supplemental reimbursement described in this section without any expenditure from the General Fund. The department may require an eligible public agency, as a condition of receiving supplemental reimbursement pursuant to this section, to enter into, and maintain, an agreement with the department for the purposes of implementing this section and reimbursing the department for the costs of administering this section. (2) Expenditures submitted to the department for purposes of claiming federal financial participation under this section shall have been paid only with funds from the public agencies described in subdivision (b) and certified to the state as provided in subdivision (e). (e) An eligible public agency shall do all of the following: (1) Certify, in conformity with the requirements of Section 433.51 of Title 42 of the Code of Federal Regulations, that the claimed expenditures for the specialty mental health services are eligible for federal financial participation. (2) Provide evidence supporting the certification as specified by the department. (3) Submit data as specified by the department to determine the appropriate amounts to claim as expenditures qualifying for federal financial participation. (4) Keep, maintain, and have readily retrievable, any records specified by the department to fully disclose reimbursement amounts to which the eligible public agency is entitled, and any other records required by the federal Centers for Medicare and Medicaid Services. (f) (1) The department shall promptly seek any necessary federal approvals for the implementation of this section. If necessary to obtain federal approval, the program shall be limited to those costs that the federal Centers for Medicare and Medicaid Services determines to be allowable expenditures under Title XIX of the federal Social Security Act (Subchapter 19 (commencing with Section 1396) of Chapter 7 of Title 42 of the United States Code). If federal approval is not obtained for implementation of this section, this section shall not be implemented. (2) The department shall submit claims for federal financial participation for the expenditures described in subdivision (e) related to specialty mental health services that are allowable expenditures under federal law. (3) The department shall, on an annual basis, submit any necessary materials to the federal Centers for Medicare and Medicaid Services to provide assurances that claims for federal financial participation will include only those expenditures that are allowable under federal law. (g) (1) The director may adopt regulations as are necessary to implement this section. The adoption, amendment, repeal, or readoption of a regulation authorized by this subdivision shall be deemed to be necessary for the immediate preservation of the public peace, health and safety, or general welfare, for purposes of Sections 11346.1 and 11349.6 of the Government Code, and the department is hereby exempted from the requirement that it describe specific facts showing the need for immediate action. (2) As an alternative to the adoption of regulations pursuant to paragraph (1), and notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the director may implement and administer this article, in whole or in part, by means of provider bulletins or similar instructions, without taking regulatory action, provided that no bulletin or similar instruction shall remain in effect after June 30, 2011. It is the intent that regulations adopted pursuant to paragraph (1) shall be in place on or before June 30, 2011. (Added by renumbering Section 5783 by Stats. 2012, Ch. 34, Sec. 185. (SB 1009) Effective June 27, 2012. Operative July 1, 2012, by Sec. 254 of Ch. 34. Conditionally inoperative as provided in Section 14721.)
  179. 14725.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

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    The State Department of Health Care Services must develop and issue quality assurance standards for Medi-Cal specialty mental health services, and those standards must be reviewed with stakeholders, based on federal Medicaid requirements, and sensitive to small rural counties.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14725. (a) The State Department of Health Care Services shall develop a quality assurance program to govern the delivery of Medi-Cal specialty mental health services, in order to ensure quality patient care based on community standards of practice. (b) The department shall issue standards and guidelines for local quality assurance activities. These standards and guidelines shall be reviewed and revised in consultation with the County Behavioral Health Directors Association of California, as well as other stakeholders from the mental health community, including, but not limited to, individuals who receive services, family members, providers, mental health advocacy groups, and other interested parties. The standards and guidelines shall be based on federal Medicaid requirements. (c) The standards and guidelines developed by the department shall reflect the special problems that small rural counties have in undertaking comprehensive quality assurance systems. (Amended by Stats. 2015, Ch. 455, Sec. 60. (SB 804) Effective January 1, 2016. Conditionally inoperative as provided in Section 14721.)
  180. 14726.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

