BILL NUMBER: SB 75 ENROLLED
BILL TEXT
PASSED THE SENATE JUNE 19, 2015
PASSED THE ASSEMBLY JUNE 19, 2015
AMENDED IN ASSEMBLY JUNE 16, 2015
AMENDED IN ASSEMBLY MARCH 24, 2015
AMENDED IN ASSEMBLY MARCH 23, 2015
INTRODUCED BY Committee on Budget and Fiscal Review
JANUARY 9, 2015
An act to amend Section 1220 of the Business and Professions Code,
to amend Sections 100504 and 100505 of the Government Code, to amend
Sections 1266, 1279.2, 1367.54, 1373.622, 1420, 1423, 104150,
104322, 110050, 120960, 120962, 124040, and 124977 of, to amend the
heading of Chapter 17 (commencing with Section 121348) of Part 4 of
Division 105 of, and to add Sections 120780.2, 121348.4, 122425,
122430, and 122435 to, the Health and Safety Code, to amend Sections
10123.184 and 10127.16 of the Insurance Code, to amend Section
19548.2 of the Revenue and Taxation Code, to amend Sections 4369,
4369.1, 4369.2, 4369.3, 4369.4, 4369.5, 14007.2, 14007.5, 14015.5,
14105.94, 14105.192, 14154, 14186, 14186.1, 14186.3, 15894, and 24005
of, to amend and repeal Section 14134 of, and to add Sections
14007.8 and 14127.7 to, the Welfare and Institutions Code, to amend
Sections 70 and 71 of Chapter 23 of, and to amend Section 5 of
Chapter 361 of, the Statutes of 2013, and to amend Section 1 of
Chapter 551 of the Statutes of 2014, relating to health, and making
an appropriation therefor, to take effect immediately, bill related
to the budget.
LEGISLATIVE COUNSEL'S DIGEST
SB 75, Committee on Budget and Fiscal Review. Health.
(1) Under existing law, the State Department of Public Health
licenses and regulates clinical laboratories and certain clinical
laboratory personnel performing clinical laboratory tests or
examinations, subject to certain exceptions. Existing law requires a
clinical laboratory to perform all clinical laboratory tests or
examinations classified as waived under the federal Clinical
Laboratory Improvement Amendments of 1988 (CLIA) in conformity with
the manufacturer's instructions. Existing law requires a clinical
laboratory that performs tests or examinations that are not
classified as waived under CLIA to establish and maintain a quality
control program that meets specified CLIA standards.
This bill would provide that the quality control program may
include the clinical laboratory's use of an alternative quality
testing procedure recognized by the Centers for Medicare and Medicaid
Services, including equivalent quality control procedures or an
Individual Quality Control Plan, as specified.
(2) Existing federal law, the federal Patient Protection and
Affordable Care Act (PPACA), enacts various health care coverage
market reforms that took effect January 1, 2014. Among other things,
PPACA requires each state, by January 1, 2014, to establish an
American Health Benefit Exchange that facilitates the purchase of
qualified health plans by qualified individuals and qualified small
employers. Existing state law establishes the California Health
Benefit Exchange (the Exchange) within state government for the
purpose of facilitating the enrollment of qualified individuals and
qualified small employers in qualified health plans, and specifies
the powers and duties of the board governing the Exchange. Among
other things, existing law grants the board the authority to
standardize products to be offered through the Exchange, and requires
the board to establish and use a competitive process to select
participating carriers and any other contractors, as specified.
This bill would require any product standardized by the board to
be discussed by the board during at least one properly noticed board
meeting prior to the board meeting at which the board adopts the
standardized products. The bill would require the board to adopt a
Health Benefit Exchange Contracting Manual incorporating procurement
and contracting policies and procedures that shall be followed by the
Exchange, as specified. The bill would also exempt any regulations
adopted, amended, or repealed by the board to implement these
provisions from the Administrative Procedure Act.
(3) Existing law authorizes the board of the Exchange to adopt
emergency regulations until January 1, 2016. Existing law prohibits
the Office of Administrative Law from repealing any emergency
regulations adopted until revised or repealed by the board, except
that existing law also requires any emergency regulation adopted by
the board to be repealed by operation of law, except as specified.
Existing law allows more than 2 readoptions of those emergency
regulations until January 1, 2017, and allows the emergency
regulations adopted by the board to remain in effect for 2 years, as
specified.
This bill would extend the authority of the board of the Exchange
to adopt emergency regulations until January 1, 2017. The bill would
delete the prohibition against the office from repealing any
emergency regulation of the board, but would continue to require any
emergency regulation adopted by the board to be repealed by operation
of law, except as specified. The bill would instead authorize the
board to allow more than 2 readoptions of those emergency regulations
until January 1, 2020, and would allow the emergency regulations
adopted by the board to instead remain in effect for 3 years, as
specified.
(4) Existing law provides for the licensure and regulation of
health care facilities, including skilled nursing facilities and
long-term health care facilities, as defined, by the State Department
of Public Health. Existing law imposes specified fees for the
licensure of skilled nursing facilities.
This bill would require the fees for the licensure of skilled
nursing facilities to be increased in a specified manner to generate
moneys for expenditure by the California Department of Aging for
purposes of its Long-Term Care Ombudsman Program for work related to
investigating complaints against skilled nursing facilities and
increasing visits to those facilities.
(5) Existing law requires the State Department of Public Health to
follow specified procedures when the department receives a written
or oral complaint about a long-term health care facility, as
specified, including investigation procedures. Existing law requires
the issuance of a citation under specified provisions to be served
upon a facility within 3 working days of a final determination,
unless a licensee agrees to an extension of time.
This bill would make changes to those investigation procedures, as
specified, including, but not limited to, changing the time period
for investigation of a complaint and authorizing an extension of that
time period under extenuating circumstances. The bill would instead
require a citation issued under those provisions to be served within
30 days of a final determination or completion of a complaint
investigation, as specified. The bill would make conforming changes
to a reporting requirement.
Existing law requires the State Department of Public Health, when
it receives a complaint or report involving a general acute care
hospital, acute psychiatric hospital, or special hospital, that
indicates an ongoing threat of imminent danger of death or serious
bodily harm, to complete an investigation of the complaint or report
within 45 days.
If the department fails to meet those requirements, this bill
would require the department to document the extenuating
circumstances leading to the failure to meet the 45-day time period,
and to provide written notice to the facility and the complainant of
the extenuating circumstances and an anticipated completion date.
(6) Existing law requires the State Department of Health Care
Services to perform various health functions, including providing for
breast and cervical cancer screening and treatment for low-income
individuals, prostate cancer screening and treatment for low-income
and uninsured men, and specified family planning services.
This bill would require, with regard to the above health care
programs, providers, or the enrolling entity, as applicable, to make
available to all applicants and beneficiaries prior to, or concurrent
with, enrollment, information on the manner in which to apply for
insurance affordability programs, in a manner determined by the
department. The information provided would be required to include the
manner in which applications can be submitted for insurance
affordability programs, information about the open enrollment periods
for the Exchange, and the continuous enrollment aspect of the
Medi-Cal program.
(7) Existing law creates the Food Safety Fund, as a special fund,
and requires all moneys collected by the State Department of Public
Health, pursuant to specified authority, to be deposited in the fund,
for use by the department, upon appropriation by the Legislature,
for the purposes of providing funds necessary to carry out and
implement, among other things, inspection provisions relating to
food, licensing, inspection, enforcement, and specified provisions
relating to water.
This bill would require moneys awarded to the department pursuant
to court orders or settlements for the use of food safety-related
activities to be deposited in the fund for those same health and
safety purposes.
(8) Existing law authorizes a public entity that receives General
Fund money from the State Department of Public Health for HIV
prevention and education to use that money to support clean needle
and syringe exchange programs authorized pursuant to law. Existing
law requires several conditions to be met for the use of funds in
this manner, such as the amount used not exceeding 7.5% of the total
amount of General Fund money received for HIV prevention and
education.
This bill would authorize the State Department of Public Health to
purchase sterile hypodermic needles and syringes, and other
supplies, for distribution to syringe exchange programs, for the
purpose of reducing the spread of HIV, hepatitis C, and other
potentially deadly blood-borne pathogens.
(9) Existing law requires the State Public Health Officer to
establish, and authorizes him or her to administer, a program to
provide drug treatments to persons infected with HIV, to the extent
that state and federal funds are appropriated. Existing law makes a
person financially eligible to receive services under this program if
his or her adjusted gross income does not exceed $50,000 per year,
and as specified. Existing law establishes a payment schedule to
determine the payment obligation of a person receiving drugs under
the program, except as specified. Existing law requires the State
Department of Public Health and the Franchise Tax Board to exchange
prescribed information in order to verify financial eligibility under
the program. Existing law provides that this information constitutes
confidential public health records, as specified.
This bill would instead make a person financially eligible to
receive services under the program if his or her modified adjusted
gross income, as defined, does not exceed 500% of the federal poverty
level, as defined, per year based on family size and household
income, as defined. The bill would make conforming changes to the
provisions that establish a payment schedule and that require the
department and the board to exchange information for purposes of
determining eligibility.
(10) Existing law establishes various programs relating to
treatment of persons with the human immunodeficiency virus (HIV) and
the acquired immune deficiency syndrome (AIDS). Under existing law,
the Office of AIDS, State Department of Public Health, is responsible
for coordinating state programs, services, and activities relating
to HIV and AIDS, and AIDS-related conditions.
This bill would require the State Department of Public Health,
upon an appropriation in the annual Budget Act, to establish the
Pre-Exposure Prophylaxis (PrEP) Navigator Services Program, under
which the department shall provide for specified activities relating
to, among other things, oversight of the program and funding for
community-based organizations and local health departments to provide
outreach and education services to populations affected by HIV.
(11) Existing law requires the State Department of Public Health
to make available protocols and guidelines developed by the National
Institutes of Health, the University of California at San Francisco,
and the California legislative advisory committees on hepatitis C for
educating physicians and health professionals and training community
service professionals and training community service providers on
the most recent scientific and medical information on hepatitis C
detection, transmission, diagnosis, treatment, and therapeutic
decisionmaking.
This bill would establish a 3-year Hepatitis C Linkage to Care
demonstration pilot project to allow for innovative, evidence-based
approaches to provide outreach, hepatitis C screening, and linkage
to, and retention in, quality health care for the most vulnerable and
underserved individuals living with, or at high risk for, hepatitis
C viral infection. The bill would, upon appropriation, require the
department to award funding to community-based organizations or local
health jurisdictions to operate demonstration pilot projects, as
specified.
(12) Existing law requires the governing board of a county to
establish a community child health and disability prevention program
for the purpose of providing early and periodic evaluation of the
health status of children in the county. The program plan is required
to include screening and evaluation for each child, including
referrals to a dentist participating in the Medi-Cal program for all
children 3 years of age and older who are eligible for Medi-Cal.
This bill would, instead, require the program plan to include
referrals to a dentist for all children eligible for the Medi-Cal
program one year of age and older. Because the bill would require
expansion of the county program plan, it would create a
state-mandated local program.
(13) Existing law requires the State Department of Public Health
to establish a program for the development, provision, and evaluation
of genetic disease testing. Existing law requires the department to
charge a fee to all payers for certain genetic disease screening
tests and activities. Existing law requires fees charged for prenatal
screening and followup services provided to persons enrolled in the
Medi-Cal program, health care service plan enrollees, or persons
covered by health insurance policies, to be paid in full and
deposited in the Genetic Disease Testing Fund or the Birth Defects
Monitoring Program Fund, as prescribed, subject to all terms and
conditions of each enrollee's or insured's health care service plan
or insurance coverage, including, but not limited to, applicable
copayments and deductibles.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care. Existing law also
provides for the regulation of health insurers by the Department of
Insurance. Under existing law, a group or individual health care
service plan contract, with designated exceptions, or a health
insurer is required to include coverage for the statewide Expanded
Alpha Feto Protein (AFP) genetic testing program.
This bill would prohibit coverage by a health care service plan or
health insurer for these genetic testing services from being subject
to copayment, coinsurance, deductible, or any other form of cost
sharing. The services would be paid according to the fee amounts set
under the department's genetic disease testing programs and
applicable regulations. The bill also would make various technical
and conforming changes.
Because existing law makes a willful violation of the provisions
relating to health care services plans a crime, by expanding the
definition of this crime, the bill would impose a state-mandated
local program.
(14) Under existing law, a health care service plan and a health
insurer are required to offer a standard benefit plan, as specified,
under which health care service plans and insurers are required to
continue to provide coverage under the same terms and conditions
prescribed under a previously authorized pilot program. Under
existing law, the State Department of Health Care Services is
responsible for paying the costs of the coverage, completing periodic
reconciliation reports with health care service plans and insurers,
and adopting appropriate regulations. Existing law requires the
department to complete reconciliation with a health care service
program or insurer for a given reporting period within 6 months after
receiving the plan's or insurer's conciliation report.
Existing law establishes the California Major Risk Medical
Insurance Program (MRMIP), which is administered by the department,
operative July 1, 2014. Under existing law, MRMIP provides major risk
medical coverage to certain categories of individuals who have been
rejected for coverage by at least one private health plan, and meet
other program requirements. Existing law specifies the powers and
duties of the department with respect to MRMIP. Existing law creates
the Major Risk Medical Insurance Fund as a continuously appropriated
fund for purposes of funding services under MRMIP and the standard
benefit plans described above.
This bill would extend the time within which the department is
required to complete reconciliation with plans and insurers, to 18
months after receiving the conciliation report. The bill would
authorize the department to implement these provisions in a specified
manner.
The bill would also establish procedures that would apply under
circumstances in which the department and a health care service plan
or health insurer have not agreed to a final reconciliation of the
amount to be expended from the Major Risk Medical Insurance Fund or
to be reimbursed to the fund for the purposes described above,
including provisions relating to the payment of interest or the
negotiation of payment plans, as specified.
(15) Existing law establishes the Office of Problem and
Pathological Gambling within the State Department of Public Health.
Under existing law, the office is responsible for developing programs
for problem gambling prevention and treatment services for
California residents. Existing law defines the terms "pathological
gambling disorder" and "problem gambling" for these purposes.
This bill would rename that office the Office of Problem Gambling
and would substitute the term "gambling disorder," as defined, for
the terms "pathological gambling disorder" and "problem gambling."
The bill would, among other things, additionally authorize the
gambling disorder prevention and treatment programs to provide
services to an affected individual, which the bill would define as a
person who experiences adverse psychiatric or physical impacts due to
another person's gambling disorder. The bill would also authorize
the treatment program to include research and training components, as
specified.
(16) Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services.
The Medi-Cal program is, in part, governed and funded by federal
Medicaid Program provisions.
The federal Medicaid Program provisions prohibit payment to a
state for medical assistance furnished to an alien who is not
lawfully admitted for permanent residence or otherwise permanently
residing in the United States under color of law.
This bill would extend eligibility for full-scope Medi-Cal
benefits to individuals under 19 years of age who do not have, or are
unable to establish, satisfactory immigration status. The bill would
direct the State Department of Health Care Services to seek any
necessary federal approvals to obtain federal financial participation
for these services, and would require that these services be
provided with state-only funds only if federal financial
participation is not available. Because counties are required to make
Medi-Cal eligibility determinations and this bill would expand
Medi-Cal eligibility, the bill would impose a state-mandated local
program.
(17) Existing law, until July 1, 2015, requires the State
Department of Health Care Services to retain or delegate the
authority to perform Medi-Cal eligibility determinations as set forth
in specified provisions related to electronic determination of
eligibility.
This bill would delete the repeal date, and would thereby extend
the operation of those provisions indefinitely.
(18) Existing law authorizes certain ground emergency medical
transportation providers to receive supplemental Medi-Cal
reimbursement in addition to the rate of payment that the provider
would otherwise receive for those services. Existing law specifies
the manner in which the supplemental reimbursement is calculated, and
requires the nonfederal share of the supplemental reimbursement to
be paid only with funds from specified governmental entities.
This bill would require the State Department of Health Care
Services to develop a modified supplemental reimbursement program
that would seek to increase the reimbursement to an eligible
provider, as specified. The bill would provide that the department
shall not implement the modified program unless it determines that
the modified program would likely result in an overall increase to
the supplemental reimbursement available under existing law, and the
department receives all necessary federal approvals.
(19) Existing law requires, except as otherwise provided, Medi-Cal
provider payments and payments for specified non-Medi-Cal programs
to be reduced by 10% for dates of service on and after June 1, 2011,
and requires payments to Medi-Cal managed health care plans to be
reduced by the actuarial equivalent amount of the payment reductions
for fee-for-service Medi-Cal benefits, as specified.
This bill would exempt from the application of those reductions
dental services and applicable ancillary services for dates of
service on or after July 1, 2015, or the effective date of any
necessary federal approvals, whichever is later. The bill would also
exempt from the application of those reductions payments to dental
managed care plans for contract amendments or change orders effective
on or after July 1, 2015, or the effective date of any necessary
federal approvals, whichever is later.
(20) Existing law authorizes the State Department of Health Care
Services, subject to federal approval, to create a Health Home
Program for Medi-Cal enrollees with chronic conditions, as
prescribed, as authorized under federal law.
This bill would create the Health Home Program Account in the
Special Deposit Fund within the State Treasury in order to collect
and allocate non-General Fund public or private grant funds, to be
expended upon allocation by the Legislature, for the purposes of
implementing the Health Home Program. The bill would appropriate
$50,000,000 from the Health Home Program Account to the State
Department of Health Care Services for the purposes of implementing
the Health Home Program.
(21) Existing law requires Medi-Cal beneficiaries to make set
copayments for specified services and, upon federal approval,
existing law revises these copayment rates and makes other related
changes, as specified.
This bill would delete the revised copayment rate provisions and
would make a conforming change.
(22) Under existing law, the Legislature finds and declares that
linking appropriate funding for county Medi-Cal administrative
operations, including annual cost-of-doing-business adjustments, with
performance standards will give counties the incentive to meet the
performance standards and enable them to continue to do the work they
do on behalf of the state. Existing law provides that it is the
intent of the Legislature to provide appropriate funding to the
counties for the effectual administration of the Medi-Cal program,
except for specified fiscal years in regard to any
cost-of-doing-business adjustment.
This bill would additionally provide that it is the intent of the
Legislature to not appropriate funds for the cost-of-doing-business
adjustment for the 2015-16 fiscal year.
(23) One of the methods by which Medi-Cal services are provided is
pursuant to contracts with various types of managed care health
plans. Existing federal law provides for the federal Medicare
Program, which is a public health insurance program for persons who
are 65 years of age or older and specified persons with disabilities
who are under 65 years of age.
Existing law requires the State Department of Health Care Services
to seek federal approval pursuant to a Medicare or Medicaid
demonstration project or waiver, or a combination thereof, to
establish a demonstration project, known as the Coordinated Care
Initiative, that enables beneficiaries who are dually eligible for
the Medi-Cal program and the Medicare Program to receive a continuum
of services that maximizes access to, and coordination of, benefits
between these programs. Existing law requires that Medi-Cal
beneficiaries who have dual eligibility in the Medi-Cal program and
Medicare Programs be assigned as mandatory enrollees into managed
care health plans in counties participating in the demonstration
project, and requires, beginning January 1, 2015, or 19 months after
commencement of beneficiary enrollment into managed care, whichever
is later, all Medi-Cal long-term services and supports, which
includes Multipurpose Senior Services Program (MSSP) services, to be
covered under managed care health contracts and only available
through managed care health plans to beneficiaries residing in
counties participating in the Coordinated Care Initiative.
This bill would extend the transition date MSSP services are
required to be a Medi-Cal benefit only available through managed care
health plans to no later than December 31, 2017, or on the date
managed care health plans and MSSP providers jointly satisfy the
readiness criteria developed by the department, and would make
additional conforming changes. The bill would require the department
to notify the appropriate fiscal and policy committees of the
Legislature of its intent to transition MSSP services to managed care
health plans at least 30 days before this transition occurs. The
bill would require the department and the California Department of
Aging, in consultation with specified entities, to develop readiness
criteria, as specified. The bill would require the department to
evaluate the readiness of the managed care health plans and MSSP
providers to commence the transition of MSSP services to managed care
health plans.
(24) Existing law requires the State Department of Health Care
Services to accept contributions by private foundations in the amount
of at least $14,000,000 for purposes of making Medi-Cal in-person
enrollment assistance payments to eligible entities and persons, as
specified, and in the amount of at least $12,500,000 to provide
allocations for the management and funding of Medi-Cal outreach and
enrollment activities, as specified. Existing law requires the
department to seek federal matching funds for those purposes.
Existing law establishes the Healthcare Outreach and Medi-Cal
Enrollment Account in the Special Deposit Fund within the State
Treasury in order to collect and allocate these funds, as specified.
Existing law appropriates specified funds to the department from this
account for the purposes described above, which are available for
encumbrance or expenditure until June 30, 2016, and until December
31, 2016, as specified.
This bill would require the department to make the in-person
enrollment assistance payments described above for submitted
applications received through June 30, 2015, that result in approved
applications. Once all of those payments have been made, the bill
would require the department to allocate any remaining funds accepted
pursuant to the in-person enrollment assistance payment provisions
to counties to be used for the Medi-Cal outreach and enrollment
activities described above. The
bill would require those remaining funds that are allocated to
those counties to be distributed to community-based organizations
providing enrollment assistance to prospective Medi-Cal enrollees, as
specified. The bill would authorize those counties to retain a
specified amount for administrative costs. The bill would require the
department to make an initial allocation to counties for these funds
no later than January 1, 2016, and the final allocation no later
than June 30, 2016. The bill would make the in-person enrollment
assistance provisions inoperative on a specified date.