    Verify source ↗

    The department must approve each local program’s initial quality assurance plan and later review and approve the program’s Medi-Cal specialty mental health services quality assurance plan when it is amended or changed.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14726. The department shall approve each local program’s initial quality assurance plan, and shall thereafter review and approve each program’s Medi-Cal specialty mental health services quality assurance plan whenever the plan is amended or changed. (Added by renumbering Section 4071 by Stats. 2012, Ch. 34, Sec. 58. (SB 1009) Effective June 27, 2012. Operative July 1, 2012, by Sec. 254 of Ch. 34. Conditionally inoperative as provided in Section 14721.)
  181. 14727.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. )

    Verify source ↗

    A mental health plan must give notice about language access, disability accommodations, grievance procedures, and nondiscrimination, and it must place that information in specified formats and locations.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 8.9. Transition of Community-Based Medi-Cal Mental Health [14700 - 14727] ( Chapter 8.9 added by Stats. 2011, Ch. 29, Sec. 20. ) ## 14727. (a) A mental health plan shall notify beneficiaries, prospective beneficiaries, and members of the public of all of the following information: (1) The availability of language assistance services, including oral interpretation and translated written materials, free of charge and in a timely manner, when those services are necessary to provide meaningful access to an individual with limited English proficiency (LEP). (2) The availability of appropriate auxiliary aids and services, including qualified interpreters for individuals with disabilities and information in alternate formats, free of charge and in a timely manner, when those aids and services are necessary to ensure an equal opportunity to participate for individuals with disabilities. (3) A mental health plan does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability. (4) The availability of the grievance procedure and how to file a grievance, including identification of, and contact information for, the designated mental health plan representative. (5) How to file a discrimination complaint with the United States Department of Health and Human Services Office for Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex. (b) Written notice of the availability of free language assistance services shall be provided in English and in the top 15 languages spoken by LEP individuals in California, as determined by the department, and consistent with the requirements identified in Part 92 of Title 45 of the Code of Federal Regulations and Section 1557 of the federal Patient Protection and Affordable Care Act (42 U.S.C. Sec. 18116). (c) (1) The information described in subdivisions (a) and (b) shall be provided in the following manner: (A) In the beneficiary handbook. (B) Posted in conspicuous physical locations where the mental health plan interacts with the public. (C) On the internet website published and maintained by the mental health plan, in a manner that allows beneficiaries, prospective beneficiaries, and members of the public to easily locate the information. (2) To the extent the information described in subdivisions (a) and (b) is not included in existing informational notices, a mental health plan shall add this information at the time of the next regularly scheduled update of the applicable publication. (d) Oral interpretation services shall be provided to an LEP beneficiary by an interpreter that, at a minimum, meets all of the following qualifications: (1) Demonstrated proficiency in speaking and understanding both English and the language spoken by the LEP beneficiary. (2) The ability to interpret effectively, accurately, and impartially, both receptively and expressly, to and from the language spoken by the LEP beneficiary and English, using any necessary specialized vocabulary, terminology, and phraseology. (3) Adherence to generally accepted interpreter ethics principles, including client confidentiality. (e) A mental health plan shall not require an LEP beneficiary to provide the beneficiary’s own interpreter or rely on a staff member who does not meet the qualifications described in subdivision (d) to communicate directly with the LEP beneficiary. (f) A mental health plan shall not rely on an adult or minor child accompanying the LEP beneficiary to interpret or facilitate communication except under either of the following circumstances: (1) In an emergency, as defined by the department, and an interpreter who meets the qualifications described in subdivision (d) is not immediately available for the LEP beneficiary. (2) If the LEP beneficiary specifically requests that the accompanying adult interpret or facilitate communication, the accompanying adult agrees to provide that assistance, and reliance on that accompanying adult for that assistance is appropriate under the circumstances. (g) This section shall be implemented only to the extent that federal financial participation is available and is not otherwise jeopardized. (Amended by Stats. 2019, Ch. 497, Sec. 322. (AB 991) Effective January 1, 2020. Conditionally inoperative as provided in Section 14721.)
  182. 148.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. )

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    This section defines “solicit” and “salvageable personal property” for the chapter.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. ) ## 148. As used in this chapter: (a) “Solicit” or any of its derivatives means to request directly or indirectly the giving of any kind of salvageable personal property on the plea or representation, express or implied, to the person requested that the property or any proceeds to be derived therefrom are to be devoted to charitable uses. The word shall extend to such requests made by any of the following means, whether or not the person making the request is given anything as a result: 1. Orally or in writing, by telephone or otherwise. 2. By distribution, circulation, mailing, posting, or publishing of any handbill, advertisement, or publication. 3. By means of any box or receptacle, upon any public street, sidewalk or way, or in any public park or in any publicly owned or controlled place; or by means of any box or receptacle in any place immediately abutting upon any public sidewalk or way, or in any place of business open to the public, or in any room, hallway, corridor, lobby, or entranceway, or other place open or accessible to the public. 4. By making of any announcement through the press, radio, telephone, television, or telegraph concerning an appeal, assemblage, athletic or sports event, bazaar, benefit, campaign, contest, dance, drive, entertainment, exhibition, exposition, party, performance, picnic, sale, or social gathering, which the public is requested to patronize. (b) “Salvageable personal property” means any type of corporeal personalty, new or used, but not including money or evidences of debt. (Added by Stats. 1959, Ch. 1410.)
  183. 148.1.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. )

    Verify source ↗

    This section says the chapter does not apply to certain member-only solicitation and resale of salvageable personal property, occasional rummage sales or bazaars by specified organizations, or qualifying associations serving people with disabilities.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. ) ## 148.1. None of the provisions of this chapter shall apply to the activities of any organization or association of persons or any person engaged by or under its authority, in soliciting donations of salvageable personal property solely from members of the organization or in selling salvageable personal property obtained from the organization’s members by that soliciting, or the soliciting and sale of salvageable personal property by fraternal, social, political, or service organizations for occasional rummage sales or bazaars where the activity does not constitute a major part of the organization’s activities and is not conducted as a permanent or continuous operation. Nor shall the provisions of this chapter apply to an association which is exempt under Section 23701d or 23701f of the Revenue and Taxation Code if the membership of the association is comprised of persons with physical, mental, or developmental disabilities and the primary purpose of the association is to provide services to persons with those disabilities. (Amended by Stats. 1989, Ch. 391, Sec. 1.)
  184. 148.2.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. )

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    Qualified organizations handling salvageable personal property must keep separate bank accounts and records, avoid mixing proceeds with other assets, and follow the charitable trustees and fundraisers law.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. ) ## 148.2. Any organization qualified under Section 148.3 to solicit donations of salvageable personal property, or to sell salvageable personal property obtained by soliciting, shall: (a) maintain separate bank accounts and separate books and records for such solicitations or sales, and shall not commingle any proceeds of such solicitations or sales with any other assets; and (b) fully comply with the provisions of the Supervision of Trustees and Fundraisers for Charitable Purposes Act (Article 7 of Chapter 6 (commencing with Section 12580) of the Government Code). (Amended by Stats. 2020, Ch. 370, Sec. 269. (SB 1371) Effective January 1, 2021.)
  185. 148.3.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. )

    Verify source ↗

    An association of persons generally must not solicit donations of salvageable personal property or sell salvageable personal property obtained through solicitation, unless it falls within the stated tax exemption.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. ) ## 148.3. It shall be unlawful for any association of persons to engage, directly or indirectly, in soliciting donations of salvageable personal property, or in selling salvageable personal property obtained by soliciting, except an association which is exempt under Section 23701d or 23701f of the Revenue and Taxation Code from any tax imposed by the Bank and Corporations Tax Law. (Amended by Stats. 1976, Ch. 500.)
  186. 148.4.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. )

    Verify source ↗

    An organization qualified under Section 148.3 may not solicit donations of salvageable personal property or use independent contractors to do that work or sell donated property.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. ) ## 148.4. It shall be unlawful for any organization qualified under Section 148.3 to solicit donations of salvageable personal property, to contract with or otherwise engage any independent contractor to perform the work of soliciting such donations or selling any personal property donated. All soliciting shall be done by the officers of the organization or agents appointed by or under the authority of such officers. (Added by Stats. 1959, Ch. 1410.)
  187. 148.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. )