This bill would make the requirement that the State Department of
Health Care Services accept the private foundation funding for
outreach and enrollment grants inoperative on June 30, 2018. The bill
would extend the availability of amounts previously appropriated
from the Healthcare Outreach and Medi-Cal Enrollment Account and the
Federal Trust Fund to June 30, 2018, thereby making an appropriation.
(25) This bill would require, upon an appropriation of funds by
the Legislature for this purpose, the State Department of Health Care
Services to provide a grant to health benefit plans that meet
certain criteria for purposes of funding health care coverage for
agricultural employees and dependents, as specified.
(26) This bill, for the 2015-16 fiscal year and upon appropriation
of funds by the Legislature for this purpose, would require the
State Department of Health Care Services to provide a grant to
LifeLong Medical Care, a federally qualified health center in Contra
Costa County, to be used to support LifeLong Medical Care.
(27) Existing law, the Budget Act of 2013, appropriates
$142,000,000 to the California Health Facilities Financing Authority
(CHFFA) for mental health wellness grants. Existing law, the Budget
Act of 2013, authorizes these funds to be available for encumbrance
or expenditure until June 30, 2016.
This bill would authorize CHFFA to use up to $3,000,000 of these
funds, if unencumbered, to develop peer respite sites. The bill would
require any grant awards authorized by CHFFA for peer respite sites
to be used to expand local resources for the development, capital,
equipment acquisition, and applicable program startup or expansion
costs to increase bed capacity for peer respite support services. The
bill would authorize CHFFA to adopt emergency regulations relating
to grants for peer respite sites in accordance with the
Administrative Procedure Act.
(28) This bill would require the Office of System Integration to
report to the Legislature by April 1, 2017, on the feasibility,
benefits, costs, and risks of installing the Modified Adjusted Gross
Income (MAGI) Eligibility Decision Engine in one, two, or all of the
Statewide Automated Welfare System consortia systems.
(29) Existing constitutional provisions require that a statute
that limits the right of access to the meetings of public bodies or
the writings of public officials and agencies be adopted with
findings demonstrating the interest protected by the limitation and
the need for protecting that interest.
This bill would make legislative findings to that effect.
(30) This bill would make legislative findings and declarations as
to the necessity of a special statute for LifeLong Medical Care and
Contra Costa County.
(31) The California Constitution requires the state to reimburse
local agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that with regard to certain mandates no
reimbursement is required by this act for a specified reason.
With regard to any other mandates, this bill would provide that,
if the Commission on State Mandates determines that the bill contains
costs so mandated by the state, reimbursement for those costs shall
be made pursuant to the statutory provisions noted above.
(32) This bill would declare that it is to take effect immediately
as a bill providing for appropriations related to the Budget Bill.
Appropriation: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. It is the intent of the Legislature that, in enacting
the amendments made to Section 1420 of the Health and Safety Code by
the act that added this section, the State Department of Public
Health continue to seek to reduce long-term care compliant
investigation timelines to less than 60 days with a goal of meeting a
45-day timeline.
SEC. 2. Section 1220 of the Business and Professions Code is
amended to read:
1220. (a) (1) Each clinical laboratory shall maintain records,
equipment, and facilities that are adequate and appropriate for the
services rendered.
(2) (A) Except for tests or examinations classified as waived
under CLIA, each clinical laboratory shall enroll, and demonstrate
successful participation, as defined under CLIA, for each specialty
and subspecialty in which it performs clinical laboratory tests or
examinations, in a proficiency testing program approved by the
department or by HCFA, to the same extent as required by CLIA in
Subpart H (commencing with Section 493.801) of Title 42 of the Code
of Federal Regulations. This requirement shall not be interpreted to
prohibit a clinical laboratory from performing clinical laboratory
tests or examinations in a specialty or subspecialty for which there
is no department or HCFA approved proficiency testing program.
(B) Each clinical laboratory shall authorize its proficiency test
results to be reported to the department in an electronic format that
is compatible with the department's proficiency testing data
monitoring system and shall authorize the release of proficiency
tests results to the public to the same extent required by CLIA.
(b) Each clinical laboratory shall be conducted, maintained, and
operated without injury to the public health.
(c) (1) The department shall conduct inspections of licensed
clinical laboratories no less than once every two years. The
department shall maintain a record of those inspections and shall
ensure that every licensed clinical laboratory in California is
inspected at least that often.
(2) Registered clinical laboratories shall not be routinely
inspected by the department.
(3) The department shall conduct an investigation of complaints
received concerning any clinical laboratory, which may include an
inspection of the laboratory.
(4) Each licensed or registered clinical laboratory shall be
subject to inspections by HCFA or HCFA agents, as defined by CLIA, as
a condition of licensure or registration.
(d) (1) Each clinical laboratory shall perform all clinical
laboratory tests or examinations classified as waived under CLIA in
conformity with the manufacturer's instructions.
(2) Except for those clinical laboratories performing only tests
or examinations classified as waived under CLIA, each clinical
laboratory shall establish and maintain all of the following:
(A) A patient test management system that meets the standards of
CLIA in Subpart J (commencing with Section 493.1100) of Title 42 of
the Code of Federal Regulations.
(B) A quality control program that meets the requirements of CLIA
in Subpart K (commencing with Section 493.1200) of Title 42 of the
Code of Federal Regulations as in effect on January 1, 2015, and that
may include the clinical laboratory's use of the following
alternative quality control testing procedures recognized by the
federal Centers for Medicare and Medicaid Services (CMS):
(i) Until December 31, 2015, equivalent quality control
procedures.
(ii) Commencing January 1, 2016, an Individualized Quality Control
Plan, as incorporated in Appendix C of the State Operations Manual
adopted by CMS.
(C) A comprehensive quality assurance program that meets the
standards of CLIA in Subpart P (commencing with Section 493.1701) of
Title 42 of the Code of Federal Regulations.
SEC. 3. Section 100504 of the Government Code is amended to read:
100504. (a) The board may do the following:
(1) With respect to individual coverage made available in the
Exchange, collect premiums and assist in the administration of
subsidies.
(2) Enter into contracts.
(3) Sue and be sued.
(4) Receive and accept gifts, grants, or donations of moneys from
any agency of the United States, any agency of the state, and any
municipality, county, or other political subdivision of the state.
(5) Receive and accept gifts, grants, or donations from
individuals, associations, private foundations, and corporations, in
compliance with the conflict of interest provisions to be adopted by
the board at a public meeting.
(6) Adopt rules and regulations, as necessary. Until January 1,
2017, any necessary rules and regulations may be adopted as emergency
regulations in accordance with the Administrative Procedure Act
(Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2). The adoption of these regulations shall be deemed to be
an emergency and necessary for the immediate preservation of the
public peace, health and safety, or general welfare. Notwithstanding
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2, including subdivisions (e) and (h) of Section 11346.1,
any emergency regulation adopted pursuant to this section shall be
repealed by operation of law unless the adoption, amendment, or
repeal of the regulation is promulgated by the board pursuant to
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code within three years of the initial
adoption of the emergency regulation. Notwithstanding subdivision (h)
of Section 11346.1, until January 1, 2020, the Office of
Administrative Law may approve more than two readoptions of an
emergency regulation adopted pursuant to this section. The amendments
made to this paragraph by the act adding this sentence shall apply
to any emergency regulation adopted pursuant to this section prior to
the effective date of the Budget Act of 2015.
(7) Collaborate with the State Department of Health Care Services
and the Managed Risk Medical Insurance Board, to the extent possible,
to allow an individual the option to remain enrolled with his or her
carrier and provider network in the event the individual experiences
a loss of eligibility of premium tax credits and becomes eligible
for the Medi-Cal program or the Healthy Families Program, or loses
eligibility for the Medi-Cal program or the Healthy Families Program
and becomes eligible for premium tax credits through the Exchange.
(8) Share information with relevant state departments, consistent
with the confidentiality provisions in Section 1411 of the federal
act, necessary for the administration of the Exchange.
(9) Require carriers participating in the Exchange to make
available to the Exchange and regularly update an electronic
directory of contracting health care providers so that individuals
seeking coverage through the Exchange can search by health care
provider name to determine which health plans in the Exchange include
that health care provider in their network. The board may also
require a carrier to provide regularly updated information to the
Exchange as to whether a health care provider is accepting new
patients for a particular health plan. The Exchange may provide an
integrated and uniform consumer directory of health care providers
indicating which carriers the providers contract with and whether the
providers are currently accepting new patients. The Exchange may
also establish methods by which health care providers may transmit
relevant information directly to the Exchange, rather than through a
carrier.
(10) Make available supplemental coverage for enrollees of the
Exchange to the extent permitted by the federal act, provided that no
General Fund money is used to pay the cost of that coverage. Any
supplemental coverage offered in the Exchange shall be subject to the
charge imposed under subdivision (n) of Section 100503.
(b) The Exchange shall only collect information from individuals
or designees of individuals necessary to administer the Exchange and
consistent with the federal act.
(c) (1) The board shall have the authority to standardize products
to be offered through the Exchange. Any products standardized by the
board pursuant to this subdivision shall be discussed by the board
during at least one properly noticed board meeting prior to the board
meeting at which the board adopts the standardized products to be
offered through the Exchange.
(2) The adoption, amendment, or repeal of a regulation by the
board to implement this subdivision is exempt from the rulemaking
provisions of the Administrative Procedure Act (Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2).
SEC. 4. Section 100505 of the Government Code is amended to read:
100505. (a) The board shall establish and use a competitive
process to select participating carriers and any other contractors
under this title. Any contract entered into pursuant to this title
shall be exempt from Chapter 1 (commencing with Section 10100) of
Part 2 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. The board shall adopt a Health Benefit Exchange
Contracting Manual incorporating procurement and contracting policies
and procedures that shall be followed by the Exchange. The policies
and procedures in the manual shall be substantially similar to the
provisions contained in the State Contracting Manual.
(b) The adoption, amendment, or repeal of a regulation by the
board to implement this section, including the adoption of a manual
pursuant to subdivision (a) and any procurement process conducted by
the Exchange in accordance with the manual, is exempt from the
rulemaking provisions of the Administrative Procedure Act (Chapter
3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title
2).
SEC. 5. Section 1266 of the Health and Safety Code is amended to
read:
1266. (a) The Licensing and Certification Division shall be
supported entirely by federal funds and special funds by no earlier
than the beginning of the 2009-10 fiscal year unless otherwise
specified in statute, or unless funds are specifically appropriated
from the General Fund in the annual Budget Act or other enacted
legislation. For the 2007-08 fiscal year, General Fund support shall
be provided to offset licensing and certification fees in an amount
of not less than two million seven hundred eighty-two thousand
dollars ($2,782,000).
(b) (1) The Licensing and Certification Program fees for the
2006-07 fiscal year shall be as follows:
Type of Facility Fee
General Acute Care Hospitals $ 134.10 per bed
Acute Psychiatric Hospitals $ 134.10 per bed
Special Hospitals $ 134.10 per bed
Chemical Dependency Recovery
Hospitals $ 123.52 per bed
Skilled Nursing Facilities $ 202.96 per bed
Intermediate Care Facilities $ 202.96 per bed
Intermediate Care Facilities- per
Developmentally Disabled $ 592.29 bed
Intermediate Care Facilities-
Developmentally Disabled- per
Habilitative $1,000.00 facility
Intermediate Care Facilities-
Developmentally Disabled- per
Nursing $1,000.00 facility
Home Health Agencies per
$2,700.00 facility
Referral Agencies per
$5,537.71 facility
Adult Day Health Centers per
$4,650.02 facility
Congregate Living Health
Facilities $ 202.96 per bed
Psychology Clinics per
$ 600.00 facility
Primary Clinics- Community per
and Free $ 600.00 facility
Specialty Clinics- Rehab
Clinics per
(For profit) $2,974.43 facility
(Nonprofit) per
$ 500.00 facility
Specialty Clinics- Surgical per
and Chronic $1,500.00 facility
Dialysis Clinics per
$1,500.00 facility
Pediatric Day Health/Respite
Care $ 142.43 per bed
Alternative Birthing Centers per
$2,437.86 facility
Hospice per
$1,000.00 provider
Correctional Treatment Centers $ 590.39 per bed
(2) (A) In the first year of licensure for intermediate care
facility/developmentally disabled-continuous nursing (ICF/DD-CN)
facilities, the licensure fee for those facilities shall be
equivalent to the licensure fee for intermediate care
facility/developmentally disabled-nursing facilities during the same
year. Thereafter, the licensure fee for ICF/DD-CN facilities shall be
established pursuant to the same procedures described in this
section.
(B) In the first year of licensure for hospice facilities, the
licensure fee shall be equivalent to the licensure fee for congregate
living health facilities during the same year. Thereafter, the
licensure fee for hospice facilities shall be established pursuant to
the same procedures described in this section.
(c) Commencing in the 2015-16 fiscal year, the fees for skilled
nursing facilities shall be increased so as to generate four hundred
thousand dollars ($400,000) for the California Department of Aging's
Long-Term Care Ombudsman Program for its work related to
investigating complaints made against skilled nursing facilities and
increasing visits to those facilities.
(d) Commencing February 1, 2007, and every February 1 thereafter,
the department shall publish a list of estimated fees pursuant to
this section. The calculation of estimated fees and the publication
of the report and list of estimated fees shall not be subject to the
rulemaking requirements of Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code.
(e) Notwithstanding Section 10231.5 of the Government Code, by
February 1 of each year, the department shall prepare the following
reports and shall make those reports, and the list of estimated fees
required to be published pursuant to subdivision (d), available to
the public by submitting them to the Legislature and posting them on
the department's Internet Web site:
(1) A report of all costs for activities of the Licensing and
Certification Program. At a minimum, this report shall include a
narrative of all baseline adjustments and their calculations, a
description of how each category of facility was calculated,
descriptions of assumptions used in any calculations, and shall
recommend Licensing and Certification Program fees in accordance with
the following:
(A) Projected workload and costs shall be grouped for each fee
category, including workload costs for facility categories that have
been established by statute and for which licensing regulations and
procedures are under development.
(B) Cost estimates, and the estimated fees, shall be based on the
appropriation amounts in the Governor's proposed budget for the next
fiscal year, with and without policy adjustments to the fee
methodology.
(C) The allocation of program, operational, and administrative
overhead, and indirect costs to fee categories shall be based on
generally accepted cost allocation methods. Significant items of
costs shall be directly charged to fee categories if the expenses can
be reasonably identified to the fee category that caused them.
Indirect and overhead costs shall be allocated to all fee categories
using a generally accepted cost allocation method.
(D) The amount of federal funds and General Fund moneys to be
received in the budget year shall be estimated and allocated to each
fee category based upon an appropriate metric.
(E) The fee for each category shall be determined by dividing the
aggregate state share of all costs for the Licensing and
Certification Program by the appropriate metric for the category of
licensure. Amounts actually received for new licensure applications,
including change of ownership applications, and late payment
penalties, pursuant to Section 1266.5, during each fiscal year shall
be calculated and 95 percent shall be applied to the appropriate fee
categories in determining Licensing and Certification Program fees
for the second fiscal year following receipt of those funds. The
remaining 5 percent shall be retained in the fund as a reserve until
appropriated.
(2) (A) A staffing and systems analysis to ensure efficient and
effective utilization of fees collected, proper allocation of
departmental resources to licensing and certification activities,
survey schedules, complaint investigations, enforcement and appeal
activities, data collection and dissemination, surveyor training, and
policy development.
(B) The analysis under this paragraph shall be made available to
interested persons and shall include all of the following:
(i) The number of surveyors and administrative support personnel
devoted to the licensing and certification of health care facilities.
(ii) The percentage of time devoted to licensing and certification
activities for the various types of health facilities.
(iii) The number of facilities receiving full surveys and the
frequency and number of followup visits.
(iv) The number and timeliness of complaint investigations,
including data on the department's compliance with the requirements
of paragraphs (3), (4), and (5) of subdivision (a) of Section 1420.
(v) Data on deficiencies and citations issued, and numbers of
citation review conferences and arbitration hearings.
(vi) Other applicable activities of the licensing and
certification division.
(3) The annual program fee report described in subdivision (d) of
Section 1416.36.
(f) The reports required pursuant to subdivision (e) shall be
submitted in compliance with Section 9795 of the Government Code.
(g) (1) The department shall adjust the list of estimated fees
published pursuant to subdivision(d) if the annual Budget Act or
other enacted legislation includes an appropriation that differs from
those proposed in the Governor's proposed budget for that fiscal
year.
(2) The department shall publish a final fee list, with an
explanation of any adjustment, by the issuance of an all facilities
letter, by posting the list on the department's Internet Web site,
and by including the final fee list as part of the licensing
application package, within 14 days of the enactment of the annual
Budget Act. The adjustment of fees and the publication of the final
fee list shall not be subject to the rulemaking requirements of
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code.
(h) (1) Fees shall not be assessed or collected pursuant to this
section from any state department, authority, bureau, commission, or
officer, unless federal financial participation would become
available by doing so and an appropriation is included in the annual
Budget Act for that state department, authority, bureau, commission,
or officer for this purpose. Fees shall not be assessed or collected
pursuant to this section from any clinic that is certified only by
the federal government and is exempt from licensure under Section
1206, unless federal financial participation would become available
by doing so.
(2) For the 2006-07 state fiscal year, a fee shall not be assessed
or collected pursuant to this section from any general acute care
hospital owned by a health care district with 100 beds or less.
(i) The Licensing and Certification Program may change annual
license expiration renewal dates to provide for efficiencies in
operational processes or to provide for sufficient cashflow to pay
for expenditures. If an annual license expiration date is changed,
the renewal fee shall be prorated accordingly. Facilities shall be
provided with a 60-day notice of any change in their annual license
renewal date.
(j) Commencing with the 2018-19 November Program estimate, the
Licensing and Certification Program shall evaluate the feasibility of
reducing investigation timelines based on experience with
implementing paragraphs (3), (4), and (5) of subdivision (a) of
Section 1420.
SEC. 6. Section 1279.2 of the Health and Safety Code is amended to
read:
1279.2. (a) (1) In any case in which the department receives a
report from a facility pursuant to Section 1279.1, or a written or
oral complaint involving a health facility licensed pursuant to
subdivision (a), (b), or (f) of Section 1250, that indicates an
ongoing threat of imminent danger of death or serious bodily harm,
the department shall make an onsite inspection or investigation
within 48 hours or two business days, whichever is greater, of the
receipt of the report or complaint and shall complete that
investigation within 45 days.
(2) Until the department has determined by onsite inspection that
the adverse event has been resolved, the department shall, not less
than once a year, conduct an unannounced inspection of any health
facility that has reported an adverse event pursuant to Section
1279.1.
(b) In any case in which the department is able to determine from
the information available to it that there is no threat of imminent
danger of death or serious bodily harm to that patient or other
patients, the department shall complete an investigation of the
report within 45 days.
(c) If the department does not meet the timeframes established in
subdivision (a), the department shall document the extenuating
circumstances explaining why it could not meet the timeframes. The
department shall provide written notice to the facility and the
complainant, if any, of the basis for the extenuating circumstances
and the anticipated completion date.
(d) The department shall notify the complainant and licensee in
writing of the department's determination as a result of an
inspection or report.
(e) For purposes of this section, "complaint" means any oral or
written notice to the department, other than a report from the health
facility, of an alleged violation of applicable requirements of
state or federal law or an allegation of facts that might constitute
a violation of applicable requirements of state or federal law.
(f) The costs of administering and implementing this section shall
be paid from funds derived from existing licensing fees paid by
general acute care hospitals, acute psychiatric hospitals, and
special hospitals.
(g) In enforcing this section and Sections 1279 and 1279.1, the
department shall take into account the special circumstances of small
and rural hospitals, as defined in Section 124840, in order to
protect the quality of patient care in those hospitals.
(h) In preparing the staffing and systems analysis required
pursuant to Section 1266, the department shall also report regarding
the number and timeliness of investigations of adverse events
initiated in response to reports of adverse events.
SEC. 7. Section 1367.54 of the Health and Safety Code is amended
to read:
1367.54. (a) Every group health care service plan contract that
provides maternity benefits, except for a specialized health care
service plan contract, that is issued, amended, renewed, or delivered
on or after January 1, 1999, and every individual health care
service plan contract of a type and form first offered for sale on or
after January 1, 1999, that provides maternity benefits, except a
specialized health care service plan contract, shall provide coverage
for participation in the California Prenatal Screening Program,
which is a statewide prenatal testing program administered by the
State Department of Public Health, pursuant to Section 124977.
Notwithstanding any other provision of law, a health care service
plan that provides maternity benefits shall not require participation
in the statewide prenatal testing program administered by the State
Department of Public Health as a prerequisite to eligibility for, or
receipt of, any other service.
(b) Coverage required by this section shall not be subject to
copayment, coinsurance, deductible, or any other form of cost
sharing.
(c) Reimbursement for services covered pursuant to this section
shall be paid at the amount set pursuant to Section 124977 and
regulations adopted thereunder.
SEC. 8. Section 1373.622 of the Health and Safety Code is amended
to read:
1373.622. (a) (1) After the termination of the pilot program
under Section 1373.62, a health care service plan shall continue to
provide coverage under the same terms and conditions specified in
Section 1376.62 as it existed on January 1, 2007, including the terms
of the standard benefit plan and the subscriber payment amount, to
each individual who was terminated from the program pursuant to
subdivision (f) of Section 12725 of the Insurance Code during the
term of the pilot program and who enrolled or applied to enroll in a
standard benefit plan within 63 days of termination. The State
Department of Health Care Services shall continue to pay the amount
described in Section 1376.62 for each of those individuals. A health
care service plan shall not be required to offer the coverage
described in Section 1373.62 after the termination of the pilot
program to individuals not already enrolled in the program.
(2) Notwithstanding paragraph (1) of this subdivision or Section
1373.62 as it existed on January 1, 2007, the following rules shall
apply:
(A) (i) A health care service plan shall not be obligated to
provide coverage to any individual pursuant to this section on or
after January 1, 2014.
(ii) The State Department of Health Care Services shall not be
obligated to provide any payment to any health care service plan
under this section for (I) health care expenses incurred on or after
January 1, 2014, or (II) the standard monthly administrative fee, as
defined in Section 1373.62 as it existed on January 1, 2007, for any
month after December 2013.
(B) Each health care service plan providing coverage pursuant to
this section shall, on or before October 1, 2013, send a notice to
each individual enrolled in a standard benefit plan that is in at
least 12-point type and with, at minimum, the following information:
(i) Notice as to whether or not the plan will terminate as of
January 1, 2014.
(ii) The availability of individual health coverage, including
through Covered California, including at least all of the following:
(I) That, beginning on January 1, 2014, individuals seeking
coverage may not be denied coverage based on health status.
(II) That the premium rates for coverage offered by a health care
service plan or a health insurer cannot be based on an individual's
health status.
(III) That individuals obtaining coverage through Covered
California may, depending upon income, be eligible for premium
subsidies and cost-sharing subsidies.
(IV) That individuals seeking coverage must obtain this coverage
during an open or special enrollment period, and a description of the
open and special enrollment periods that may apply.
(C) As a condition of receiving payment for a reporting period
pursuant to this section, a health care service plan shall provide
the State Department of Health Care Services with a complete, final
annual reconciliation report by the earlier of December 31, 2014, or
an earlier date as prescribed by Section 1373.62, as it existed on
January 1, 2007, for that reporting period. To the extent that it
receives a complete, final reconciliation report for a reporting
period by the date required pursuant to this subparagraph, the State
Department of Health Care Services shall complete reconciliation with
the health care service plan for that reporting period within 18
months after receiving the report.
(b) If the state fails to expend, pursuant to this section,
sufficient funds for the state's contribution amount to any health
care service plan, the health care service plan may increase the
monthly payments that its subscribers are required to pay for any
standard benefit plan to the amount that the State Department of
Health Care Services would charge without a state subsidy for the
same plan issued to the same individual within the program.
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the State
Department of Health Care Services may implement, interpret, or make
specific this section by means of all-county letters, plan letters,
plan or provider bulletins, or similar instructions, without taking
regulatory action.
SEC. 9. Section 1420 of the Health and Safety Code is amended to
read:
1420. (a) (1) Upon receipt of a written or oral complaint, the
state department shall assign an inspector to make a preliminary
review of the complaint and shall notify the complainant within two
working days of the receipt of the complaint of the name of the
inspector. Unless the state department determines that the complaint
is willfully intended to harass a licensee or is without any
reasonable basis, it shall make an onsite inspection or investigation
within 10 working days of the receipt of the complaint. In any case
in which the complaint involves a threat of imminent danger of death
or serious bodily harm, the state department shall make an onsite
inspection or investigation within 24 hours of the receipt of the
complaint. In any event, the complainant shall be promptly informed
of the state department's proposed course of action and of the
opportunity to accompany the inspector on the inspection or
investigation of the facility. Upon the request of either the
complainant or the state department, the complainant or his or her
representative, or both, may be allowed to accompany the inspector to
the site of the alleged violations during his or her tour of the
facility, unless the inspector determines that the privacy of any
patient would be violated thereby.
(2) When conducting an onsite inspection or investigation
pursuant to this section, the state department shall collect and
evaluate all available evidence and may issue a citation based upon,
but not limited to, all of the following:
(A) Observed conditions.
(B) Statements of witnesses.
(C) Facility records.
(3) (A) For a complaint that involves a threat of imminent danger
of death or serious bodily harm that is received on or after July 1,
2016, the state department shall complete an investigation of the
complaint within 90 days of receipt of the complaint. At the
completion of the complaint investigation, the state department shall
notify the complainant and licensee in writing of the state
department's determination as a result of the inspection or
investigation.
(B) The time period described in subparagraph (A) may be extended
up to an additional 60 days if the investigation cannot be completed
due to extenuating circumstances. The state department shall document
these circumstances in its final determination and notify the
facility and the complainant in writing of the basis for the
extension and the estimated completion date.
(4) (A) For a complaint that does not involve a threat of imminent
danger of death or serious bodily harm pursuant to paragraph (3) and
that is received on or after July 1, 2017, and prior to July 1,
2018, the state department shall complete an investigation of the
complaint within 90 days of receipt of the complaint. At the
completion of the complaint investigation, the state department shall
notify the complainant and licensee in writing of the state
department's determination as a result of the inspection or
investigation.
(B) The time period described in subparagraph (A) may be extended
up to an additional 90 days if the investigation cannot be completed
due to extenuating circumstances. The state department shall document
these circumstances in its final determination and notify the
facility and the complainant in writing of the basis for the
extension and the estimated completion date.
(5) (A) For a complaint that is received on or after July 1, 2018,
the state department shall complete an investigation of the
complaint within 60 days of receipt of the complaint. At the
completion of the complaint investigation, the state department shall
notify the complainant and licensee in writing of the state
department's determination as a result of the inspection or
investigation.
(B) The time period described in subparagraph (A) may be extended
up to an additional 60 days if the investigation cannot be completed
due to extenuating circumstances. The state department shall document
these circumstances in its final determination and notify the
facility and the complainant in writing of the basis for the
extension and the estimated completion date.
(b) Upon being notified of the state department's determination
as a result of the inspection or investigation, a complainant who is
dissatisfied with the state department's determination, regarding a
matter which would pose a threat to the health, safety, security,
welfare, or rights of a resident, shall be notified by the state
department of the right to an informal conference, as set forth in
this section. The complainant may, within five business days after
receipt of the notice, notify the director in writing of his or her
request for an informal conference. The informal conference shall be
held with the designee of the director for the county in which the
long-term health care facility which is the subject of the complaint
is located. The long-term health care facility may participate as a
party in this informal conference. The director's designee shall
notify the complainant and licensee of his or her determination
within 10 working days after the informal conference and shall
apprise the complainant and licensee in writing of the appeal rights
provided in subdivision (c).
(c) If the complainant is dissatisfied with the determination of
the director's designee in the county in which the facility is
located, the complainant may, within 15 days after receipt of this
determination, notify in writing the Deputy Director of the Licensing
and Certification Division of the state department, who shall assign
the request to a representative of the Complainant Appeals Unit for
review of the facts that led to both determinations. As a part of the
Complainant Appeals Unit's independent investigation, and at the
request of the complainant, the representative shall interview the
complainant in the district office where the complaint was initially
referred. Based upon this review, the Deputy Director of the
Licensing and Certification Division of the state department shall
make his or her own determination and notify the complainant and the
facility within 30 days.
(d) Any citation issued as a result of a conference or review
provided for in subdivision (b) or (c) shall be issued and served
upon the facility within 30 days of the final determination. Service
shall be effected either personally or by registered or certified
mail. A copy of the citation shall also be sent to each complainant
by registered or certified mail.
(e) A miniexit conference shall be held with the administrator or
his or her representative upon leaving the facility at the
completion of the investigation to inform him or her of the status of
the investigation. The state department shall also state the items
of noncompliance and compliance found as a result of a complaint and
those items found to be in compliance, provided the disclosure
maintains the anonymity of the complainant. In any matter in which
there is a reasonable probability that the identity of the
complainant will not remain anonymous, the state department shall
also notify the facility that it is unlawful to discriminate or seek
retaliation against a resident, employee, or complainant.
(f) Any citation issued as a result of the complaint investigation
provided for in paragraph (3), (4), or (5) of subdivision (a), and
in compliance with Section 1423, shall be issued and served upon the
facility within 30 days of the completion of the complaint
investigation.
(g) For purposes of this section, "complaint" means any oral or
written notice to the state department, other than a report from the
facility of an alleged violation of applicable requirements of state
or federal law or any alleged facts that might constitute such a
violation.
(h) Nothing in this section shall be interpreted to diminish the
state department's authority and obligation to investigate any
alleged violation of applicable requirements of state or federal law,
or any alleged facts that might constitute a violation of applicable
requirements of state or federal law, and to enforce applicable
requirements of law.
SEC. 10. Section 1423 of the Health and Safety Code is amended to
read:
1423. (a) If upon inspection or investigation the director
determines that any nursing facility is in violation of any state or
federal law or regulation relating to the operation or maintenance of
the facility, or determines that any other long-term health care
facility is in violation of any statutory provision or regulation
relating to the operation or maintenance of the facility, the
director shall promptly, but not later than 24 hours, excluding
Saturday, Sunday, and holidays, after the director determines or has
reasonable cause to determine that an alleged violation has occurred,
issue a notice to correct the violation and of intent to issue a
citation to the licensee. Before completing the investigation and
making the final determination whether to issue a citation, the
department shall hold an exit conference with the licensee to
identify the potential for issuing a citation for any violation,
discuss investigative findings, and allow the licensee to provide the
department with additional information related to the violation. The
department shall consider this additional information, in
conjunction with information from the inspection or investigation, in
determining whether to issue a citation, or whether other action
would be appropriate. If the department determines that the violation
warrants the issuing of a citation and an exit conference has been
completed it shall either:
(1) Recommend the imposition of a federal enforcement remedy or
remedies on a nursing facility in accordance with federal law; or
(2) Issue a citation pursuant to state licensing laws, and if the
facility is a nursing facility, may recommend the imposition of a
federal enforcement remedy.
A state citation shall be served upon the licensee within 30 days
after completion of the investigation. Service shall be effected
either personally or by registered or certified mail. A copy of the
citation shall also be sent to each complainant. Each citation shall
be in writing and shall describe with particularity the nature of the
violation, including a reference to the statutory provision,
standard, rule, or regulation alleged to have been violated, the
particular place or area of the facility in which it occurred, as
well as the amount of any proposed assessment of a civil penalty. The
name of any patient jeopardized by the alleged violation shall not
be specified in the citation in order to protect the privacy of the
patient. However, at the time the licensee is served with the
citation, the licensee shall also be served with a written list of
each of the names of the patients alleged to have been jeopardized by
the violation, that shall not be subject to disclosure as a public
record. The citation shall fix the earliest feasible time for the
elimination of the condition constituting the alleged violation, when
appropriate.
(b) Where no harm to patients, residents, or guests has occurred,
a single incident, event, or occurrence shall result in no more than
one citation for each statute or regulation violated.
(c) No citation shall be issued for a violation that has been
reported by the licensee to the state department, or its designee, as
an "unusual occurrence," if all of the following conditions are met:
(1) The violation has not caused harm to any patient, resident, or
guest, or significantly contributed thereto.
(2) The licensee has promptly taken reasonable measures to correct
the violation and to prevent a recurrence.
(3) The unusual occurrence report was the first source of
information reported to the state department, or its designee,
regarding the violation.
SEC. 11. Section 104150 of the Health and Safety Code is amended
to read:
104150. (a) (1) A provider or entity that participates in the
grant made to the department by the federal Centers for Disease
Control and Prevention breast and cervical cancer early detection
program established under Title XV of the federal Public Health
Service Act (42 U.S.C. Sec. 300k et seq.) in accordance with
requirements of Section 1504 of that act (42 U.S.C. Sec. 300n) may
only render screening services under the grant to an individual if
the provider or entity determines that the individual's family income
does not exceed 200 percent of the federal poverty level.
(2) Providers, or the enrolling entity, shall make available to
all applicants and beneficiaries, prior to or concurrent with
enrollment, information on the manner in which to apply for insurance
affordability programs, in a manner determined by the State
Department of Health Care Services. The information shall include the
manner in which applications can be submitted for insurance
affordability programs, information about the open enrollment periods
for the California Health Benefit Exchange, and the continuous
enrollment aspect of the Medi-Cal program.
(b) The department shall provide for breast cancer and cervical
cancer screening services under the grant at the level of funding
budgeted from state and other resources during the fiscal year in
which the Legislature has appropriated funds to the department for
this purpose. These screening services shall not be deemed to be an
entitlement.
(c) To implement the federal breast and cervical cancer early
detection program specified in this section, the department may
contract, to the extent permitted by Section 19130 of the Government
Code, with public and private entities, or utilize existing health
care service provider enrollment and payment mechanisms, including
the Medi-Cal program's fiscal intermediary. However, the Medi-Cal
program's fiscal intermediary shall only be utilized if services
provided under the program are specifically identified and reimbursed
in a manner that does not claim federal financial reimbursement. Any
contracts with, and the utilization of, the Medi-Cal program's
fiscal intermediary shall not be subject to Chapter 3 (commencing
with Section 12100) of Part 2 of Division 2 of the Public Contract
Code. Contracts to implement the federal breast and cervical cancer
early detection program entered into by the department with entities
other than the Medi-Cal program's fiscal intermediary shall not be
subject to Part 2 (commencing with Section 10100) of Division 2 of
the Public Contract Code.
(d) The department shall enter into an interagency agreement with
the State Department of Health Care Services to transfer that portion
of the grant made to the department by the federal Centers for
Disease Control and Prevention breast and cervical cancer early
detection program established under Title XV of the federal Public
Health Service Act (42 U.S.C. Sec. 300k et seq.) to the State
Department of Health Care Services. The department shall have no
other liability to the State Department of Health Care Services under
this article.
SEC. 12. Section 104322 of the Health and Safety Code is amended
to read:
104322. (a) (1) The State Department of Health Care Services
shall develop and implement a program to provide quality prostate
cancer treatment for low-income and uninsured men.
(2) The State Department of Health Care Services shall award one
or more contracts to provide prostate cancer treatment through
private or public nonprofit organizations, including, but not limited
to, community-based organizations, local health care providers, the
University of California medical centers, and the Charles R. Drew
University of Medicine and Science, an affiliate of the David Geffen
School of Medicine at the University of California at Los Angeles.
Contracts awarded, subsequent to the effective date of the amendments
to this section made during the 2005 portion of the 2005-06 Regular
Session, pursuant to this paragraph shall be consistent with both of
the following:
(A) Eighty-seven percent of the total contract funding shall be
used for direct patient care.
(B) No less than 70 percent of the total contract funding shall be
expended on direct patient care treatment costs, which shall be
defined as funding to fee-for-service providers for Medi-Cal eligible
services.
(3) The contracts described in paragraph (2) shall not be subject
to Part 2 (commencing with Section 10100) of Division 2 of the Public
Contract Code. Commencing July 1, 2006, those contracts shall be
entered into on a competitive bid basis.
(4) It is the intent of the Legislature to support the prostate
cancer treatment program provided for pursuant to this section, and
that the program be cost-effective and maximize the number of men
served for the amount of funds appropriated. It is further the intent
of the Legislature to ensure that the program has an adequate health
care provider network to facilitate reasonable access to treatment.
(b) (1) Treatment provided under this chapter shall be provided to
uninsured and underinsured men with incomes at or below 200 percent
of the federal poverty level.
(2) The enrolling entity shall make available to all applicants
and beneficiaries, prior to or concurrent with enrollment,
information on the manner in which to apply for insurance
affordability programs, in a manner determined by the State
Department of Health Care Services. The information provided shall
include the manner in which applications can be submitted for
insurance affordability programs, information about the open
enrollment periods for the California Health Benefit Exchange, and
the continuous enrollment aspect of the Medi-Cal program.
(3) Covered services shall be limited to prostate cancer
treatment and prostate cancer-related services. Eligible men shall be
enrolled in a 12-month treatment regimen.
(c) The State Department of Health Care Services shall contract
for prostate cancer treatment services only at the level of funding
budgeted from state and other sources during a fiscal year in which
the Legislature has appropriated funds to the department for this
purpose.
(d) Notwithstanding subdivision (a) of Section 2.00 of the Budget
Act of 2003 and any other law, commencing with the 2003-04 fiscal
year and for each fiscal year thereafter, any amount appropriated to
the State Department of Health Care Services for the prostate cancer
treatment program implemented pursuant to this chapter shall be made
available, for purposes of that program, for encumbrance for one
fiscal year beyond the year of appropriation and for expenditure for
two fiscal years beyond the year of encumbrance.
SEC. 13. Section 110050 of the Health and Safety Code is amended
to read:
110050. The Food Safety Fund is hereby created as a special fund
in the State Treasury. All moneys collected by the department under
subdivision (c) of Section 110466 and Sections 110470, 110471,
110485, 114365, 114365.6, 111130, and 113717, and under Article 7
(commencing with Section 110810) of Chapter 5, or awarded to the
department pursuant to court orders or settlements for the use of
food safety-related activities, shall be deposited in the fund, for
use by the department, upon appropriation by the Legislature, for the
purposes of providing funds necessary to carry out and implement the
inspection provisions of this part relating to food, licensing,
inspection, enforcement, and other provisions of Article 12
(commencing with Section 111070) of Chapter 5, relating to water, the
provisions relating to education and training in the prevention of
microbial contamination pursuant to Section 110485, and the
registration provisions of Article 7 (commencing with Section 110810)
of Chapter 5, and to carry out and implement the provisions of the
California Retail Food Code (Part 7 (commencing with Section 113700)
of Division 104).
SEC. 14. Section 120780.2 is added to the Health and Safety Code,
to read:
120780.2. In order to reduce the spread of HIV, hepatitis C, and
other potentially deadly blood-borne pathogens, the State Department
of Public Health may purchase sterile hypodermic needles and
syringes, and other supplies, for distribution to syringe exchange
programs authorized pursuant to law. Supplies provided to programs,
including those administered by local health departments, are not
subject to the formulas and limits of Section 120780.1.
SEC. 15. Section 120960 of the Health and Safety Code is amended
to read:
120960. (a) The department shall establish uniform standards of
financial eligibility for the drugs under the program established
under this chapter.
(b) Nothing in the financial eligibility standards shall prohibit
drugs to an otherwise eligible person whose modified adjusted gross
income does not exceed 500 percent of the federal poverty level per
year based on family size and household income. However, the director
may authorize drugs for persons with incomes higher than 500 percent
of the federal poverty level per year based on family size and
household income if the estimated cost of those drugs in one year is
expected to exceed 20 percent of the person's modified adjusted gross
income.
(c) The department shall establish and may administer a payment
schedule to determine the payment obligation of a person receiving
drugs. No person shall be obligated for payment whose modified
adjusted gross income is less than four times the federal poverty
level based on family size and household income. The payment
obligation shall be the lesser of the following:
(1) Two times the person's annual state income tax liability, less
funds expended by the person for health insurance premiums.
(2) The cost of drugs.
(d) Persons who have been determined to have a payment obligation
pursuant to subdivision (c) shall be advised by the department of
their right to request a reconsideration of that determination to the
department. Written notice of the right to request a reconsideration
shall be provided to the person at the time that notification is
given that he or she is subject to a payment obligation. The payment
determination shall be reconsidered if one or more of the following
apply:
(1) The determination was based on an incorrect calculation made
pursuant to subdivision (b).
(2) There has been a substantial change in income since the
previous eligibility determination that has resulted in a current
income that is inadequate to meet the calculated payment obligation.
(3) Unavoidable family or medical expenses that reduce the
disposable income and that result in current income that is
inadequate to meet the payment obligation.
(4) Any other situation that imposes undue financial hardship on
the person and would restrict his or her ability to meet the payment
obligation.
(e) The department may exempt a person, who has been determined to
have a payment obligation pursuant to subdivision (c), from the
obligation if both of the following criteria are satisfied:
(1) One or more of the circumstances specified in subdivision (d)
exist.
(2) The department has determined that the payment obligation will
impose an undue financial hardship on the person.
(f) If a person requests reconsideration of the payment obligation
determination, the person shall not be obligated to make any payment
until the department has completed the reconsideration request
pursuant to subdivision (d). If the department denies the exemption,
the person shall be obligated to make payments for drugs received
while the reconsideration request is pending.
(g) A county public health department administering this program
pursuant to an agreement with the director pursuant to subdivision
(b) of Section 120955 shall use no more than 5 percent of total
payments it collects pursuant to this section to cover any
administrative costs related to eligibility determinations, reporting
requirements, and the collection of payments.
(h) A county public health department administering this program
pursuant to subdivision (b) of Section 120955 shall provide all drugs
added to the program pursuant to subdivision (a) of Section 120955
within 60 days of the action of the director, subject to the
repayment obligations specified in subdivision (d) of Section 120965.
(i) For purposes of this section, the following terms shall have
the following meanings:
(1) "Family size" has the meaning given to that term in Section
36B(d)(1) of the Internal Revenue Code of 1986, and shall include
same or opposite sex married couples, registered domestic partners,
and any tax dependents, as defined by Section 152 of the Internal
Revenue Code of 1986, of
either spouse or registered domestic partner.
(2) "Federal poverty level" refers to the poverty guidelines
updated periodically in the Federal Register by the United States
Department of Health and Human Services under the authority of
Section 9902(2) of Title 42 of the United States Code.
(3) "Household income" means the sum of the applicant's or
recipient's modified adjusted gross income, plus the modified
adjusted gross income of the applicant's or recipient's spouse or
registered domestic partner, and the modified adjusted gross incomes
of all other individuals for whom the applicant or recipient, or the
applicant's or recipient's spouse or registered domestic partner, is
allowed a federal income tax deduction for the taxable year.
(4) "Internal Revenue Code of 1986" means Title 26 of the United
States Code, including all amendments enacted to that code.
(5) "Modified adjusted gross income" has the meaning given to that
term in Section 36B(d)(2)(B) of the Internal Revenue Code of 1986.
SEC. 16. Section 120962 of the Health and Safety Code is amended
to read:
120962. (a) (1) For the purpose of verifying financial
eligibility pursuant to Section 120960 and the federal Ryan White
HIV/AIDS Treatment Extension Act of 2009 (42 U.S.C. Sec. 201 et
seq.), the department shall verify the accuracy of the adjusted gross
income reported on an AIDS Drug Assistance Program application
submitted by an applicant or recipient with data, if available, from
the Franchise Tax Board.