    Verify source ↗

    A person may not solicit donations of salvageable personal property unless acting as an officer or agent of a qualifying organization and appointed as required by the chapter.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. ) ## 148.5. It shall be unlawful for any person to engage in soliciting donations of salvageable personal property except as an officer or agent of an organization meeting the requirements of Section 148.3, and who has been appointed in the manner prescribed by this chapter. (Added by Stats. 1959, Ch. 1410.)
  188. 148.6.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. )

    Verify source ↗

    Qualified charitable organizations must give solicitors ID cards, show them on demand, give buyers receipts, and keep sales records open to peace officer inspection.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. ) ## 148.6. Every organization qualified under Section 148.3 to solicit donations of salvageable personal property, shall furnish each officer or agent engaged to work as a solicitor with an identification card stating the name and address of the solicitor, the name of the organization for whom he is soliciting, that he has been appointed by the organization to act as a solicitor, and the signature of the person by whom he was so appointed. The identification card must be exhibited on the demand of any person solicited or of any peace officer. Any such organization receiving the proceeds from any sale of salvageable personal property obtained by soliciting, shall see that each purchaser of such property is given a receipt stating the price paid for the property sold. Every such organization shall keep accurate books and records setting out the proceeds of such sales and the amounts devoted directly to charitable uses, which books and records shall be open to the inspection of any peace officer. (Added by Stats. 1959, Ch. 1410.)
  189. 148.8.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. )

    Verify source ↗

    Violating any provision of this chapter is a misdemeanor. It is also a misdemeanor for a person to solicit salvageable personal property donations while using an identification card device not furnished under the chapter.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. ) ## 148.8. The violation of any provision of this chapter by any person or organization is a misdemeanor. Any person who solicits a donation of salvageable personal property, and uses any device purporting to be an identification card and which is not furnished in accordance with the provisions of this chapter is guilty of a misdemeanor. (Added by Stats. 1959, Ch. 1410.)
  190. 148.9.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. )

    Verify source ↗

    This section preserves counties’ and cities’ power to set additional requirements for soliciting and selling salvageable personal property within their jurisdictions.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 1.8. Acquisition and Disposition of Salvageable Personal Property for Charitable Purposes [148 - 148.9] ( Chapter 1.8 added by Stats. 1959, Ch. 1410. ) ## 148.9. The enactment of this chapter shall in no way limit or infringe upon the powers of counties and cities to impose additional requirements for the privilege of soliciting and selling salvageable personal property within their jurisdictions. (Added by Stats. 1959, Ch. 1410.)
  191. 15.

    ## Welfare and Institutions Code - WIC ## GENERAL PROVISIONS ( General Provisions enacted by Stats. 1937, Ch. 369. )

    Verify source ↗

    This provision says “shall” means mandatory and “may” means permissive.

    ## Welfare and Institutions Code - WIC ## GENERAL PROVISIONS ( General Provisions enacted by Stats. 1937, Ch. 369. ) ## 15. “Shall” is mandatory and “may” is permissive. (Enacted by Stats. 1937, Ch. 369.)
  192. 150.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 2. Unattended Collection Boxes [150 - 153] ( Chapter 2 added by Stats. 2010, Ch. 75, Sec. 1. )

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    This section defines key terms used in the chapter on unattended collection boxes.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 2. Unattended Collection Boxes [150 - 153] ( Chapter 2 added by Stats. 2010, Ch. 75, Sec. 1. ) ## 150. For purposes of this chapter, the following definitions shall apply: (a) “Collection box” means an unattended cannister, box, receptacle, or similar device, used for soliciting and collecting donations of salvageable personal property. (b) “Commercial fundraiser” shall have the same meaning as in subdivision (a) of Section 12599 of the Government Code. (c) “Nonprofit organization” means an organization that is exempt from taxation pursuant to Section 501(c)(3) or 501(c)(4) of the United States Internal Revenue Code. (d) “Salvageable personal property” has the same meaning as in subdivision (b) of Section 148. (Added by Stats. 2010, Ch. 75, Sec. 1. (AB 918) Effective January 1, 2011.)
  193. 1500.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 2. MINORS CROSSING THE MEXICAN BORDER [1500- 1500.] ( Part 2 added by Stats. 1973, Ch. 336. )

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    A city or county peace officer must stop a California resident under 18 from entering Mexico at the border if the minor is unaccompanied, lacks written parental/guardian consent, or does not have a passport.