(2) Notwithstanding any other law, the department shall disclose
the name and individual taxpayer identification number (ITIN) or
social security number of an applicant for, or recipient of, services
under this chapter to the Franchise Tax Board for the purpose of
verifying the adjusted gross income of, any tax-exempt interest
received by, any tax-exempt social security benefits received by, and
any foreign earned income of an applicant or recipient pursuant to
subdivision (b) of Section 120960.
(b) (1) The Franchise Tax Board, upon receipt of this information,
shall inform the department of all of the following:
(A) The amount of the federal adjusted gross income as reported by
the taxpayer to the Franchise Tax Board.
(B) The amount of the California adjusted gross income as reported
by the taxpayer to the Franchise Tax Board or as adjusted by the
Franchise Tax Board.
(C) The amount of any tax-exempt interest received by the
taxpayer, as reported to the Franchise Tax Board.
(D) The amount of any tax-exempt social security benefits received
by the taxpayer, as reported to the Franchise Tax Board.
(E) The amount of any foreign earned income of the taxpayer, as
reported to the Franchise Tax Board.
(2) The Franchise Tax Board shall provide the information to the
department for the most recent taxable year that the Franchise Tax
Board has information available, and shall include the first and last
name, date of birth, and the ITIN or social security number of the
taxpayer.
(c) (1) Information provided by the department pursuant to this
section shall constitute confidential public health records as
defined in Section 121035, and shall remain subject to the
confidentiality protections and restrictions on further disclosure by
the recipient under subdivisions (d) and (e) of Section 121025.
(2) To the extent possible, verification of financial eligibility
shall be done in a way to eliminate or minimize, by use of computer
programs or other electronic means, Franchise Tax Board staff and
contractors' access to confidential public health records.
(3) Prior to accessing confidential HIV-related public health
records, Franchise Tax Board staff and contractors shall be required
to annually sign a confidentiality agreement developed by the
department that includes information related to the penalties under
Section 121025 for a breach of confidentiality and the procedures for
reporting a breach of confidentiality under subdivision (h) of
Section 121022. Those agreements shall be reviewed annually by the
department.
(4) The Franchise Tax Board shall return or destroy all
information received from the department after completing the
exchange of information.
(d) For purposes of this section, "foreign earned income" also
includes any deduction taken for the housing expenses of an
individual while living abroad pursuant to Section 911 of Title 26 of
the Internal Revenue Code.
SEC. 17. The heading of Chapter 17 (commencing with Section
121348) of Part 4 of Division 105 of the Health and Safety Code is
amended to read:
CHAPTER 17. PRE- AND POST-EXPOSURE PROPHYLAXIS
SEC. 18. Section 121348.4 is added to the Health and Safety Code,
to read:
121348.4. Upon an appropriation in the annual Budget Act, the
State Department of Public Health shall establish the Pre-Exposure
Prophylaxis (PrEP) Navigator Services Program, under which the
department shall provide for the following activities:
(a) Oversight and evaluation of the PrEP Navigator Services
Program.
(b) Implementation of a process to request applications, and award
funding on a competitive basis, to community-based organizations or
local health departments. An eligible entity shall collaborate with
the Office of AIDS to conduct outcome and process evaluation of
navigator services. An entity in any county shall be eligible to
receive funding if it can demonstrate all of the following:
(1) Capacity to ensure access for and serve the most vulnerable
and underserved Californians at high risk for HIV.
(2) Ability to develop protocols to conduct outreach to targeted
populations, to provide PrEP education to clients and providers, and
to assess and refer persons to appropriate clinical care and
prevention services.
(c) Development and distribution of PrEP education materials
statewide, including providing training for and support of any
additional activity that is consistent with the goals of this
chapter.
SEC. 19. Section 122425 is added to the Health and Safety Code, to
read:
122425. There is hereby established a three-year Hepatitis C
Linkage to Care demonstration pilot project to allow for innovative,
evidence-based approaches to provide outreach, hepatitis C screening,
and linkage to, and retention in, quality health care for the most
vulnerable and underserved individuals living with, or at high risk
for, hepatitis C viral infection (HCV). This demonstration pilot
project is authorized for fiscal years 2015-16, 2016-17, and 2017-18.
SEC. 20. Section 122430 is added to the Health and Safety Code, to
read:
122430. (a) Upon an appropriation for the purpose described in
Section 122425 in the annual Budget Act for the 2015-16, 2016-17, and
2017-18 fiscal years, the department shall award funding, on a
competitive basis, to community-based organizations or local health
jurisdictions to operate demonstration pilot projects pursuant to
this chapter. The department shall determine the funding levels of
each demonstration project based on scope and geographic area. Funds
may be used to support other activities consistent with the goals of
this chapter, including the purchase of hepatitis C viral infection
(HCV) test kits, syringe exchange supplies, or other HCV prevention
and linkage to care materials and activities.
(b) An applicant for funding shall demonstrate each of the
following qualifications:
(1) Leadership on access to HCV care and testing issues and
experience addressing the needs of highly marginalized populations in
accessing medical care and support.
(2) Experience with the target population or relationships with
community-based organizations or nongovernmental organizations, or
both, that demonstrates expertise, history, and credibility working
successfully in engaging the target population.
(3) Experience working with nontraditional collaborators who work
within and beyond the field of HCV education and outreach, including
homeless services, veterans' medical and service programs, substance
use disorders treatment, syringe exchange programs, women's health,
reproductive health, immigration, mental health, or human
immunodeficiency virus (HIV) prevention and treatment.
(4) Strong relationships with community-based HCV health care
providers that have the trust of the targeted population.
(5) Strong relationships with the state and local health
departments.
(6) Capacity to coordinate a communitywide planning phase
involving multiple community collaborators.
(7) Experience implementing evidence-based programs or generating
innovative strategies, or both, with at least preliminary evidence of
program effectiveness.
(8) Administrative systems and accountability mechanisms for grant
management.
(9) Capacity to participate in evaluation activities.
(10) Strong communication systems that are in place to participate
in public relations activities.
SEC. 21. Section 122435 is added to the Health and Safety Code, to
read:
122435. During the demonstration pilot project described in
Section 122425, each demonstration pilot project shall prepare and
disseminate information regarding best practices for, and the lessons
learned regarding, providing outreach and education to the most
vulnerable and underserved individuals living with hepatitis C viral
infection (HCV) or at a high risk for HCV infection, for use by
providers, the State Department of Public Health, including the
Office of AIDS and the Office of Viral Hepatitis Prevention, federal
departments and agencies, including the federal Department of Health
and Human Services, and other national HIV/AIDS and viral hepatitis
groups.
SEC. 22. Section 124040 of the Health and Safety Code is amended
to read:
124040. (a) The governing body of each county or counties shall
establish a community child health and disability prevention program
for the purpose of providing early and periodic assessments of the
health status of children in the county or counties by July 1, 1974.
However, this shall be the responsibility of the department for all
counties that contract with the state for health services. Contract
counties, at the option of the board of supervisors, may provide
services pursuant to this article in the same manner as other county
programs, if the option is exercised prior to the beginning of each
fiscal year. Each plan shall include, but is not limited to, the
following requirements:
(1) Outreach and educational services.
(2) Agreements with public and private facilities and
practitioners to carry out the programs.
(3) Health screening and evaluation services for all children,
including a physical examination, immunizations appropriate for the
child's age and health history, and laboratory procedures appropriate
for the child's age and population group performed by, or under the
supervision or responsibility of, a physician licensed to practice
medicine in California or by a certified family nurse practitioner or
a certified pediatric nurse practitioner.
(4) Referral for diagnosis or treatment when needed, including,
for all children eligible for Medi-Cal, referral for treatment by a
provider participating in the Medi-Cal program of the conditions
detected, and methods for assuring referral is carried out.
(5) Recordkeeping and program evaluations.
(6) The health screening and evaluation part of each community
child health and disability prevention program plan shall include,
but is not limited to, the following for each child:
(A) A health and development history.
(B) An assessment of physical growth.
(C) An examination for obvious physical defects.
(D) Ear, nose, mouth, and throat inspection, including inspection
of teeth and gums, and for all children one year of age and older who
are eligible for Medi-Cal, referral to a dentist participating in
the Medi-Cal program.
(E) Screening tests for vision, hearing, anemia, tuberculosis,
diabetes, and urinary tract conditions.
(7) An assessment of nutritional status.
(8) An assessment of immunization status.
(9) If appropriate, testing for sickle-cell trait, lead poisoning,
and other tests that may be necessary to the identification of
children with potential disabilities requiring diagnosis and possibly
treatment.
(10) For all children eligible for Medi-Cal, necessary assistance
with scheduling appointments for services and with transportation.
(b) Dentists receiving referrals of children eligible for Medi-Cal
under this section shall employ procedures to advise the child's
parent or parents of the need for and scheduling of annual
appointments.
(c) Standards for procedures to carry out health screening and
evaluation services and to establish the age at which particular
tests should be carried out shall be established by the director. At
the discretion of the department, these health screening and
evaluation services may be provided at the frequency provided under
the Healthy Families Program and permitted in managed care plans
providing services under the Medi-Cal program, and shall be
contingent upon appropriation in the annual Budget Act. Immunizations
may be provided at the frequency recommended by the Committee on
Infectious Disease of the American Academy of Pediatrics and the
Advisory Committee on Immunization Practices of the Centers for
Disease Control and Prevention.
(d) Each community child health and disability prevention program
shall, pursuant to standards set by the director, establish a record
system that contains a health case history for each child so that
costly and unnecessary repetition of screening, immunization and
referral will not occur and appropriate health treatment will be
facilitated as specified in Section 124085.
SEC. 23. Section 124977 of the Health and Safety Code is amended
to read:
124977. (a) It is the intent of the Legislature that, unless
otherwise specified, the genetic disease testing program carried out
pursuant to this chapter be fully supported from fees collected for
services provided by the program.
(b) (1) The department shall charge a fee to all payers for any
tests or activities performed pursuant to this chapter. The amount of
the fee shall be established by regulation and periodically adjusted
by the director in order to meet the costs of this chapter.
Notwithstanding any other law, any fees charged for prenatal
screening and followup services provided to persons enrolled in the
Medi-Cal program, health care service plan enrollees, or persons
covered by health insurance policies, shall be paid in full and
deposited in the Genetic Disease Testing Fund or the Birth Defects
Monitoring Program Fund consistent with this section.
(2) The department shall expeditiously undertake all steps
necessary to implement the fee collection process, including
personnel, contracts, and data processing, so as to initiate the fee
collection process at the earliest opportunity.
(3) Effective for services provided on and after July 1, 2002, the
department shall charge a fee to the hospital of birth, or, for
births not occurring in a hospital, to families of the newborn, for
newborn screening and followup services. The hospital of birth and
families of newborns born outside the hospital shall make payment in
full to the Genetic Disease Testing Fund. The department shall not
charge or bill Medi-Cal beneficiaries for services provided under
this chapter.
(4) (A) The department shall charge a fee for prenatal screening
to support the pregnancy blood sample storage, testing, and research
activities of the Birth Defects Monitoring Program.
(B) The prenatal screening fee for activities of the Birth Defects
Monitoring Program shall be ten dollars ($10).
(5) The department shall set guidelines for invoicing, charging,
and collecting from approved researchers the amount necessary to
cover all expenses associated with research application requests made
under this section, data linkage, retrieval, data processing, data
entry, reinventory, and shipping of blood samples or their
components, and related data management.
(6) The only funds from the Genetic Disease Testing Fund that may
be used for the purpose of supporting the pregnancy blood sample
storage, testing, and research activities of the Birth Defects
Monitoring Program are those prenatal screening fees assessed and
collected prior to the creation of the Birth Defects Monitoring
Program Fund specifically to support those Birth Defects Monitoring
Program activities.
(7) The Birth Defects Monitoring Program Fund is hereby created as
a special fund in the State Treasury. Fee revenues that are
collected pursuant to paragraph (4) shall be deposited into the fund
and shall be available upon appropriation by the Legislature to
support the pregnancy blood sample storage, testing, and research
activities of the Birth Defects Monitoring Program. Notwithstanding
Section 16305.7 of the Government Code, interest earned on funds in
the Birth Defects Monitoring Program Fund shall be deposited as
revenue into the fund to support the Birth Defects Monitoring
Program.
(c) (1) The Legislature finds that timely implementation of
changes in genetic screening programs and continuous maintenance of
quality statewide services requires expeditious regulatory and
administrative procedures to obtain the most cost-effective
electronic data processing, hardware, software services, testing
equipment, and testing and followup services.
(2) The expenditure of funds from the Genetic Disease Testing Fund
for these purposes shall not be subject to Section 12102 of, and
Chapter 2 (commencing with Section 10290) of Part 2 of Division 2 of,
the Public Contract Code, or to Division 25.2 (commencing with
Section 38070). The department shall provide the Department of
Finance with documentation that equipment and services have been
obtained at the lowest cost consistent with technical requirements
for a comprehensive high-quality program.
(3) The expenditure of funds from the Genetic Disease Testing Fund
for implementation of the Tandem Mass Spectrometry screening for
fatty acid oxidation, amino acid, and organic acid disorders, and
screening for congenital adrenal hyperplasia may be implemented
through the amendment of the Genetic Disease Branch Screening
Information System contracts and shall not be subject to Chapter 3
(commencing with Section 12100) of Part 2 of Division 2 of the Public
Contract Code, Article 4 (commencing with Section 19130) of Chapter
5 of Part 2 of Division 5 of Title 2 of the Government Code, and any
policies, procedures, regulations, or manuals authorized by those
laws.
(4) The expenditure of funds from the Genetic Disease Testing Fund
for the expansion of the Genetic Disease Branch Screening
Information System to include cystic fibrosis, biotinidase, severe
combined immunodeficiency (SCID), and adrenoleukodystrophy (ALD) may
be implemented through the amendment of the Genetic Disease Branch
Screening Information System contracts, and shall not be subject to
Chapter 2 (commencing with Section 10290) or Chapter 3 (commencing
with Section 12100) of Part 2 of Division 2 of the Public Contract
Code, Article 4 (commencing with Section 19130) of Chapter 5 of Part
2 of Division 5 of Title 2 of the Government Code, or Sections 4800
to 5180, inclusive, of the State Administrative Manual as they relate
to approval of information technology projects or approval of
increases in the duration or costs of information technology
projects. This paragraph shall apply to the design, development, and
implementation of the expansion, and to the maintenance and operation
of the Genetic Disease Branch Screening Information System,
including change requests, once the expansion is implemented.
(d) (1) The department may adopt emergency regulations to
implement and make specific this chapter in accordance with Chapter
3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title
2 of the Government Code. For the purposes of the Administrative
Procedure Act, the adoption of regulations shall be deemed an
emergency and necessary for the immediate preservation of the public
peace, health and safety, or general welfare. Notwithstanding Chapter
3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title
2 of the Government Code, these emergency regulations shall not be
subject to the review and approval of the Office of Administrative
Law. Notwithstanding Sections 11346.1 and 11349.6 of the Government
Code, the department shall submit these regulations directly to the
Secretary of State for filing. The regulations shall become effective
immediately upon filing by the Secretary of State. Regulations shall
be subject to public hearing within 120 days of filing with the
Secretary of State and shall comply with Sections 11346.8 and 11346.9
of the Government Code or shall be repealed.
(2) The Office of Administrative Law shall provide for the
printing and publication of these regulations in the California Code
of Regulations. Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code, the
regulations adopted pursuant to this chapter shall not be repealed
by the Office of Administrative Law and shall remain in effect until
revised or repealed by the department.
(3) The Legislature finds and declares that the health and safety
of California newborns is in part dependent on an effective and
adequately staffed genetic disease program, the cost of which shall
be supported by the fees generated by the program.
SEC. 24. Section 10123.184 of the Insurance Code is amended to
read:
10123.184. (a) Every group policy of disability insurance that
covers hospital, medical, or surgical expenses, and that provides
maternity benefits, that is issued, amended, renewed, or delivered on
or after January 1, 1999, and every individual policy of disability
insurance that covers hospital, medical, or surgical expenses, and
that provides maternity benefits, that is of a type and form first
offered for sale on or after January 1, 1999, shall provide coverage
for participation in the California Prenatal Screening Program, which
is a statewide prenatal testing program administered by the State
Department of Public Health, pursuant to Section 124977 of the Health
and Safety Code. Notwithstanding any other law, a disability insurer
that provides coverage for maternity benefits shall not require
participation in the statewide prenatal testing program administered
by the State Department of Public Health as a prerequisite to
eligibility for, or receipt of, any other service.
(b) Coverage required under this section shall not be subject to
copayment, coinsurance, deductible, or any other form of cost
sharing.
(c) Reimbursement for services covered pursuant to this section
shall be paid at the amount set pursuant to Section 124977 of the
Health and Safety Code and regulations adopted thereunder.
SEC. 25. Section 10127.16 of the Insurance Code is amended to
read:
10127.16. (a) (1) After the termination of the pilot program
under Section 10127.15, a health insurer shall continue to provide
coverage under the same terms and conditions specified in Section
10127.15 as it existed on January 1, 2007, including the terms of the
standard benefit plan and the subscriber payment amount, to each
individual who was terminated from the program, pursuant to
subdivision (f) of Section 12725 of the Insurance Code during the
term of the pilot program and who enrolled or applied to enroll in a
standard benefit plan within 63 days of termination. The State
Department of Health Care Services shall continue to pay the amount
described in Section 10127.15 for each of those individuals. A health
insurer shall not be required to offer the coverage described in
Section 10127.15 after the termination of the pilot program to
individuals not already enrolled in the program.
(2) Notwithstanding paragraph (1) of this subdivision or Section
10127.15 as it existed on January 1, 2007, the following rules shall
apply:
(A) (i) A health insurer shall not be obligated to provide
coverage to any individual pursuant to this section on or after
January 1, 2014.
(ii) The State Department of Health Care Services shall not be
obligated to provide any payment to any health insurer under this
section for (I) health care expenses incurred on or after January 1,
2014, or (II) the standard monthly administrative fee, as defined in
Section 10127.15 as it existed on January 1, 2007, for any month
after December 2013.
(B) Each health insurer providing coverage pursuant to this
section shall, on or before October 1, 2013, send a notice to each
individual enrolled in a standard benefit plan that is in at least
12-point type and with, at minimum, the following information:
(i) Notice as to whether or not the plan will terminate as of
January 1, 2014.
(ii) The availability of individual health coverage, including
through Covered California, including at least all of the following:
(I) That, beginning on January 1, 2014, individuals seeking
coverage may not be denied coverage based on health status.
(II) That the premium rates for coverage offered by a health care
service plan or a health insurer cannot be based on an individual's
health status.
(III) That individuals obtaining coverage through Covered
California may, depending upon income, be eligible for premium
subsidies and cost-sharing subsidies.
(IV) That individuals seeking coverage must obtain this coverage
during an open or special enrollment period, and a description of the
open and special enrollment periods that may apply.
(C) As a condition of receiving payment for a reporting period
pursuant to this section, a health insurer shall provide the State
Department of Health Care Services with a complete, final annual
reconciliation report by the earlier of December 31, 2014, or an
earlier date as prescribed by Section 10127.15, as it existed on
January 1, 2007, for that reporting period. To the extent that it
receives a complete, final reconciliation report for a reporting
period by the date required pursuant to this subparagraph, the State
Department of Health Care Services shall complete reconciliation with
the health insurer for that reporting period within 18 months after
receiving the report.
(b) If the state fails to expend, pursuant to this section,
sufficient funds for the state's contribution amount to any health
insurer, the health insurer may increase the monthly payments that
its subscribers are required to pay for any standard benefit plan to
the amount that the State Department of Health Care Services would
charge without a state subsidy for the same insurance product issued
to the same individual
within the program.
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the State
Department of Health Care Services may implement, interpret, or make
specific this section by means of all-county letters, plan letters,
plan or provider bulletins, or similar instructions, without taking
regulatory action.
SEC. 26. Section 19548.2 of the Revenue and Taxation Code is
amended to read:
19548.2. (a) Notwithstanding any other law and in accordance with
Section 120962 of the Health and Safety Code, the State Department
of Public Health shall disclose the name and individual taxpayer
identification number (ITIN) or social security number of an
applicant for, or recipient of services pursuant to Chapter 6
(commencing with Section 120950) of Part 4 of Division 105 of the
Health and Safety Code to the Franchise Tax Board for the purpose of
verifying the adjusted gross income of, any tax-exempt interest
received by, any tax-exempt social security benefits received by, and
any foreign earned income of an applicant or recipient.
(b) (1) The Franchise Tax Board, upon receipt of this information,
shall inform the State Department of Public Health of all of the
following:
(A) The amounts of the federal adjusted gross income as reported
by the taxpayer to the Franchise Tax Board.
(B) The amounts of the California adjusted gross income as
reported by the taxpayer to the Franchise Tax Board or as adjusted by
the Franchise Tax Board.
(C) The amount of any tax-exempt interest received by the
taxpayer, as reported to the Franchise Tax Board.
(D) The amount of any tax-exempt social security benefits received
by the taxpayer, as reported to the Franchise Tax Board.
(E) The amount of any foreign earned income of the taxpayer, as
reported to the Franchise Tax Board.
(2) The Franchise Tax Board shall provide the information to the
State Department of Public Health for the most recent taxable year
that the Franchise Tax Board has information available, and shall
include the first and last name, date of birth, and the ITIN or
social security number of the taxpayer.
(c) (1) Information provided by the State Department of Public
Health pursuant to this section shall constitute confidential public
health records as defined in Section 121035 of the Health and Safety
Code, and shall remain subject to the confidentiality protections and
restrictions on further disclosure by the recipient under
subdivisions (d) and (e) of Section 121025.
(2) Prior to accessing confidential HIV-related public health
records, Franchise Tax Board staff and contractors shall be required
to annually sign a confidentiality agreement developed by the State
Department of Public Health that includes information related to the
penalties under Section 121025 of the Health and Safety Code for a
breach of confidentiality and the procedures for reporting a breach
of confidentiality under subdivision (h) of Section 121022 of the
Health and Safety Code. Those agreements shall be reviewed annually
by the State Department of Public Health.
(3) The Franchise Tax Board shall return or destroy all
information received from the State Department of Public Health after
completing the exchange of information.
(d) For purposes of this section, "foreign earned income" also
includes any deduction taken for the housing expenses of an
individual while living abroad pursuant to Section 911 of Title 26 of
the Internal Revenue Code.
SEC. 27. Section 4369 of the Welfare and Institutions Code is
amended to read:
4369. There is within the State Department of Public Health, the
Office of Problem Gambling.
SEC. 28. Section 4369.1 of the Welfare and Institutions Code is
amended to read:
4369.1. As used in this chapter, the following definitions shall
apply:
(a) "Affected individual" means a person who experiences adverse
psychiatric or physical impacts due to another person's gambling
disorder.
(b) "Department" means the State Department of Public Health.
(c) "Gambling disorder" means a condition that causes the person
to be unable to resist impulses to gamble, which can lead to harmful
negative consequences, and that meets the diagnostic criteria set
forth in the American Psychiatric Association's Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition. Gambling
disorder includes both pathological and problem gambling behavior.
(d) "Office" means the Office of Problem Gambling.
(e) "Prevention program" means a program designed to reduce the
prevalence of gambling disorders among California residents. The
program shall include, but is not limited to, public education and
awareness, outreach to high-risk populations, early identification
and responsible gambling programs.
(f) "Treatment program" means a program designed to assist
individuals who experience harmful negative consequences related to
gambling disorders. This program shall include, but is not limited
to, training and educating providers, establishing a provider network
for the provision of treatment services, and conducting research to
ensure the delivery of evidence-based practices.
SEC. 29. Section 4369.2 of the Welfare and Institutions Code is
amended to read:
4369.2. (a) The office shall develop a gambling disorder
prevention program, which shall consist of all of the following:
(1) A toll-free telephone service for immediate crisis management
with subsequent referrals of gamblers and affected individuals to
health providers at various levels of care who can provide treatment
for gambling disorders and related problems and to self-help groups.
(2) Public awareness campaigns that focus on prevention and
education among the general public including, for example,
dissemination of youth oriented preventive literature, educational
experiences, and public service announcements in the media.
(3) Empirically driven research programs focusing on
epidemiology/prevalence, etiology/causation, and best practices in
prevention and treatment.
(4) Training of health care professionals and educators, and
training for law enforcement agencies and nonprofit organizations in
the identification of gambling disorders and knowledge of referral
services and treatment programs.
(5) Training of gambling industry personnel in identifying
customers at risk for gambling disorders and knowledge of referral
and treatment services.
(b) The office shall develop a treatment program for California
residents who have a gambling disorder or who are affected
individuals. The treatment program may consist of all of the
following components:
(1) Training for licensed health providers, including screening
and assessment of gambling disorders, the use of evidence-based
treatment modalities, and the administrative practices for treatment
services implemented under this chapter.
(2) A network of licensed health providers authorized to receive
reimbursement from the state for the provision of treatment services.
This network may be created through partnerships with established
health or substance use disorder facilities or individuals in private
practice that can provide treatment for gambling disorders. State
funded treatment services may include, but are not limited to, the
following: self-administered, home-based educational programs;
telephone counseling; group treatment; outpatient treatment; and
inpatient residential treatment when medically necessary.
(3) A research program to conduct studies and develop
evidence-based tools for use in treating gambling disorders.
(4) A funding allocation methodology that ensures treatment
services are delivered efficiently and effectively to areas of the
state most in need.
(5) Appropriate review and monitoring of the treatment program by
the director of the office or a designated institution, including
grant oversight and monitoring of contracts, the standards for
treatment, and outcome monitoring.
(6) Treatment efforts shall provide services that are relevant to
the needs of a diverse multicultural population with attention to
groups with unique needs, including female gamblers, underserved
ethnic groups, the elderly, and the physically challenged.
(c) The office shall make information available as requested by
the Governor and the Legislature with respect to the comprehensive
program.
SEC. 30. Section 4369.3 of the Welfare and Institutions Code is
amended to read:
4369.3. In designing and developing the overall program, the
office shall do all of the following:
(a) Develop a statewide plan to address gambling disorders.
(b) Adopt any regulations necessary to administer the program.
(c) Develop priorities for funding services and criteria for
distributing program funds.
(d) Monitor the expenditures of state funds by agencies and
organizations receiving program funding.
(e) Evaluate the effectiveness of services provided through the
program. The department is authorized to contract with academic
experts to perform these evaluations.
(f) Notwithstanding any other provision of law, any contracts
required to meet the requirements of this chapter are exempt from the
requirements contained in the Public Contract Code and the State
Administrative Manual, and are exempt from the approval of the
Department of General Services.
(g) Administrative costs for the program may not exceed 10 percent
of the total funding budgeted for the program.
SEC. 31. Section 4369.4 of the Welfare and Institutions Code is
amended to read:
4369.4. All state agencies, including, but not limited to, the
California Horse Racing Board, the California Gambling Control
Commission, the Department of Justice, and any other agency that
regulates casino gambling or cardrooms within the state, and the
Department of Corrections and Rehabilitation, the State Department of
Public Health, the State Department of Health Care Services, and the
California State Lottery, shall coordinate with the office to ensure
that state programs take into account, as much as practicable,
gambling disorders. The office shall also coordinate and work with
other entities involved in gambling and the treatment of gambling
disorders.
SEC. 32. Section 4369.5 of the Welfare and Institutions Code is
amended to read:
4369.5. (a) It is the intent of the Legislature that the Office
of Problem Gambling establish and maintain ongoing venues for system
stakeholders to provide input into public policy issues related to
gambling disorders, including, but not limited to, consumers of
services and their families, providers of services and supports, and
county representatives. It is further the intent of the Legislature
that the Office of Problem Gambling shall have input into policy
discussions at the State Department of Public Health and at the
California Health and Human Services Agency, when appropriate.
(b) It is the intent of the Legislature to ensure that the impacts
of the transition of the Office of Problem Gambling from the State
Department of Alcohol and Drug Programs to the State Department of
Public Health are identified and evaluated, initially and over time.
It is further the intent of the Legislature to establish a baseline
for evaluating, on an ongoing basis, how and why services provided
and overseen by the Office of Problem Gambling were improved, or
otherwise changed, as a result of this transition.
(c) (1) By April 1, 2014, and March 1 annually thereafter, the
State Department of Public Health shall report to the Joint
Legislative Budget Committee and the appropriate budget subcommittees
and policy committees of the Legislature, and publicly post a report
on the Office of Problem Gambling on its Internet Web site.
(2) The report shall contain all of the following:
(A) A description of education and outreach activities related to
the prevention program and how the Office of Problem Gambling
establishes linkages with State Department of Public Health partners,
including local health officers and other relevant entities, in
order to increase awareness of, and provide input to, the Office of
Problem Gambling, and how stakeholder involvement was changed,
maintained, or enhanced after the transition.
(B) Beginning in the 2012-13 fiscal year, a description of
year-over-year changes in the following: access to services,
demographics of people served, the number of providers, and treatment
program outcomes. The description of access to services shall
include, but not be limited to, information regarding utilization of
services and waiting lists for services. The description of providers
shall include, but not be limited to, types and numbers of
providers, including gambling disorder counselors, training protocols
for providers, and workforce trends. The description of demographics
of people served shall include, but not be limited to, age, sex,
ethnicity, economic status, and geographic regions. The description
of treatment program outcomes shall include, but not be limited to,
participation levels in programs, recidivism rates, and quality of
life measures.
(d) This section shall become inoperative on July 1, 2018, and, as
of January 1, 2019, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2019, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 33. Section 14007.2 of the Welfare and Institutions Code is
amended to read:
14007.2. (a) Any individual who is otherwise eligible for
Medi-Cal services, but who does not meet the documentation
requirements described in subdivision (e) of Section 14011.2, shall
be eligible only for the scope of services made available to aliens
under subdivision (d) of Section 14007.5, and Sections 14007.65,
14007.7, and 14007.8.
(b) To the extent that federal financial participation is
available to fund services described under subdivision (a), the
department shall file all necessary state plan amendments or waivers
to obtain that funding.
SEC. 34. Section 14007.5 of the Welfare and Institutions Code is
amended to read:
14007.5. (a) Aliens shall be eligible for Medi-Cal, whether
federally funded or state-funded, only to the same extent as
permitted under federal law and regulations for receipt of federal
financial participation under Title XIX of the federal Social
Security Act, except as otherwise provided in this section and
elsewhere in this chapter.
(b) In accordance with Section 1903(v)(1) of the federal Social
Security Act (42 U.S.C. Sec. 1396b(v)(1)), an alien shall only be
eligible for the full scope of Medi-Cal benefits, if the alien has
been lawfully admitted for permanent residence, or is otherwise
permanently residing in the United States under color of law.
For purposes of this section, aliens "permanently residing in the
United States under color of law" shall be interpreted to include all
aliens residing in the United States with the knowledge and
permission of the United States Immigration and Naturalization
Service and whose departure the United States Immigration and
Naturalization Service does not contemplate enforcing and with
respect to whom federal financial participation is available under
Title XIX of the federal Social Security Act.
(c) Any alien whose immigration status has been adjusted either to
lawful temporary resident or lawful permanent resident in accordance
with the provisions of Section 210, 210A, or 245A of the federal
Immigration and Nationality Act, and who meets all other eligibility
requirements, shall be eligible only for care and services under
Medi-Cal for which the alien is not disqualified pursuant to those
sections of the federal act.
(d) Any alien who is otherwise eligible for Medi-Cal services, but
who does not meet the requirements under subdivision (b) or (c),
shall only be eligible for care and services that are necessary for
the treatment of an emergency medical condition and medical care
directly related to the emergency, as defined in federal law. For
purposes of this section, the term "emergency medical condition"
means a medical condition manifesting itself by acute symptoms of
sufficient severity, including severe pain, such that the absence of
immediate medical attention could reasonably be expected to result in
any of the following:
(1) Placing the patient's health in serious jeopardy.
(2) Serious impairment to bodily functions.
(3) Serious dysfunction to any bodily organ or part. It is the
intent of this section to entitle eligible individuals to inpatient
and outpatient services that are necessary for the treatment of the
emergency medical condition in the same manner as administered by the
department through regulations and provisions of federal law.
(e) Pursuant to Section 14001.2, each county department shall
require that each applicant for, or beneficiary of, Medi-Cal,
including a child, shall provide his or her social security number
account number, or numbers, if he or she has more than one social
security number.
(f) (1) In order to be eligible for benefits under subdivision (b)
or (c), an alien applicant or beneficiary shall present alien
registration documentation or other proof of satisfactory immigration
status from the United States Immigration and Naturalization
Service.
(2) Any alien who meets all other program requirements but who
lacks documentation of alien registration or other proof of
satisfactory immigration status shall be provided a reasonable
opportunity to submit the evidence. For purposes of this paragraph,
"reasonable opportunity" means 30 days or the time it actually takes
the county to process the Medi-Cal application, whichever is longer.
(3) During the reasonable opportunity period under paragraph (2),
the county department shall process the applicant's application for
medical assistance in a manner that conforms to its normal processing
procedures and timeframes.
(g) (1) The county department shall grant only the Medi-Cal
benefits set forth in subdivision (d) of this section or in Section
14007.7 to any individual who, after 30 calendar days or the time it
actually takes the county to process the Medi-Cal application,
whichever is longer, has failed to submit documents constituting
reasonable evidence indicating a satisfactory immigration status for
Medi-Cal purposes, or who is reported by the United States
Immigration and Naturalization Service to lack a satisfactory
immigration status for Medi-Cal purposes.
(2) If an alien has been receiving Medi-Cal benefits based on
eligibility established prior to the effective date of this section
and that individual, upon redetermination of eligibility for
benefits, fails to submit documents constituting reasonable evidence
indicating a satisfactory immigration status for Medi-Cal purposes,
the county department shall discontinue the Medi-Cal benefits, except
for the care and services set forth in subdivision (d) of this
section or in Section 14007.7. The county department shall provide
adequate notice to the individual of any adverse action and shall
accord the individual an opportunity for a fair hearing if he or she
requests one.
(h) To the extent permitted by federal law and regulations, an
alien applying for services under subdivisions (b) and (c) shall be
granted eligibility for the scope of services to which he or she
would otherwise be entitled if, at the time the county department
makes the determination about his or her eligibility, the alien meets
either of the following requirements:
(1) He or she has not had a reasonable opportunity to submit
documents constituting reasonable evidence indicating satisfactory
immigration status.
(2) He or she has provided documents constituting reasonable
evidence indicating a satisfactory immigration status, but the county
department has not received timely verification of the alien's
immigration status from the United States Immigration and
Naturalization Service.
(3) The verification process shall protect the privacy of all
participants. An alien's immigration status shall be subject to
verification by the United States Immigration and Naturalization
Service, to the extent required for receipt of federal financial
participation in the Medi-Cal program.
(i) If an alien does not declare status as a lawful permanent
resident or alien permanently residing under color of law, or as an
alien legalized under Section 210, 210A, or 245A of the federal
Immigration and Nationality Act (Public Law 82-414), Medi-Cal
coverage under subdivision (d) of this section or in Section 14007.7
shall be provided to the individual if he or she is otherwise
eligible.
(j) If an alien subject to this section is not fluent in English,
the county department shall provide an understandable explanation of
the requirements of this section in a language in which the alien is
fluent.
(k) Aliens who were receiving long-term care or renal dialysis
services (1) on the day prior to the effective date of the amendment
to paragraph (1) of subdivision (f) of Section 1 of Chapter 1441 of
the Statutes of 1988 at the 1991-92 Regular Session of the
Legislature and (2) under the authority of paragraph (1) of
subdivision (f) of Section 1 of Chapter 1441 of the Statutes of 1988
as it read on June 30, 1992, shall continue to receive these
services. The authority for continuation of long-term care or renal
dialysis services in this subdivision shall not apply to any person
whose long-term care or renal dialysis services end for any reason
after the effective date of the amendment described in this
subdivision.
SEC. 35. Section 14007.8 is added to the Welfare and Institutions
Code, to read:
14007.8. (a) After the director determines, and communicates that
determination in writing to the Department of Finance, that systems
have been programmed for implementation of this section, but no
sooner than May 1, 2016, an individual who is under 19 years of age
and who does not have satisfactory immigration status or is unable to
establish satisfactory immigration status as required by Section
14011.2 shall be eligible for the full scope of Medi-Cal benefits, if
he or she is otherwise eligible for benefits under this chapter.
(b) To the extent permitted by state and federal law, an
individual eligible under this section shall be required to enroll in
a Medi-Cal managed care health plan in those counties in which a
Medi-Cal managed care health plan is available.
(c) The department shall seek any necessary federal approvals to
obtain federal financial participation in implementing this section.
Benefits for services under this section shall be provided with
state-only funds only if federal financial participation is not
available for those services.
(d) The department shall maximize federal financial participation
in implementing this section to the extent allowable.
(e) This section shall be implemented only to the extent it is in
compliance with Section 1621(d) of Title 8 of the United States Code.
(f) (1) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking any further regulatory action, shall
implement, interpret, or make specific this section by means of
all-county letters, plan letters, plan or provider bulletins, or
similar instructions until the time any necessary regulations are
adopted. Thereafter, 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) Commencing six months after the effective date of this
section, and notwithstanding Section 10231.5 of the Government Code,
the department shall provide a status report to the Legislature on a
semiannual basis, in compliance with Section 9795 of the Government
Code, until regulations have been adopted.
(g) In implementing this section, the department may contract, as
necessary, on a bid or nonbid basis. This subdivision establishes an
accelerated process for issuing contracts pursuant to this section.
Those contracts, and any other contracts entered into pursuant to
this subdivision, may be on a noncompetitive bid basis and shall be
exempt from the following:
(1) Part 2 (commencing with Section 10100) of Division 2 of the
Public Contract Code and any policies, procedures or regulations
authorized by that part.
(2) Article 4 (commencing with Section 19130) of Chapter 5 of Part
2 of Division 5 of Title 2 of the Government Code.
(3) Review or approval of contracts by the Department of General
Services.
SEC. 36. Section 14015.5 of the Welfare and Institutions Code is
amended to read:
14015.5. (a) Notwithstanding any other state law, the department
shall retain or delegate the authority to perform Medi-Cal
eligibility determinations as set forth in this section.
(b) If after an assessment and verification for potential
eligibility for Medi-Cal benefits using the applicable MAGI-based
income standard of all persons that apply through an electronic or a
paper application processed by CalHEERS, which is jointly managed by
the department and the Exchange, and to the extent required by
federal law and regulation is completed, the Exchange and the
department is able to electronically determine the applicant's
eligibility for Medi-Cal benefits using only the information
initially provided online, or through the written application
submitted by, or on behalf of, the applicant, and without further
staff review to verify the accuracy of the submitted information, the
Exchange and the department shall determine that applicant's
eligibility for the Medi-Cal program using the applicable MAGI-based
income standard.
(c) Except as provided in subdivision (b) and Section 14015.7, the
county of residence shall be responsible for eligibility
determinations and ongoing case management for the Medi-Cal program.
(d) (1) Notwithstanding any other state law, the Exchange shall be
authorized to provide information regarding available Medi-Cal
managed health care plan selection options to applicants determined
to be eligible for Medi-Cal benefits using the MAGI-based income
standard and allow those applicants to choose an available managed
health care plan.
(2) The Exchange is authorized to record an applicant's health
plan selection into CalHEERS for reporting to the department.
CalHEERS shall have the ability to report to the department the
results of an applicant's health plan selection.
(e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department, without taking any further regulatory action, shall
implement, interpret,
or make specific this section by means of all-county letters, plan
letters, plan or provider bulletins, or similar instructions until
the time regulations are adopted. Thereafter, 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. Beginning six months after the effective date
of this section, and notwithstanding Section 10231.5 of the
Government Code, the department shall provide a status report to the
Legislature on a semiannual basis until regulations have been
adopted.
(f) For the purposes of this section, the following definitions
shall apply:
(1) "ACA" means the federal Patient Protection and Affordable Care
Act (Public Law 111-148), as amended by the federal Health Care and
Education Reconciliation Act of 2010 (Public Law 111-152).
(2) "CalHEERS" means the California Healthcare Eligibility,
Enrollment, and Retention System developed under Section 15926.
(3) "Exchange" means the California Health Benefit Exchange
established pursuant to Section 100500 of the Government Code.
(4) "MAGI-based income" means income calculated using the
financial methodologies described in Section 1396a(e)(14) of Title 42
of the United States Code as added by ACA and any subsequent
amendments.
(g) This section shall be implemented only if and to the extent
that federal financial participation is available and any necessary
federal approvals have been obtained.
(h) This section shall become operative on October 1, 2013.
SEC. 37. Section 14105.94 of the Welfare and Institutions Code is
amended to read:
14105.94. (a) An eligible provider, as described in subdivision
(b), may, in addition to the rate of payment that the provider would
otherwise receive for Medi-Cal ground emergency medical
transportation services, receive supplemental Medi-Cal reimbursement
to the extent provided in this section.
(b) A provider shall be eligible for supplemental reimbursement
only if the provider has all of the following characteristics
continuously during a state fiscal year:
(1) Provides ground emergency medical transportation services to
Medi-Cal beneficiaries.
(2) Is a provider that is enrolled as a Medi-Cal provider for the
period being claimed.
(3) Is owned or operated by the state, a city, county, city and
county, fire protection district organized pursuant to Part 2.7
(commencing with Section 13800) of Division 12 of the Health and
Safety Code, special district organized pursuant to Chapter 1
(commencing with Section 58000) of Division 1 of Title 6 of the
Government Code, community services district organized pursuant to
Part 1 (commencing with Section 61000) of Division 3 of Title 6 of
the Government Code, health care district organized pursuant to
Chapter 1 (commencing with Section 32000) of Division 23 of the
Health and Safety Code, or a federally recognized Indian tribe.
(c) An eligible provider's supplemental reimbursement pursuant to
this section shall be calculated and paid as follows:
(1) The supplemental reimbursement to an eligible provider, as
described in subdivision (b), 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) In no instance shall the amount certified pursuant to
paragraph (1) of subdivision (e), when combined with the amount
received from all other sources of reimbursement from the Medi-Cal
program, exceed 100 percent of actual costs, as determined pursuant
to the Medi-Cal State Plan, for ground emergency medical
transportation services.
(3) The supplemental Medi-Cal reimbursement provided by this
section shall be distributed exclusively to eligible providers under
a payment methodology based on ground emergency medical
transportation services provided to Medi-Cal beneficiaries by
eligible providers on a per-transport basis or other federally
permissible basis. The department shall obtain approval from the
federal Centers for Medicare and Medicaid Services for the payment
methodology to be utilized, and may not make any payment pursuant to
this section prior to obtaining that approval.
(d) (1) It is the Legislature's intent in enacting this section to
provide the supplemental reimbursement described in this section
without any expenditure from the General Fund. An eligible provider,
as a condition of receiving supplemental reimbursement pursuant to
this section, shall 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) The nonfederal share of the supplemental reimbursement
submitted to the federal Centers for Medicare and Medicaid Services
for purposes of claiming federal financial participation shall be
paid only with funds from the governmental entities described in
paragraph (3) of subdivision (b) and certified to the state as
provided in subdivision (e).