    ## Welfare and Institutions Code - WIC ## DIVISION 2. CHILDREN [100 - 1500] ( Division 2 enacted by Stats. 1937, Ch. 369. ) ## PART 2. MINORS CROSSING THE MEXICAN BORDER [1500- 1500.] ( Part 2 added by Stats. 1973, Ch. 336. ) ## 1500. A peace officer of any city or county shall prevent the entry from California into the Republic of Mexico at the border by any resident of this state under the age of 18 years who is unaccompanied by a parent or guardian or who does not have written consent for such entry from a parent or guardian or who does not have a passport. The authority of the peace officer under this part shall be only to prevent entry and not otherwise to detain. Nothing in this part shall be construed to limit the authority of a peace officer under any other law of this state. (Added by Stats. 1973, Ch. 336.)
  194. 15000.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 9. Financial Provisions [15000 - 15207] ( Chapter 9 added by Stats. 1965, Ch. 1784. ) ## ARTICLE 1. General Provisions [15000 - 15001] ( Article 1 added by Stats. 1965, Ch. 1784. )

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    Warrants payable to public assistance recipients must not contain words or abbreviations that show aid, assistance, charity, needy, support, or welfare.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 9. Financial Provisions [15000 - 15207] ( Chapter 9 added by Stats. 1965, Ch. 1784. ) ## ARTICLE 1. General Provisions [15000 - 15001] ( Article 1 added by Stats. 1965, Ch. 1784. ) ## 15000. Notwithstanding any provisions of Sections 29800 and 29805 of the Government Code, warrants payable to recipients of public assistance shall not include any word or abbreviation indicative of aid, assistance, charity, needy, support, or welfare. Nothing in this section prohibits the use of code numbers or other code symbols used and understood by county officers and agencies to identify the purpose and liability for which such warrants are drawn, if such code numbers or other code symbols are not generally so understood by the public. (Added by Stats. 1965, Ch. 1784.)
  195. 15001.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 9. Financial Provisions [15000 - 15207] ( Chapter 9 added by Stats. 1965, Ch. 1784. ) ## ARTICLE 1. General Provisions [15000 - 15001] ( Article 1 added by Stats. 1965, Ch. 1784. )

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    Warrants issued to pay aid under this division must comply with Government Code Section 29802 and must state on their face that they become void if not presented to the county treasurer within six months after issuance.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 9. Financial Provisions [15000 - 15207] ( Chapter 9 added by Stats. 1965, Ch. 1784. ) ## ARTICLE 1. General Provisions [15000 - 15001] ( Article 1 added by Stats. 1965, Ch. 1784. ) ## 15001. Any warrant issued in payment of aid under this division is subject to the provisions of Section 29802 of the Government Code. Each such warrant shall bear on its face a statement that the warrant shall be void if not presented to the county treasurer for payment within six months after the date of issuance thereof. The provision for a substitute warrant shall also apply to the assignee of a warrant, or the legal representative or heir of a deceased recipient, in accordance with the provisions of Section 12158 of this code. (Amended by Stats. 1970, Ch. 1041.)
  196. 15050.5.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 9. Financial Provisions [15000 - 15207] ( Chapter 9 added by Stats. 1965, Ch. 1784. ) ## ARTICLE 2. Social Welfare Federal Fund [15050.5- 15050.5.] ( Article 2 added by Stats. 1965, Ch. 1784. )

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    References to the Social Welfare Federal Fund are to be treated as references to the Federal Trust Fund.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 9. Financial Provisions [15000 - 15207] ( Chapter 9 added by Stats. 1965, Ch. 1784. ) ## ARTICLE 2. Social Welfare Federal Fund [15050.5- 15050.5.] ( Article 2 added by Stats. 1965, Ch. 1784. ) ## 15050.5. All references in this division or in any other provision of law to the Social Welfare Federal Fund shall be deemed references to the Federal Trust Fund. (Added by Stats. 1984, Ch. 235, Sec. 4. Operative July 1, 1985, by Sec. 16 of Ch. 235.)
  197. 151.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 2. Unattended Collection Boxes [150 - 153] ( Chapter 2 added by Stats. 2010, Ch. 75, Sec. 1. )

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    Collection boxes must display owner/operator contact details and a required ownership statement on the front; nonprofit and for-profit boxes have additional wording requirements, and commercial fundraisers have extra limits on side notices and notice size.