(e) Participation in the program by an eligible provider described
in this section is voluntary. If an applicable governmental entity
elects to seek supplemental reimbursement pursuant to this section on
behalf of an eligible provider owned or operated by the entity, as
described in paragraph (3) of subdivision (b), the governmental
entity 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 ground emergency medical transportation 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 provider 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. The department may
limit the program to those costs that are allowable expenditures
under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et
seq.). 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 for the services described in
subdivision (e) that are allowable expenditures under federal law.
(3) The department shall, on an annual basis, submit any necessary
materials to the federal government to provide assurances that
claims for federal financial participation will include only those
expenditures that are allowable under federal law.
(g) (1) If either a final judicial determination is made by any
court of appellate jurisdiction or a final determination is made by
the administrator of the federal Centers for Medicare and Medicaid
Services that the supplemental reimbursement provided for in this
section must be made to any provider not described in this section,
the director shall execute a declaration stating that the
determination has been made and on that date this section shall
become inoperative.
(2) The declaration executed pursuant to this subdivision shall be
retained by the director, provided to the fiscal and appropriate
policy committees of the Legislature, the Secretary of State, the
Secretary of the Senate, the Chief Clerk of the Assembly, and the
Legislative Counsel, and posted on the department's Internet Web
site.
(h) 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 and administer this section by means of
provider bulletins, or similar instructions, without taking
regulatory action.
(i) (1) Upon the effective date of the act that added this
subdivision, the department shall develop, in consultation with the
providers described in subdivision (b), and seek any necessary
federal approvals for, a modified program for the supplemental
reimbursement authorized by this section that will seek to provide
increased reimbursement to an eligible provider that participates in
the program. The nonfederal share of any supplemental reimbursement
provided under the modified program shall be derived from voluntary
intergovernmental transfers of local funds. The department shall
otherwise develop the modified program consistent with the
requirements of this section, except for paragraph (2) of subdivision
(c), and only to the extent that federal financial participation is
available.
(2) The department shall be reimbursed for costs associated with
administering the modified program described in paragraph (1) in
accordance with subdivision (d). The department shall not otherwise
assess a percentage fee in connection with any intergovernmental
transfer of funds made pursuant to this subdivision.
(3) The department shall not implement the modified program
described in paragraph (1) until it obtains all necessary federal
approvals. Until those federal approvals are obtained, supplemental
reimbursement shall continue to be available pursuant to the
provisions of this section that were operative prior to the effective
date of the act that added this subdivision.
(j) The department shall not implement the modified program
described in paragraph (1) of subdivision (i) unless it determines
that the modified program will likely result in an overall increase
to the supplemental reimbursement available pursuant to the
provisions of this section that were operative prior to the effective
date of the act that added this subdivision.
SEC. 38. Section 14105.192 of the Welfare and Institutions Code is
amended to read:
14105.192. (a) The Legislature finds and declares the following:
(1) Costs within the Medi-Cal program continue to grow due to the
rising cost of providing health care throughout the state and also
due to increases in enrollment, which are more pronounced during
difficult economic times.
(2) In order to minimize the need for drastically cutting
enrollment standards or benefits during times of economic crisis, it
is crucial to find areas within the program where reimbursement
levels are higher than required under the standard provided in
Section 1902(a)(30)(A) of the federal Social Security Act and can be
reduced in accordance with federal law.
(3) The Medi-Cal program delivers its services and benefits to
Medi-Cal beneficiaries through a wide variety of health care
providers, some of which deliver care via managed care or other
contract models while others do so through fee-for-service
arrangements.
(4) The setting of rates within the Medi-Cal program is complex
and is subject to close supervision by the United States Department
of Health and Human Services.
(5) As the single state agency for Medicaid in California, the
department has unique expertise that can inform decisions that set or
adjust reimbursement methodologies and levels consistent with the
requirements of federal law.
(b) Therefore, it is the intent of the Legislature for the
department to analyze and identify where reimbursement levels can be
reduced consistent with the standard provided in Section 1902(a)(30)
(A) of the federal Social Security Act and consistent with federal
and state law and policies, including any exemptions contained in the
provisions of the act that added this section, provided that the
reductions in reimbursement shall not exceed 10 percent on an
aggregate basis for all providers, services and products.
(c) Notwithstanding any other law, the director shall adjust
provider payments, as specified in this section.
(d) (1) Except as otherwise provided in this section, payments
shall be reduced by 10 percent for Medi-Cal fee-for-service benefits
for dates of service on and after June 1, 2011.
(2) For managed health care plans that contract with the
department pursuant to this chapter or Chapter 8 (commencing with
Section 14200), except contracts with Senior Care Action Network and
AIDS Healthcare Foundation, payments shall be reduced by the
actuarial equivalent amount of the payment reductions specified in
this section pursuant to contract amendments or change orders
effective on July 1, 2011, or thereafter.
(3) Payments shall be reduced by 10 percent for non-Medi-Cal
programs described in Article 6 (commencing with Section 124025) of
Chapter 3 of Part 2 of Division 106 of the Health and Safety Code,
and Section 14105.18, for dates of service on and after June 1, 2011.
This paragraph shall not apply to inpatient hospital services
provided in a hospital that is paid under contract pursuant to
Article 2.6 (commencing with Section 14081).
(4) (A) Notwithstanding any other law, the director may adjust the
payments specified in paragraphs (1) and (3) of this subdivision
with respect to one or more categories of Medi-Cal providers, or for
one or more products or services rendered, or any combination
thereof, so long as the resulting reductions to any category of
Medi-Cal providers, in the aggregate, total no more than 10 percent.
(B) The adjustments authorized in subparagraph (A) shall be
implemented only if the director determines that, for each affected
product, service, or provider category, the payments resulting from
the adjustment comply with subdivision (m).
(e) Notwithstanding any other provision of this section, payments
to hospitals that are not under contract with the State Department of
Health Care Services pursuant to Article 2.6 (commencing with
Section 14081) for inpatient hospital services provided to Medi-Cal
beneficiaries and that are subject to Section 14166.245 shall be
governed by that section.
(f) Notwithstanding any other provision of this section, the
following shall apply:
(1) Payments to providers that are paid pursuant to Article 3.8
(commencing with Section 14126) shall be governed by that article.
(2) (A) Subject to subparagraph (B), for dates of service on and
after June 1, 2011, Medi-Cal reimbursement rates for intermediate
care facilities for the developmentally disabled licensed pursuant to
subdivision (e), (g), or (h) of Section 1250 of the Health and
Safety Code, and facilities providing continuous skilled nursing care
to developmentally disabled individuals pursuant to the pilot
project established by Section 14132.20, as determined by the
applicable methodology for setting reimbursement rates for these
facilities, shall not exceed the reimbursement rates that were
applicable to providers in the 2008-09 rate year.
(B) (i) If Section 14105.07 is added to the Welfare and
Institutions Code during the 2011-12 Regular Session of the
Legislature, subparagraph (A) shall become inoperative.
(ii) If Section 14105.07 is added to the Welfare and Institutions
Code during the 2011-12 Regular Session of the Legislature, then for
dates of service on and after June 1, 2011, payments to intermediate
care facilities for the developmentally disabled licensed pursuant to
subdivision (e), (g), or (h) of Section 1250 of the Health and
Safety Code, and facilities providing continuous skilled nursing care
to developmentally disabled individuals pursuant to the pilot
project established by Section 14132.20, shall be governed by the
applicable methodology for setting reimbursement rates for these
facilities and by Section 14105.07.
(g) The department may enter into contracts with a vendor for the
purposes of implementing this section on a bid or nonbid basis. In
order to achieve maximum cost savings, the Legislature declares that
an expedited process for contracts under this subdivision is
necessary. Therefore, contracts entered into to implement this
section and all contract amendments and change orders shall be exempt
from Chapter 2 (commencing with Section 10290) of Part 2 Division 2
of the Public Contract Code.
(h) To the extent applicable, the services, facilities, and
payments listed in this subdivision shall be exempt from the payment
reductions specified in subdivision (d) as follows:
(1) Acute hospital inpatient services that are paid under
contracts pursuant to Article 2.6 (commencing with Section 14081).
(2) Federally qualified health center services, including those
facilities deemed to have federally qualified health center status
pursuant to a waiver pursuant to subsection (a) of Section 1115 of
the federal Social Security Act (42 U.S.C. Sec. 1315(a)).
(3) Rural health clinic services.
(4) Payments to facilities owned or operated by the State
Department of State Hospitals or the State Department of
Developmental Services.
(5) Hospice services.
(6) Contract services, as designated by the director pursuant to
subdivision (k).
(7) Payments to providers to the extent that the payments are
funded by means of a certified public expenditure or an
intergovernmental transfer pursuant to Section 433.51 of Title 42 of
the Code of Federal Regulations. This paragraph shall apply to
payments described in paragraph (3) of subdivision (d) only to the
extent that they are also exempt from reduction pursuant to
subdivision (l).
(8) Services pursuant to local assistance contracts and
interagency agreements to the extent the funding is not included in
the funds appropriated to the department in the annual Budget Act.
(9) Breast and cervical cancer treatment provided pursuant to
Section 14007.71 and as described in paragraph (3) of subdivision (a)
of Section 14105.18 or Article 1.5 (commencing with Section 104160)
of Chapter 2 of Part 1 of Division 103 of the Health and Safety Code.
(10) The Family Planning, Access, Care, and Treatment (Family
PACT) Program pursuant to subdivision (aa) of Section 14132.
(11) (A) Effective for dates of service on or after July 1, 2015,
or the effective date of any necessary federal approvals as required
by subdivisions (n) and (o), whichever is later, dental services and
applicable ancillary services.
(B) For dental managed care plans that contract with the
department pursuant to this chapter or Chapter 8 (commencing with
Section 14200), payments pursuant to contract amendments or change
orders effective on or after July 1, 2015, or the effective date of
any necessary federal approvals as required by subdivisions (n) and
(o), whichever is later.
(i) Subject to the exception for services listed in subdivision
(h), the payment reductions required by subdivision (d) shall apply
to the benefits rendered by any provider who may be authorized to
bill for the service, including, but not limited to, physicians,
podiatrists, nurse practitioners, certified nurse-midwives, nurse
anesthetists, and organized outpatient clinics.
(j) Notwithstanding any other law, for dates of service on and
after June 1, 2011, Medi-Cal reimbursement rates applicable to the
following classes of providers shall not exceed the reimbursement
rates that were applicable to those classes of providers in the
2008-09 rate year, as described in subdivision (f) of Section
14105.191, reduced by 10 percent:
(1) Intermediate care facilities, excluding those facilities
identified in paragraph (2) of subdivision (f). For purposes of this
section, "intermediate care facility" has the same meaning as defined
in Section 51118 of Title 22 of the California Code of Regulations.
(2) Skilled nursing facilities that are distinct parts of general
acute care hospitals. For purposes of this section, "distinct part"
has the same meaning as defined in Section 72041 of Title 22 of the
California Code of Regulations.
(3) Rural swing-bed facilities.
(4) Subacute care units that are, or are parts of, distinct parts
of general acute care hospitals. For purposes of this subparagraph,
"subacute care unit" has the same meaning as defined in Section
51215.5 of Title 22 of the California Code of Regulations.
(5) Pediatric subacute care units that are, or are parts of,
distinct parts of general acute care hospitals. For purposes of this
subparagraph, "pediatric subacute care unit" has the same meaning as
defined in Section 51215.8 of Title 22 of the California Code of
Regulations.
(6) Adult day health care centers.
(7) Freestanding pediatric subacute care units, as defined in
Section 51215.8 of Title 22 of the California Code of Regulations.
(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 and administer this section by means of
provider bulletins or similar instructions, without taking regulatory
action.
( l ) The reductions described in this section shall
apply only to payments for services when the General Fund share of
the payment is paid with funds directly appropriated to the
department in the annual Budget Act and shall not apply to payments
for services paid with funds appropriated to other departments or
agencies.
(m) Notwithstanding any other provision of this section, the
payment reductions and adjustments provided for in subdivision (d)
shall be implemented only if the director determines that the
payments that result from the application of this section will comply
with applicable federal Medicaid requirements and that federal
financial participation will be available.
(1) In determining whether federal financial participation is
available, the director shall determine whether the payments comply
with applicable federal Medicaid requirements, including those set
forth in Section 1396a(a)(30)(A) of Title 42 of the United States
Code.
(2) To the extent that the director determines that the payments
do not comply with the federal Medicaid requirements or that federal
financial participation is not available with respect to any payment
that is reduced pursuant to this section, the director retains the
discretion to not implement the particular payment reduction or
adjustment and may adjust the payment as necessary to comply with
federal Medicaid requirements.
(n) The department shall seek any necessary federal approvals for
the implementation of this section.
(o) (1) The payment reductions and adjustments set forth in this
section shall not be implemented until federal approval is obtained.
(2) To the extent that federal approval is obtained for one or
more of the payment reductions and adjustments in this section and
Section 14105.07, the payment reductions and adjustments set forth in
Section 14105.191 shall cease to be implemented for the same
services provided by the same class of providers. In the event of a
conflict between this section and Section 14105.191, other than the
provisions setting forth a payment reduction or adjustment, this
section shall govern.
(3) When federal approval is obtained, the payments resulting from
the application of this section shall be implemented retroactively
to June 1, 2011, or on any other date or dates as may be applicable.
(4) The director may clarify the application of this subdivision
by means of provider bulletins or similar instructions, pursuant to
subdivision (k).
(p) Adjustments to pharmacy drug product payment pursuant to this
section shall no longer apply when the department determines that the
average acquisition cost methodology pursuant to Section 14105.45
has been fully implemented and the department's pharmacy budget
reduction targets, consistent with payment reduction levels pursuant
to this section, have been met.
SEC. 39. Section 14127.7 is added to the Welfare and Institutions
Code, to read:
14127.7. (a) The Health Home Program Account is hereby created in
the Special Deposit Fund within the State Treasury in order to
collect and allocate non-General Fund public or private grant funds,
to be expended, upon appropriation by the Legislature, for the
purposes of implementing the Health Home Program established pursuant
to this article.
(b) The department may accept funding from local governments,
foundations, or other organizations to provide funding for the Health
Home Program.
(c) Any unexpended funds within the Health Home Program Account,
within the Special Deposit Fund, from a local government, foundation,
or other organization, shall be returned to the contributing entity.
SEC. 40. Section 14134 of the Welfare and Institutions Code, as
amended by Section 65 of Chapter 23 of the Statutes of 2013, is
amended to read:
14134. (a) Except for any prescription, refill, visit, service,
device, or item for which the program's payment is ten dollars ($10)
or less, in which case no copayment shall be required, a recipient of
services under this chapter shall be required to make copayments not
to exceed the maximum permitted under federal regulations or federal
waivers, as follows:
(1) Copayment of five dollars ($5) shall be made for nonemergency
services received in an emergency department or emergency room when
the services do not result in the treatment of an emergency medical
condition or inpatient admittance. For the purposes of this section,
"nonemergency services" means services not required to, as
appropriate, medically screen, examine, evaluate, or stabilize an
emergency medical condition that manifests itself by acute symptoms
of sufficient severity, including severe pain, so that the absence of
immediate medical attention could reasonably be expected to result
in any of the following:
(A) Placing the individual's health, or, with respect to a
pregnant woman, the health of the woman or her unborn child, in
serious jeopardy.
(B) Serious impairment to bodily functions.
(C) Serious dysfunction of any bodily organ or part.
(2) Copayment of one dollar ($1) shall be made for each drug
prescription or refill.
(3) Copayment of one dollar ($1) shall be made for each visit for
services under subdivisions (a) and (h) of Section 14132.
(4) The copayment amounts set forth in paragraphs (1), (2), and
(3) may be collected and retained, or waived by the provider.
(5) The department shall not reduce the reimbursement otherwise
due to providers as a result of the copayment. The copayment amounts
shall be in addition to any reimbursement otherwise due to the
provider for services rendered under this program.
(6) This section does not apply to emergency services, family
planning services, or to any services received by any of the
following:
(A) A child in AFDC-Foster Care, as defined in Section 11400.
(B) A person who is an inpatient in a
health facility, as defined in Section 1250 of the Health and Safety
Code.
(C) A person 18 years of age or under.
(D) A woman receiving perinatal care.
(7) Paragraph (2) does not apply to a person 65 years of age or
over.
(8) A provider of service shall not deny care or services to an
individual solely because of that person's inability to copay under
this section. However, an individual shall remain liable to the
provider for any copayment amount owed.
(9) This section shall not apply to preventive services that are
assigned a grade of A or B by the United States Preventive Services
Task Force provided by a physician or other licensed practitioner of
the healing arts, or any approved adult vaccines and their
administration recommended by the Advisory Committee on Immunization
Practices. Pursuant to Section 1905(b) of the federal Social Security
Act (42 U.S.C. Sec. 1396d(b)), these services shall be provided
without any cost sharing by the beneficiary in order for the state to
receive an increased federal medical assistance percentage for these
services.
(b) The department shall seek any federal waivers necessary to
implement this section. The provisions for which appropriate federal
waivers cannot be obtained shall not be implemented, but provisions
for which waivers are either obtained or found to be unnecessary
shall be unaffected by the inability to obtain federal waivers for
the other provisions.
(c) The director shall adopt regulations necessary to implement
this section as emergency regulations in accordance with Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code. The adoption of the regulations shall be deemed
to be an emergency and necessary for the immediate preservation of
the public peace, health and safety, or general welfare. The director
shall transmit these emergency regulations directly to the Secretary
of State for filing and the regulations shall become effective
immediately upon filing. Upon completion of the formal regulation
adoption process and prior to the expiration of the 120 day duration
period of emergency regulations, the director shall transmit directly
to the Secretary of State for filing the adopted regulations, the
rulemaking file, and the certification of compliance as required by
subdivision (e) of Section 11346.1 of the Government Code.
SEC. 41. Section 14134 of the Welfare and Institutions Code, as
amended by Section 66 of Chapter 23 of the Statutes of 2013, is
repealed.
SEC. 42. Section 14154 of the Welfare and Institutions Code is
amended to read:
14154. (a) (1) The department shall establish and maintain a plan
whereby costs for county administration of the determination of
eligibility for benefits under this chapter will be effectively
controlled within the amounts annually appropriated for that
administration. The plan, to be known as the County Administrative
Cost Control Plan, shall establish standards and performance
criteria, including workload, productivity, and support services
standards, to which counties shall adhere. The plan shall include
standards for controlling eligibility determination costs that are
incurred by performing eligibility determinations at county
hospitals, or that are incurred due to the outstationing of any other
eligibility function. Except as provided in Section 14154.15,
reimbursement to a county for outstationed eligibility functions
shall be based solely on productivity standards applied to that
county's welfare department office.
(2) (A) The plan shall delineate both of the following:
(i) The process for determining county administration base costs,
which include salaries and benefits, support costs, and staff
development.
(ii) The process for determining funding for caseload changes,
cost-of-living adjustments, and program and other changes.
(B) The annual county budget survey document utilized under the
plan shall be constructed to enable the counties to provide
sufficient detail to the department to support their budget requests.
(3) The plan shall be part of a single state plan, jointly
developed by the department and the State Department of Social
Services, in conjunction with the counties, for administrative cost
control for the California Work Opportunity and Responsibility to
Kids (CalWORKs), CalFresh, and Medical Assistance (Medi-Cal)
programs. Allocations shall be made to each county and shall be
limited by and determined based upon the County Administrative Cost
Control Plan. In administering the plan to control county
administrative costs, the department shall not allocate state funds
to cover county cost overruns that result from county failure to meet
requirements of the plan. The department and the State Department of
Social Services shall budget, administer, and allocate state funds
for county administration in a uniform and consistent manner.
(4) The department and county welfare departments shall develop
procedures to ensure the data clarity, consistency, and reliability
of information contained in the county budget survey document
submitted by counties to the department. These procedures shall
include the format of the county budget survey document and process,
data submittal and its documentation, and the use of the county
budget survey documents for the development of determining county
administration costs. Communication between the department and the
county welfare departments shall be ongoing as needed regarding the
content of the county budget surveys and any potential issues to
ensure the information is complete and well understood by involved
parties. Any changes developed pursuant to this section shall be
incorporated within the state's annual budget process by no later
than the 2011-12 fiscal year.
(5) The department shall provide a clear narrative description
along with fiscal detail in the Medi-Cal estimate package, submitted
to the Legislature in January and May of each year, of each component
of the county administrative funding for the Medi-Cal program. This
shall describe how the information obtained from the county budget
survey documents was utilized and, if applicable, modified and the
rationale for the changes.
(6) Notwithstanding any other law, the department shall develop
and implement, in consultation with county program and fiscal
representatives, a new budgeting methodology for Medi-Cal county
administrative costs that reflects the impact of PPACA implementation
on county administrative work. The new budgeting methodology shall
be used to reimburse counties for eligibility processing and case
maintenance for applicants and beneficiaries.
(A) The budgeting methodology may include, but is not limited to,
identification of the costs of eligibility determinations for
applicants, and the costs of eligibility redeterminations and case
maintenance activities for recipients, for different groupings of
cases, based on variations in time and resources needed to conduct
eligibility determinations. The calculation of time and resources
shall be based on the following factors: complexity of eligibility
rules, ongoing eligibility requirements, and other factors as
determined appropriate by the department. The development of the new
budgeting methodology may include, but is not limited to, county
survey of costs, time and motion studies, in-person observations by
department staff, data reporting, and other factors deemed
appropriate by the department.
(B) The new budgeting methodology shall be clearly described,
state the necessary data elements to be collected from the counties,
and establish the timeframes for counties to provide the data to the
state.
(C) The new budgeting methodology developed pursuant to this
paragraph shall be implemented no sooner than the 2015-16 fiscal
year. The department may develop a process for counties to phase in
the requirements of the new budgeting methodology.
(D) The department shall provide the new budgeting methodology to
the legislative fiscal committees by March 1 of the fiscal year
immediately preceding the first fiscal year of implementation of the
new budgeting methodology.