    ## Welfare and Institutions Code - WIC ## DIVISION 1. ADMINISTRATION OF WELFARE AND INSTITUTIONS [148 - 153] ( Division 1 enacted by Stats. 1937, Ch. 369. ) ## CHAPTER 2. Unattended Collection Boxes [150 - 153] ( Chapter 2 added by Stats. 2010, Ch. 75, Sec. 1. ) ## 151. (a) The front of every collection box shall conspicuously display both of the following: (1) The name, address, telephone number, and, if available, the Internet Web address of the owner and operator of the collection box. (2) A statement, in at least two-inch typeface, that either reads, “this collection box is owned and operated by a for-profit organization” or “this collection box is owned and operated by a nonprofit organization.” For purposes of this chapter, a commercial fundraiser shall be classified as a for-profit organization. (b) If the collection box is owned by a nonprofit organization, the front of the collection box shall also conspicuously display a statement describing the charitable cause that will benefit from the donations. (c) If the collection box is owned by a for-profit entity, the front of the collection box shall also conspicuously display a statement that reads “this donation is not tax deductible.” If the collection box is owned and operated by a commercial fundraiser, the commercial fundraiser may post notice of donations to a charitable cause only on the sides of the box. This notice shall always be smaller in size than the for-profit entity’s name and address and shall constitute only 25 percent of the notice space of the box. (Added by Stats. 2010, Ch. 75, Sec. 1. (AB 918) Effective January 1, 2011.)
  198. 15100.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 9. Financial Provisions [15000 - 15207] ( Chapter 9 added by Stats. 1965, Ch. 1784. ) ## ARTICLE 3. Welfare Advance Fund [15100- 15100.] ( Article 3 added by Stats. 1965, Ch. 1784. )

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    This section creates the Welfare Advance Fund and directs how its money may be used and moved.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 9. Financial Provisions [15000 - 15207] ( Chapter 9 added by Stats. 1965, Ch. 1784. ) ## ARTICLE 3. Welfare Advance Fund [15100- 15100.] ( Article 3 added by Stats. 1965, Ch. 1784. ) ## 15100. A revolving fund in the State Treasury is hereby created to be known as the Welfare Advance Fund. All moneys in the fund are appropriated for the purpose of making payments or advances to counties, Indian tribes, the federal Social Security Administration, or other federal, state, or governmental entities, of the state and federal shares of local assistance programs, and for the payment of refunds. In addition, the fund may be used for the purpose of making a consolidated payment, comprised of the state and federal shares of local assistance costs, to any payee associated with programs administered by the State Department of Social Services. Payments or advances of funds to counties, Indian tribes, the federal Social Security Administration, or other federal, state, or governmental entities, or to any payee, which payments or advances are properly chargeable to appropriations made from other funds in the State Treasury, may be made by Controller’s warrant drawn against the Welfare Advance Fund. For every warrant so issued, the several purposes and amounts for which it was drawn shall be identified for the payee. The amounts to be transferred to the Welfare Advance Fund at any time shall be determined by the department, and, upon order of the Controller, shall be transferred from the funds and appropriations otherwise properly chargeable therewith to the Welfare Advance Fund. Refunds of amounts disbursed from the Welfare Advance Fund shall, on order of the Controller, be deposited in the Welfare Advance Fund, and, on order of the Controller, shall be transferred therefrom to the funds and appropriations from which the amounts were originally derived. Claims for amounts erroneously paid into the Welfare Advance Fund shall be submitted by the department to the Controller who, if he or she approves the claims, shall draw his or her warrant in payment thereof against the Welfare Advance Fund. All amounts increasing the cash balance in the Welfare Advance Fund, which were derived from the cancellation of warrants issued therefrom, shall, on order of the Controller, be transferred to and in augmentation of the appropriations from which the amounts were originally derived. (Amended by Stats. 2003, Ch. 323, Sec. 4. Effective January 1, 2004.)
  199. 15125.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 9. Financial Provisions [15000 - 15207] ( Chapter 9 added by Stats. 1965, Ch. 1784. ) ## ARTICLE 3.5. Central Benefit Issuance Fund [15125 - 15126] ( Article 3.5 added by Stats. 1993, Ch. 696, Sec. 2. )