(E) To the extent that the funding for the county budgets
developed pursuant to the new budget methodology is not fully
appropriated in any given fiscal year, the department, with input
from the counties, shall identify and consider options to align
funding and workload responsibilities.
(F) For purposes of this paragraph, "PPACA" means the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152) and any subsequent amendments.
(G) 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 paragraph
by means of all-county letters, plan letters, plan or provider
bulletins, or similar instructions until the time any necessary
regulations are adopted. The department shall adopt regulations by
July 1, 2017, in accordance with the requirements of Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code. Beginning six months after the implementation
of the new budgeting methodology pursuant to this paragraph, and
notwithstanding Section 10231.5 of the Government Code, the
department shall provide a status report to the Legislature on a
semiannual basis, in compliance with Section 9795 of the Government
Code, until regulations have been adopted.
(b) Nothing in this section, Section 15204.5, or Section 18906
shall be construed to limit the administrative or budgetary
responsibilities of the department in a manner that would violate
Section 14100.1, and thereby jeopardize federal financial
participation under the Medi-Cal program.
(c) (1) The Legislature finds and declares that in order for
counties to do the work that is expected of them, it is necessary
that they receive adequate funding, including adjustments for
reasonable annual cost-of-doing-business increases. The Legislature
further finds and declares that linking appropriate funding for
county Medi-Cal administrative operations, including annual
cost-of-doing-business adjustments, with performance standards will
give counties the incentive to meet the performance standards and
enable them to continue to do the work they do on behalf of the
state. It is therefore the Legislature's intent to provide
appropriate funding to the counties for the effective administration
of the Medi-Cal program at the local level to ensure that counties
can reasonably meet the purposes of the performance measures as
contained in this section.
(2) It is the intent of the Legislature to not appropriate funds
for the cost-of-doing-business adjustment for the 2008-09, 2009-10,
2010-11, 2011-12, 2012-13, 2014-15, and 2015-16 fiscal years.
(d) The department is responsible for the Medi-Cal program in
accordance with state and federal law. A county shall determine
Medi-Cal eligibility in accordance with state and federal law. If in
the course of its duties the department becomes aware of accuracy
problems in any county, the department shall, within available
resources, provide training and technical assistance as appropriate.
Nothing in this section shall be interpreted to eliminate any remedy
otherwise available to the department to enforce accurate county
administration of the program. In administering the Medi-Cal
eligibility process, each county shall meet the following performance
standards each fiscal year:
(1) Complete eligibility determinations as follows:
(A) Ninety percent of the general applications without applicant
errors and are complete shall be completed within 45 days.
(B) Ninety percent of the applications for Medi-Cal based on
disability shall be completed within 90 days, excluding delays by the
state.
(2) (A) The department shall establish best-practice guidelines
for expedited enrollment of newborns into the Medi-Cal program,
preferably with the goal of enrolling newborns within 10 days after
the county is informed of the birth. The department, in consultation
with counties and other stakeholders, shall work to develop a process
for expediting enrollment for all newborns, including those born to
mothers receiving CalWORKs assistance.
(B) Upon the development and implementation of the best-practice
guidelines and expedited processes, the department and the counties
may develop an expedited enrollment timeframe for newborns that is
separate from the standards for all other applications, to the extent
that the timeframe is consistent with these guidelines and
processes.
(3) Perform timely annual redeterminations, as follows:
(A) Ninety percent of the annual redetermination forms shall be
mailed to the recipient by the anniversary date.
(B) Ninety percent of the annual redeterminations shall be
completed within 60 days of the recipient's annual redetermination
date for those redeterminations based on forms that are complete and
have been returned to the county by the recipient in a timely manner.
(C) Ninety percent of those annual redeterminations where the
redetermination form has not been returned to the county by the
recipient shall be completed by sending a notice of action to the
recipient within 45 days after the date the form was due to the
county.
(D) If a child is determined by the county to change from no share
of cost to a share of cost and the child meets the eligibility
criteria for the Healthy Families Program established under Section
12693.98 of the Insurance Code, the child shall be placed in the
Medi-Cal-to-Healthy Families Bridge Benefits Program, and these cases
shall be processed as follows:
(i) Ninety percent of the families of these children shall be sent
a notice informing them of the Healthy Families Program within five
working days from the determination of a share of cost.
(ii) Ninety percent of all annual redetermination forms for these
children shall be sent to the Healthy Families Program within five
working days from the determination of a share of cost if the parent
has given consent to send this information to the Healthy Families
Program.
(iii) Ninety percent of the families of these children placed in
the Medi-Cal-to-Healthy Families Bridge Benefits Program who have not
consented to sending the child's annual redetermination form to the
Healthy Families Program shall be sent a request, within five working
days of the determination of a share of cost, to consent to send the
information to the Healthy Families Program.
(E) Subparagraph (D) shall not be implemented until 60 days after
the Medi-Cal and Joint Medi-Cal and Healthy Families applications and
the Medi-Cal redetermination forms are revised to allow the parent
of a child to consent to forward the child's information to the
Healthy Families Program.
(e) The department shall develop procedures in collaboration with
the counties and stakeholder groups for determining county review
cycles, sampling methodology and procedures, and data reporting.
(f) On January 1 of each year, each applicable county, as
determined by the department, shall report to the department on the
county's results in meeting the performance standards specified in
this section. The report shall be subject to verification by the
department. County reports shall be provided to the public upon
written request.
(g) If the department finds that a county is not in compliance
with one or more of the standards set forth in this section, the
county shall, within 60 days, submit a corrective action plan to the
department for approval. The corrective action plan shall, at a
minimum, include steps that the county shall take to improve its
performance on the standard or standards with which the county is out
of compliance. The plan shall establish interim benchmarks for
improvement that shall be expected to be met by the county in order
to avoid a sanction.
(h) (1) If a county does not meet the performance standards for
completing eligibility determinations and redeterminations as
specified in this section, the department may, at its sole
discretion, reduce the allocation of funds to that county in the
following year by 2 percent. Any funds so reduced may be restored by
the department if, in the determination of the department, sufficient
improvement has been made by the county in meeting the performance
standards during the year for which the funds were reduced. If the
county continues not to meet the performance standards, the
department may reduce the allocation by an additional 2 percent for
each year thereafter in which sufficient improvement has not been
made to meet the performance standards.
(2) No reduction of the allocation of funds to a county shall be
imposed pursuant to this subdivision for failure to meet performance
standards during any period of time in which the
cost-of-doing-business increase is suspended.
(i) The department shall develop procedures, in collaboration with
the counties and stakeholders, for developing instructions for the
performance standards established under subparagraph (D) of paragraph
(3) of subdivision (d), no later than September 1, 2005.
(j) No later than September 1, 2005, the department shall issue a
revised annual redetermination form to allow a parent to indicate
parental consent to forward the annual redetermination form to the
Healthy Families Program if the child is determined to have a share
of cost.
(k) The department, in coordination with the Managed Risk Medical
Insurance Board, shall streamline the method of providing the Healthy
Families Program with information necessary to determine Healthy
Families eligibility for a child who is receiving services under the
Medi-Cal-to-Healthy Families Bridge Benefits Program.
( l ) Notwithstanding Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code, and except as provided in subparagraph (G) of paragraph (6) of
subdivision (a), the department shall, without taking any further
regulatory action, implement, interpret, or make specific this
section and any applicable federal waivers and state plan amendments
by means of all-county letters or similar instructions.
SEC. 43. Section 14186 of the Welfare and Institutions Code is
amended to read:
14186. (a) It is the intent of the Legislature that long-term
services and supports (LTSS) be covered through managed care health
plans in Coordinated Care Initiative counties.
(b) It is further the intent of the Legislature that all of the
following occur:
(1) Persons receiving health care services through Medi-Cal
receive these services through a coordinated health care system that
reduces the unnecessary use of emergency and hospital services.
(2) Coordinated health care services, including medical, long-term
services and supports, and enhanced care management be covered
through Medi-Cal managed care health plans in order to eliminate
system inefficiencies and align incentives with positive health care
outcomes.
(3) Managed care health plans shall, in coordination with LTSS
care management providers, develop and expand care coordination
practices in consultation with counties, nursing facilities, area
agencies on aging, and other home- and community-based providers, and
share best practices. Unless the consumer objects, managed care
health plans may establish care coordination teams as needed. If the
consumer is an IHSS recipient, his or her participation and the
participation of his or her provider shall be subject to the consumer'
s consent. These care coordination teams shall include the consumer,
and his or her authorized representative, health plan, county social
services agency, Community-Based Adult Services (CBAS) case manager
for CBAS clients, Multipurpose Senior Services Program (MSSP) case
manager for MSSP clients, and, if an IHSS recipient, may include
others.
(4) To the extent possible, for Medi-Cal beneficiaries also
enrolled in the Medicare Program, that the department work with the
federal government to coordinate financing and incentives and permit
managed care health plans to coordinate health care provided under
both health care systems.
(5) The health care choices made by Medi-Cal beneficiaries be
considered with regard to all of the following:
(A) Receiving care in a home- and community-based setting to
maintain independence and quality of life.
(B) Selecting their health care providers in the managed care plan
network.
(C) Controlling care planning, decisionmaking, and coordination
with their health care providers.
(D) Gaining access to services that are culturally,
linguistically, and operationally sensitive to meet their needs or
limitations and that improve their health outcomes, enhance
independence, and promote living in home- and community-based
settings.
(E) Self-directing their care by being able to hire, fire, and
supervise their IHSS provider.
(F) Being assured by the department and coordinating departments
of their oversight of the quality of these coordinated health care
services.
(6) (A) Counties continue to perform functions necessary for the
administration of the IHSS program, including conducting assessments
and determining authorized hours for recipients, pursuant to Article
7 (commencing with Section 12300) of Chapter 3. County agency
assessments shall be shared with care coordination teams, when
applicable. The county agency thereafter may receive and consider
additional input from the care coordination team.
(B) Managed care health plans may authorize personal care services
and related domestic services in addition to the hours authorized
under Article 7 (commencing with Section 12300) of Chapter 3, which
managed care health plans shall be responsible for paying at no share
of cost to the county. The department, in consultation with the
State Department of Social Services, shall develop policies and
procedures for these additional benefits, which managed care health
plans may authorize. The grievance process for these benefits shall
be the same process as used for other benefits authorized by managed
care health plans, and shall comply with Section 14450, and Sections
1368 and 1368.1 of the Health and Safety Code.
(7) (A) No later than December 31, 2017, or on the date the
managed care health plans and MSSP providers jointly satisfy the
readiness criteria developed pursuant to subparagraph (D) of
paragraph (4) of subdivision (b) of Section 14186.3, whichever is
earlier, MSSP services shall transition from a federal waiver
pursuant to Section 1915(c) under the federal Social Security Act (42
U.S.C. Sec. 1396n(c)) to a benefit administered and allocated by
managed care health plans in Coordinated Care Initiative counties.
(B) Notwithstanding Chapter 8 (commencing with Section 9560) of
Division 8.5, it is also the intent of the Legislature that the
provisions of this article shall apply to dual eligible and
Medi-Cal-only beneficiaries enrolled in MSSP. It is the further
intent of the Legislature that managed care health plans shall work
in collaboration with MSSP providers to begin development of an
integrated, person-centered care management and care coordination
model that works within the context of managed care, and explore
which portions of the MSSP program model may be adapted to managed
care while maintaining the integrity and efficacy of the MSSP model.
(C) At least 30 days before the MSSP services transition to a
benefit administered and allocated by managed care health plans in
Coordinated Care Initiative counties, the department shall notify the
appropriate policy and fiscal committees of the Legislature of its
intent to transition the MSSP services to managed care health plans.
(8) In lieu of providing nursing facility services, managed care
health plans may authorize home- and community-based services plan
benefits, as defined in subdivision (d) of Section 14186.1, which
managed care health plans shall be responsible for paying at no share
of cost to the county.
(c) If the Coordinated Care Initiative becomes inoperative
pursuant to Section 34 of Chapter 37 of the Statutes of 2013, MSSP
services shall be governed by the provisions of Chapter 8 (commencing
with Section 9560) of Division 8.5.
SEC. 44. Section 14186.1 of the Welfare and Institutions Code is
amended to read:
14186.1. For purposes of this article, the following definitions
shall apply unless otherwise specified:
(a) "Coordinated Care Initiative counties" has the same meaning as
that term is defined in paragraph (1) of subdivision (b) of Section
14182.16.
(b) "Home- and community-based services" means services provided
pursuant to paragraphs (1), (2), and (3) of subdivision (c).
(c) "Long-term services and supports" or "LTSS" means all of the
following:
(1) In-home supportive services (IHSS) provided pursuant to
Article 7 (commencing with Section 12300) of Chapter 3, and Sections
14132.95, 14132.952, and 14132.956.
(2) Community-Based Adult Services (CBAS).
(3) Multipurpose Senior Services Program (MSSP) services, which
include those services approved under a federal home- and
community-based services waiver or, beginning January 1, 2018, or on
the date the managed care health plans and MSSP providers jointly
satisfy the readiness criteria developed pursuant to subparagraph (D)
of paragraph (4) of subdivision (b) of Section 14186.3, whichever is
earlier, equivalent services.
(4) Skilled nursing facility services and subacute care services
established under subdivision (c) of Section 14132, including those
services described in Sections 51511 and 51511.5 of Title 22 of the
California Code of Regulations, regardless of whether the service is
included in the basic daily rate or billed separately, and any leave
of absence or bed hold provided consistent with Section 72520 of
Title 22 of the California Code of Regulations or the state plan.
However, services provided by any category of intermediate care
facility for the developmentally disabled shall not be considered
long-term services and supports.
(d) "Home- and community-based services (HCBS) plan benefits" may
include in-home and out-of-home respite, nutritional assessment,
counseling, and supplements, minor home or environmental adaptations,
habilitation, and other services that may be deemed necessary by the
managed care health plan, including its care coordination team. The
department, in consultation with stakeholders, may determine whether
health plans shall be required to include these benefits in their
scope of service, and may
establish guidelines for the scope, duration, and intensity of
these benefits. The grievance process for these benefits shall be
the same process as used for other benefits authorized by managed
care health plans, and shall comply with Section 14450, and Sections
1368 and 1368.1 of the Health and Safety Code.
(e) "Managed care health plan" means an individual, organization,
or entity that enters into a contract with the department pursuant to
Article 2.7 (commencing with Section 14087.3), Article 2.8
(commencing with Section 14087.5), Article 2.81 (commencing with
Section 14087.96), or Article 2.91 (commencing with Section 14089),
of this chapter, or Chapter 8 (commencing with Section 14200). For
purposes of this article, "managed care health plan" shall not
include an individual, organization, or entity that enters into a
contract with the department to provide services pursuant to Chapter
8.75 (commencing with Section 14591) or the Senior Care Action
Network.
(f) "Other health coverage" means health coverage providing the
same full or partial benefits as the Medi-Cal program, health
coverage under another state or federal medical care program except
for the Medicare Program (Title XVIII of the federal Social Security
Act (42 U.S.C. Sec. 1395 et seq.)), or health coverage under a
contractual or legal entitlement, including, but not limited to, a
private group or indemnification insurance program.
(g) "Recipient" means a Medi-Cal beneficiary eligible for IHSS
provided pursuant to Article 7 (commencing with Section 12300) of
Chapter 3, and Sections 14132.95, 14132.952, and 14132.956.
(h) "Stakeholder" shall include, but not be limited to, area
agencies on aging and independent living centers.
SEC. 45. Section 14186.3 of the Welfare and Institutions Code is
amended to read:
14186.3. (a) (1) No sooner than July 1, 2012, Community-Based
Adult Services (CBAS) shall be a Medi-Cal benefit covered under every
managed care health plan contract and available only through managed
care health plans. Medi-Cal beneficiaries who are eligible for CBAS
shall enroll in a managed care health plan in order to receive those
services, except for beneficiaries exempt under subdivision (c) of
Section 14186.2 or in counties or geographic regions where Medi-Cal
benefits are not covered through managed care health plans.
Notwithstanding subdivision (a) of Section 14186.2 and pursuant to
the provisions of an approved federal waiver or plan amendment, the
provision of CBAS as a Medi-Cal benefit through a managed care health
plan shall not be limited to Coordinated Care Initiative counties.
(2) Managed care health plans shall determine a member's medical
need for CBAS using the assessment tool and eligibility criteria
established pursuant to the provisions of an approved federal waiver
or amendments and shall approve the number of days of attendance and
monitor treatment plans of their members. Managed care health plans
shall reauthorize CBAS in compliance with criteria established
pursuant to the provisions of the approved federal waiver or
amendment requirements.
(b) (1) Beginning in the 2012 calendar year, managed care health
plans shall collaborate with MSSP providers to begin development of
an integrated, person-centered care management and care coordination
model and explore how the MSSP program model may be adapted to
managed care while maintaining the efficacy of the MSSP model. The
California Department of Aging and the department shall work with the
MSSP site association and managed care health plans to develop a
template contract to be used by managed care health plans contracting
with MSSP sites in Coordinated Care Initiative counties.
(2) Notwithstanding the implementation date authorized in
paragraph (1) of subdivision (a) of Section 14186.2, no later than
December 31, 2017, or on the date the managed care health plans and
MSSP providers jointly satisfy the readiness criteria developed
pursuant to subparagraph (D) of paragraph (4), whichever is earlier:
(A) Multipurpose Senior Services Program (MSSP) services shall be
a Medi-Cal benefit available only through managed care health plans,
except for beneficiaries exempt under subdivision (c) of Section
14186.2 in Coordinated Care Initiative counties.
(B) Managed care health plans shall contract with all county and
nonprofit organizations that are designated providers of MSSP
services for the provision of MSSP case management and waiver
services. These contracts shall provide for all of the following:
(i) Managed care health plans shall allocate to the MSSP providers
the same level of funding they would have otherwise received under
their MSSP contract with the California Department of Aging.
(ii) MSSP providers shall continue to meet all existing federal
waiver standards and program requirements, which include maintaining
the contracted service levels.
(iii) Managed care plans and MSSP providers shall share
confidential beneficiary data with one another, as necessary to
implement the provisions of this section.
(C) The California Department of Aging shall continue to contract
with all designated MSSP sites, including those in the counties
participating in the demonstration project, and perform MSSP waiver
oversight and monitoring.
(D) The California Department of Aging and the department, in
consultation with MSSP providers, managed care health plans, and
stakeholders, shall develop service fee structures, services, and
person-centered care coordination models that shall be effective June
2013, for the provision of care coordination and home- and
community-based services to beneficiaries who are enrolled in managed
care health plans but not enrolled in MSSP, and who may have care
coordination and service needs that are similar to MSSP participants.
The service fees for MSSP providers and MSSP services for any
additional beneficiaries and additional services for existing MSSP
beneficiaries shall be based upon, and consistent with, the rates and
services delivered in MSSP.
(3) In the 2014 calendar year, the provisions of paragraph (2)
shall continue. In addition, managed care health plans shall work in
collaboration with MSSP providers to begin development of an
integrated, person-centered care management and care coordination
model that works within the context of managed care and explore which
portions of the MSSP program model may be adapted to managed care
while maintaining the integrity and efficacy of the MSSP model.
(4) (A) No later than December 31, 2017, or on the date the
managed care health plans and MSSP providers jointly satisfy the
readiness criteria developed pursuant to subparagraph (D) of this
paragraph, whichever is earlier, MSSP services in Coordinated Care
Initiative counties shall transition from a federal waiver pursuant
to Section 1915(c) under the federal Social Security Act (42 U.S.C.
Sec. 1396n(c)) to a benefit administered and allocated by managed
care health plans.
(B) No later than January 1, 2014, the department, in consultation
with the California Department of Aging and the Department of
Managed Health Care, and with stakeholder input, shall submit a
transition plan to the Legislature to describe how subparagraph (A)
shall be implemented. The plan shall incorporate the principles of
the MSSP in the managed care benefit, and shall include provisions to
ensure seamless transitions and continuity of care. Managed care
health plans shall, in partnership with local MSSP providers, conduct
a local stakeholder process to develop recommendations that the
department shall consider when developing the transition plan.
(C) No later than 90 days prior to implementation of subparagraph
(A), the department, in consultation with the California Department
of Aging and the Department of Managed Health Care, and with
stakeholder input, shall submit a transition plan to the Legislature
that includes steps to address concerns, if any, raised by
stakeholders subsequent to the plan developed pursuant to
subparagraph (B).
(D) Before MSSP services transition to a benefit administered and
allocated by managed care health plans pursuant to subparagraph (A)
of paragraph (2), the California Department of Aging and the
department, in consultation with MSSP providers, managed care health
plans, and stakeholders, shall develop readiness criteria for the
transition. The readiness criteria shall include, but are not limited
to, the mutual agreement of the affected managed care health plans
and MSSP providers to the transition date. The department shall
evaluate the readiness of the managed care health plans and MSSP
providers to commence the transition of MSSP services to managed care
health plans.
(E) At least 30 days before the MSSP services transition to a
benefit administered and allocated by managed care health plans in
Coordinated Care Initiative counties, the department shall notify the
appropriate policy and fiscal committees of the Legislature of its
intent to transition the MSSP services to managed care health plans.
(c) (1) Not sooner than March 1, 2013, or on the date that any
necessary federal approvals or waivers are obtained, whichever is
later, nursing facility services and subacute facility services shall
be Medi-Cal benefits available only through managed care health
plans.
(2) Managed care health plans shall authorize utilization of
nursing facility services or subacute facility services for their
members when medically necessary. The managed care health plan shall
maintain the standards for determining levels of care and
authorization of services for both Medicare and Medi-Cal services
that are consistent with policies established by the federal Centers
for Medicare and Medicaid Services and consistent with the criteria
for authorization of Medi-Cal services specified in Section 51003 of
Title 22 of the California Code of Regulations, which includes
utilization of the "Manual of Criteria for Medi-Cal Authorization,"
published by the department in January 1982, last revised April 11,
2011.