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    This section creates the Central Benefit Issuance Fund and assigns the department and Controller duties for administering it, replacing warrants, printing notices, and handling unpaid warrants.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 9. Financial Provisions [15000 - 15207] ( Chapter 9 added by Stats. 1965, Ch. 1784. ) ## ARTICLE 3.5. Central Benefit Issuance Fund [15125 - 15126] ( Article 3.5 added by Stats. 1993, Ch. 696, Sec. 2. ) ## 15125. (a) The Central Benefit Issuance Fund is hereby created in the State Treasury. (b) The fund shall be administered by the State Department of Social Services, and, notwithstanding Section 13340 of the Government Code, all moneys in the fund are hereby continuously appropriated to the department, without regard to fiscal years, for expenditure for the purpose of making payments or advances to recipients of public social services and CalFresh benefits, as provided in Section 11006.6. (c) Amounts to be transferred to the Central Benefit Issuance Fund shall be determined by the department, in accordance with an agreed upon format with the Controller, from the funds and appropriations properly chargeable for the implementation of the central benefit issuance system provided for in Section 11006.6. (d) (1) Notwithstanding Section 17070 of the Government Code, any warrant drawn on the Central Benefit Issuance Fund that remains unpaid for 180 days after it becomes payable, shall be void and shall be canceled by the Controller. (2) The Controller shall cause to be printed prominently on the face of each warrant issued from the fund, a notice regarding the requirements of paragraph (1). (e) Notwithstanding Sections 17091 and 17092 of the Government Code, the department, with the concurrence of the Controller, shall provide for the replacement of lost or stolen warrants consistent with Section 29853.5 of the Government Code. The department may adopt regulations implementing this subdivision. (Amended by Stats. 2011, Ch. 227, Sec. 63. (AB 1400) Effective January 1, 2012.)
  200. 15126.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 9. Financial Provisions [15000 - 15207] ( Chapter 9 added by Stats. 1965, Ch. 1784. ) ## ARTICLE 3.5. Central Benefit Issuance Fund [15125 - 15126] ( Article 3.5 added by Stats. 1993, Ch. 696, Sec. 2. )

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    Counties in the central benefit issuance system must pay their share of public social services costs to the department at intervals set by the department, and failure to pay on time can trigger an offset from state funds.

    ## Welfare and Institutions Code - WIC ## DIVISION 9. PUBLIC SOCIAL SERVICES [10000 - 18999.98] ( Division 9 added by Stats. 1965, Ch. 1784. ) ## PART 3. AID AND MEDICAL ASSISTANCE [11000 - 15771] ( Part 3 added by Stats. 1965, Ch. 1784. ) ## CHAPTER 9. Financial Provisions [15000 - 15207] ( Chapter 9 added by Stats. 1965, Ch. 1784. ) ## ARTICLE 3.5. Central Benefit Issuance Fund [15125 - 15126] ( Article 3.5 added by Stats. 1993, Ch. 696, Sec. 2. ) ## 15126. Counties participating in the central benefit issuance system, pursuant to Section 11006.6, shall pay to the department, at regular intervals as determined by the department, the share of public social services costs otherwise attributable to local government. Failure to pay within the determined intervals shall result in offsetting the appropriate amount from any funds going to the county from the state. Counties shall remit their share of public social services costs directly to the state, in accordance with an agreed upon format with the Controller, for deposit to the Central Benefit Issuance Fund or where deemed appropriate by the department. (Added by Stats. 1993, Ch. 696, Sec. 2. Effective January 1, 1994.)

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