(3) The managed care health plan shall maintain continuity of care
for beneficiaries by recognizing any prior treatment authorization
made by the department for not less than six months following
enrollment of a beneficiary into the health plan.
(4) When a managed care health plan has authorized services in a
facility and there is a change in the beneficiary's condition under
which the facility determines that the facility may no longer meet
the needs of the beneficiary, the beneficiary's health has improved
sufficiently so the resident no longer needs the services provided by
the facility, or the health or safety of individuals in the facility
is endangered by the beneficiary, the managed care health plan shall
arrange and coordinate a discharge of the beneficiary and continue
to pay the facility the applicable rate until the beneficiary is
successfully discharged and transitioned into an appropriate setting.
(5) The managed care health plan shall pay providers, including
institutional providers, in accordance with the prompt payment
provisions contained in each health plan's contracts with the
department, including the ability to accept and pay electronic
claims.
SEC. 46. Section 15894 of the Welfare and Institutions Code is
amended to read:
15894. (a) Except as provided in Section 15894.5, the department
shall authorize the expenditure of money in the fund to cover program
expenses, including program expenses that exceed subscriber
contributions, and to cover expenses relating to Section 10127.16 of
the Insurance Code, or to Section 1373.622 of the Health and Safety
Code. The department shall determine the amount of funds expended for
each of these purposes, taking into consideration the requirements
of this chapter, Section 10127.16 of the Insurance Code, and Section
1373.622 of the Health and Safety Code.
(b) Following consultation with a health care service plan or
health insurer, if the department and the health care service plan or
health insurer have not agreed to a final reconciliation of the
amount to be expended from the fund or to be reimbursed to the fund,
the department shall give written notice of its determination to the
health care service plan or health insurer of the final
reconciliation amount, as determined by the department. The health
care service plan or health insurer shall remit payment to the
department within 60 days of the date of notice from the department.
If payment is not received, interest shall accrue in the amount of 7
percent per annum. The department may offset the amount to be
reimbursed to the fund against any other payments owed to the health
care service plan or health insurer by the department, or may
negotiate a payment plan with the health care service plan or health
insurer for full payment, and in that case may waive interest accrual
as long as payment from the health care service plan or health
insurer is made in accordance with the payment plan. This subdivision
shall control over any conflict or ambiguity between this
subdivision and the provisions of Section 1373.622 of the Health and
Safety Code, Section 10127.16 of the Insurance Code, Part 6.5
(commencing with Section 12700) of Division 2 of the Insurance Code,
or this chapter.
SEC. 47. Section 24005 of the Welfare and Institutions Code is
amended to read:
24005. (a) This section shall apply to the Family Planning,
Access, Care, and Treatment Program identified in subdivision (aa) of
Section 14132 and this program.
(b) Only licensed medical personnel with family planning skills,
knowledge, and competency may provide the full range of family
planning medical services covered in this program.
(c) Medi-Cal enrolled providers, as determined by the department,
shall be eligible to provide family planning services under the
program when these services are within their scope of practice and
licensure. Those clinical providers electing to participate in the
program and approved by the department shall provide the full scope
of family planning education, counseling, and medical services
specified for the program, either directly or by referral, consistent
with standards of care issued by the department.
(d) The department shall require providers to enter into clinical
agreements with the department to ensure compliance with standards
and requirements to maintain the fiscal integrity of the program.
Provider applicants, providers, and persons with an ownership or
control interest, as defined in federal Medicaid regulations, shall
be required to submit to the department their social security numbers
to the full extent allowed under federal law. All state and federal
statutes and regulations pertaining to the audit or examination of
Medi-Cal providers shall apply to this program.
(e) Clinical provider agreements shall be signed by the provider
under penalty of perjury. The department may screen applicants at the
initial application and at any reapplication pursuant to
requirements developed by the department to determine provider
suitability for the program.
(f) The department may complete a background check on clinical
provider applicants for the purpose of verifying the accuracy of
information provided to the department for purposes of enrolling in
the program and in order to prevent fraud and abuse. The background
check may include, but not be limited to, unannounced onsite
inspection prior to enrollment, review of business records, and data
searches. If discrepancies are found to exist during the
preenrollment period, the department may conduct additional
inspections prior to enrollment. Failure to remediate significant
discrepancies as prescribed by the director may result in denial of
the application for enrollment. Providers that do not provide
services consistent with the standards of care or that do not comply
with the department's rules related to the fiscal integrity of the
program may be disenrolled as a provider from the program at the sole
discretion of the department.
(g) The department shall not enroll any applicant who, within the
previous 10 years:
(1) Has been convicted of any felony or misdemeanor that involves
fraud or abuse in any government program, that relates to neglect or
abuse of a patient in connection with the delivery of a health care
item or service, or that is in connection with the interference with,
or obstruction of, any investigation into health care related fraud
or abuse.
(2) Has been found liable for fraud or abuse in any civil
proceeding, or that has entered into a settlement in lieu of
conviction for fraud or abuse in any government program.
(h) In addition, the department may deny enrollment to any
applicant that, at the time of application, is under investigation by
the department or any local, state, or federal government law
enforcement agency for fraud or abuse. The department shall not deny
enrollment to an otherwise qualified applicant whose felony or
misdemeanor charges did not result in a conviction solely on the
basis of the prior charges. If it is discovered that a provider is
under investigation by the department or any local, state, or federal
government law enforcement agency for fraud or abuse, that provider
shall be subject to immediate disenrollment from the program.
(i) (1) The program shall disenroll as a program provider any
individual who, or any entity that, has a license, certificate, or
other approval to provide health care, which is revoked or suspended
by a federal, California, or other state's licensing, certification,
or other approval authority, has otherwise lost that license,
certificate, or approval, or has surrendered that license,
certificate, or approval while a disciplinary hearing on the license,
certificate, or approval was pending. The disenrollment shall be
effective on the date the license, certificate, or approval is
revoked, lost, or surrendered.
(2) A provider shall be subject to disenrollment if the provider
submits claims for payment for the services, goods, supplies, or
merchandise provided, directly or indirectly, to a program
beneficiary, by an individual or entity that has been previously
suspended, excluded, or otherwise made ineligible to receive,
directly or indirectly, reimbursement from the program or from the
Medi-Cal program and the individual has previously been listed on
either the Suspended and Ineligible Provider List, which is published
by the department, to identify suspended and otherwise ineligible
providers or any list published by the federal Office of the
Inspector General regarding the suspension or exclusion of
individuals or entities from the federal Medicare and Medicaid
programs, to identify suspended, excluded, or otherwise ineligible
providers.
(3) The department shall deactivate, immediately and without prior
notice, the provider numbers used by a provider to obtain
reimbursement from the program when warrants or documents mailed to a
provider's mailing address, its pay to address, or its service
address, if any, are returned by the United States Postal Service as
not deliverable or when a provider has not submitted a claim for
reimbursement from the program for one year. Prior to taking this
action, the department shall use due diligence in attempting to
contact the provider at its last known telephone number and to
ascertain if the return by the United States Postal Service is by
mistake and shall use due diligence in attempting to contact the
provider by telephone or in writing to ascertain whether the provider
wishes to continue to participate in the Medi-Cal program. If
deactivation pursuant to this section occurs, the provider shall meet
the requirements for reapplication as specified in regulation.
(4) For purposes of this subdivision:
(A) "Mailing address" means the address that the provider has
identified to the department in its application for enrollment as the
address at which it wishes to receive general program
correspondence.
(B) "Pay to address" means the address that the provider has
identified to the department in its application for enrollment as the
address at which it wishes to receive warrants.
(C) "Service address" means the address that the provider has
identified to the department in its application for enrollment as the
address at which the provider will provide services to program
beneficiaries.
(j) Subject to Article 4 (commencing with Section 19130) of
Chapter 5 of Part 2 of Division 5 of Title 2 of the Government Code,
the department may enter into contracts to secure consultant services
or information technology including, but not limited to, software,
data, or analytical techniques or methodologies for the purpose of
fraud or abuse detection and prevention. Contracts under this section
shall be exempt from the Public Contract Code.
(k) Enrolled providers shall attend specific orientation approved
by the department in comprehensive family planning services. Enrolled
providers who insert IUDs or contraceptive implants shall have
received prior clinical training specific to these procedures.
( l ) Upon receipt of reliable evidence that would be
admissible under the administrative adjudication provisions of
Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of
Title 2 of the Government Code, of fraud or willful misrepresentation
by a provider under the program or commencement of a suspension
under Section 14123, the department may do any of the following:
(1) Collect any State-Only Family Planning program or Family
Planning, Access, Care, and Treatment Program overpayment identified
through an audit or examination, or any portion thereof from any
provider. Notwithstanding Section 100171 of the Health and Safety
Code, a provider may appeal the collection of overpayments under this
section pursuant to procedures established in Article 5.3
(commencing with Section 14170) of Chapter 7 of Part 3 of Division 9.
Overpayments collected under this section shall not be returned to
the provider during the pendency of any appeal and may be offset to
satisfy audit or appeal findings, if the findings are against the
provider. Overpayments shall be returned to a provider with interest
if findings are in favor of the provider.
(2) Withhold payment for any goods or services, or any portion
thereof, from any State-Only Family Planning program or Family
Planning, Access, Care, and Treatment Program provider. The
department shall notify the provider within five days of any
withholding of payment under this section. The notice shall do all of
the following:
(A) State that payments are being withheld in accordance with this
paragraph and that the withholding is for a temporary period and
will not continue after it is determined that the evidence of fraud
or willful misrepresentation is insufficient or when legal
proceedings relating to the alleged fraud or willful
misrepresentation are completed.
(B) Cite the circumstances under which the withholding of the
payments will be terminated.
(C) Specify, when appropriate, the type or types of claimed
payments being withheld.
(D) Inform the provider of the right to submit written evidence
that is evidence that would be admissible under the administrative
adjudication provisions of Chapter 5 (commencing with Section 11500)
of Part 1 of Division 3 of Title 2 of the Government Code, for
consideration by the department.
(3) Notwithstanding Section 100171 of the Health and Safety Code,
a provider may appeal a withholding of payment under this section
pursuant to Section 14043.65. Payments withheld under this section
shall not be returned to the provider during the pendency of any
appeal and may be offset to satisfy audit or appeal findings.
(m) As used in this section:
(1) "Abuse" means either of the following:
(A) Practices that are inconsistent with sound fiscal or business
practices and result in unnecessary cost to the Medicaid program, the
Medicare program, the Medi-Cal program, including the Family
Planning, Access, Care, and Treatment Program, identified in
subdivision (aa) of Section 14132, another state's Medicaid program,
or the State-Only Family Planning program, or other health care
programs operated, or financed in whole or in part, by the federal
government or any state or local agency in this state or any other
state.
(B) Practices that are inconsistent with sound medical practices
and result in reimbursement, by any of the programs referred to in
subparagraph (A) or other health care programs operated, or financed
in whole or in part, by the federal government or any state or local
agency in this state or any other state, for services that are
unnecessary or for substandard items or services that fail to meet
professionally recognized standards for health care.
(2) "Fraud" means an intentional deception or misrepresentation
made by a person with the knowledge that the deception could result
in some unauthorized benefit to himself or herself or some other
person. It includes any act that constitutes fraud under applicable
federal or state law.
(3) "Provider" means any individual, partnership, group,
association, corporation, institution, or entity, and the officers,
directors, owners, managing employees, or agents of any partnership,
group, association, corporation, institution, or entity, that
provides services, goods, supplies, or merchandise, directly or
indirectly, to a beneficiary and that has been enrolled in the
program.
(4) "Convicted" means any of the following:
(A) A judgment of conviction has been entered against an
individual or entity by a federal, state, or local court, regardless
of whether there is a post-trial motion or an appeal pending or the
judgment of conviction or other record relating to the criminal
conduct has been expunged or otherwise removed.
(B) A federal, state, or local court has made a finding of guilt
against an individual or entity.
(C) A federal, state, or local court has accepted a plea of guilty
or nolo contendere by an individual or entity.
(D) An individual or entity has entered into participation in a
first offender, deferred adjudication, or other program or
arrangement where judgment of conviction has been withheld.
(5) "Professionally recognized standards of health care" means
statewide or national standards of care, whether in writing or not,
that professional peers of the individual or entity whose provision
of care is an issue, recognize as applying to those peers practicing
or providing care within a state. When the United States Department
of Health and Human Services has declared a treatment modality not to
be safe and effective, practitioners that employ that treatment
modality shall be deemed not to meet professionally recognized
standards of health care. This
definition shall not be construed to mean that all other treatments
meet professionally recognized standards of care.
(6) "Unnecessary or substandard items or services" means those
that are either of the following:
(A) Substantially in excess of the provider's usual charges or
costs for the items or services.
(B) Furnished, or caused to be furnished, to patients, whether or
not covered by Medicare, Medicaid, or any of the state health care
programs to which the definitions of applicant and provider apply,
and which are substantially in excess of the patient's needs, or of a
quality that fails to meet professionally recognized standards of
health care. The department's determination that the items or
services furnished were excessive or of unacceptable quality shall be
made on the basis of information, including sanction reports, from
the following sources:
(i) The professional review organization for the area served by
the individual or entity.
(ii) State or local licensing or certification authorities.
(iii) Fiscal agents or contractors, or private insurance
companies.
(iv) State or local professional societies.
(v) Any other sources deemed appropriate by the department.
(7) "Enrolled or enrollment in the program" means authorized under
any and all processes by the department or its agents or contractors
to receive, directly or indirectly, reimbursement for the provision
of services, goods, supplies, or merchandise to a program
beneficiary.
(n) In lieu of, or in addition to, the imposition of any other
sanctions available, including the imposition of a civil penalty
under Sections 14123.2 or 14171.6, the program may impose on
providers any or all of the penalties pursuant to Section 14123.25,
in accordance with the provisions of that section. In addition,
program providers shall be subject to the penalties contained in
Section 14107.
(o) (1) Notwithstanding any other provision of law, every primary
supplier of pharmaceuticals, medical equipment, or supplies shall
maintain accounting records to demonstrate the manufacture, assembly,
purchase, or acquisition and subsequent sale, of any
pharmaceuticals, medical equipment, or supplies, to providers.
Accounting records shall include, but not be limited to, inventory
records, general ledgers, financial statements, purchase and sales
journals, and invoices, prescription records, bills of lading, and
delivery records.
(2) For purposes of this subdivision, the term "primary supplier"
means any manufacturer, principal labeler, assembler, wholesaler, or
retailer.
(3) Accounting records maintained pursuant to paragraph (1) shall
be subject to audit or examination by the department or its agents.
The audit or examination may include, but is not limited to,
verification of what was claimed by the provider. These accounting
records shall be maintained for three years from the date of sale or
the date of service.
(p) Each provider of health care services rendered to any program
beneficiary shall keep and maintain records of each service rendered,
the beneficiary to whom rendered, the date, and such additional
information as the department may by regulation require. Records
required to be kept and maintained pursuant to this subdivision shall
be retained by the provider for a period of three years from the
date the service was rendered.
(q) A program provider applicant or a program provider shall
furnish information or copies of records and documentation requested
by the department. Failure to comply with the department's request
shall be grounds for denial of the application or automatic
disenrollment of the provider.
(r) A program provider may assign signature authority for
transmission of claims to a billing agent subject to Sections 14040,
14040.1, and 14040.5.
(s) Moneys payable or rights existing under this division shall be
subject to any claim, lien, or offset of the State of California,
and any claim of the United States of America made pursuant to
federal statute, but shall not otherwise be subject to enforcement of
a money judgment or other legal process, and no transfer or
assignment, at law or in equity, of any right of a provider of health
care to any payment shall be enforceable against the state, a fiscal
intermediary, or carrier.
(t) (1) Notwithstanding any other law, within 30 calendar days of
receiving a complete application for enrollment into the Family PACT
Program from an affiliate primary care clinic licensed under Section
1218.1 of the Health and Safety Code, the department shall do one of
the following:
(A) Approve the provider's Family PACT Program application,
provided the applicant meets the Family PACT Program provider
enrollment requirements set forth in this section.
(B) If the provider is an enrolled Medi-Cal provider in good
standing, notify the applicant in writing of any discrepancies in the
Family PACT Program enrollment application. The applicant shall have
30 days from the date of written notice to correct any identified
discrepancies. Upon receipt of all requested corrections, the
department shall approve the application within 30 calendar days.
(C) If the provider is not an enrolled Medi-Cal provider in good
standing, the department shall not proceed with the actions described
in this subdivision until the department receives confirmation of
good standing and enrollment as a Medi-Cal provider.
(2) The effective date of enrollment into the Family PACT Program
shall be the later of the date the department receives confirmation
of enrollment as a Medi-Cal provider, or the date the applicant meets
all Family PACT Program provider enrollment requirements set forth
in this section.
(u) Providers, or the enrolling entity, shall make available to
all applicants and beneficiaries prior to, or concurrent with,
enrollment, information on the manner in which to apply for insurance
affordability programs, in a manner determined by the State
Department of Health Care Services. The information provided shall
include the manner in which applications can be submitted for
insurance affordability programs, information about the open
enrollment periods for the California Health Benefit Exchange, and
the continuous enrollment aspect of the Medi-Cal program.
SEC. 48. Section 70 of Chapter 23 of the Statutes of 2013 is
amended to read:
Sec. 70. (a) The State Department of Health Care Services shall
accept contributions by private foundations in the amount of at least
fourteen million dollars ($14,000,000) for the purpose of this
section and shall immediately seek an equal amount of federal
matching funds.
(b) Entities and persons that are eligible for Medi-Cal in-person
enrollment assistance payments of fifty-eight dollars ($58) per
approved Medi-Cal application and payment processing costs shall be
those trained and eligible for in-person enrollment assistance
payments by the California Health Benefit Exchange. The payments may
be made by the State Department of Health Care Services or through
the California Health Benefit Exchange in-person assistance payment
system.
(c) Enrollment assistance payments shall be made only for Medi-Cal
applicants newly eligible for coverage pursuant to the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the Health Care and Education Reconciliation Act of 2010
(Public Law 111-152), or those who have not been enrolled in the
Medi-Cal program during the previous 12 months prior to making the
application.
(d) The commencement of enrollment assistance payments shall be
consistent with those of the California Health Benefit Exchange.
(e) The State Department of Health Care Services or the California
Health Benefit Exchange shall provide monthly and cumulative payment
updates and number of persons enrolled through in-person assistance
payments on its Internet Web site.
(f) The State Department of Health Care Services shall make
enrollment assistance payments pursuant to this section for submitted
applications received through June 30, 2015, that result in approved
applications. Once all of those payments have been made, any
remaining funds described in subdivision (a) shall be allocated to
the county outreach and enrollment grants under Section 71 of Chapter
23 of the Statutes of 2013. Any of those remaining funds that are
allocated to those grants shall be distributed to community-based
organizations providing enrollment assistance to prospective Medi-Cal
enrollees pursuant to Section 71 of Chapter 23 of the Statutes of
2013. The State Department of Health Care Services shall make
authorized payments to counties for distribution to community-based
organizations. Counties that receive money pursuant to this
subdivision may retain an amount for administrative costs not to
exceed 10 percent of grants approved by the State Department of
Health Care Services. The State Department of Health Care Services
shall require progress reports, in a manner as determined by the
department, from those receiving allocations under this subdivision.
The State Department of Health Care Services shall make an initial
allocation to the counties for these funds no later than January 1,
2016, and the final allocation no later than June 30, 2016.
(g) This section shall be inoperative and cease to be implemented
on the date that all of the private contributions accepted pursuant
to subdivision (a) and any federal matching funds have been
exhausted.
SEC. 49. Section 71 of Chapter 23 of the Statutes of 2013, as
amended by Section 4 of Chapter 361 of the Statutes of 2013, is
amended to read:
Sec. 71. (a) (1) The State Department of Health Care Services
shall accept funding from private foundations in the amount of at
least twelve million five hundred thousand dollars ($12,500,000) to
provide allocations for the management and funding of Medi-Cal
outreach and enrollment plans specific to the provisions contained in
this section.
(2) The department shall seek necessary federal approval for
purposes of obtaining federal funding for activities conducted under
this section.
(3) Notwithstanding any other law, and in a manner that the
Director of Health Care Services shall provide, the department may
make allocations to fund Medi-Cal outreach and enrollment activities
as described in this section.
(b) (1) Funds appropriated by the Legislature to the department
for the purposes of this section shall be made available to selected
counties, counties acting jointly, and the County Medical Services
Program Governing Board pursuant to Section 16809 of the Welfare and
Institutions Code.
(2) Selected counties, counties acting jointly, and the County
Medical Services Program Governing Board may partner with
community-based organizations as applicable to conduct outreach and
enrollment to the target population as contained in subdivision (d).
(3) The director may, at his or her discretion, also give
consideration to community-based organizations in an area or region
of the state if a county, or counties acting jointly do not seek an
allocation or funds are made available.
(4) For purposes of this section only, "county" shall be defined
as county, city and county, a consortium of counties serving a region
consisting of more than one county, the County Medical Services
Program Governing Board, or a health authority.
(c) (1) The allocations shall be apportioned geographically, by
the entities identified in subdivision (b), according to the
estimated number of persons who are eligible but not enrolled in
Medi-Cal and who will be newly Medi-Cal eligible as of January 1,
2014.
(2) The department may determine the number of allocations and the
application process. The director may consult or obtain technical
assistance from private foundations in implementation of the
application and allocation process.
(3) The department shall coordinate and partner with the
California Health Benefit Exchange on certified application assister
and outreach, enrollment, and marketing activities related to the
federal Patient Protection and Affordable Care Act.
(d) Notwithstanding any other law, the department shall develop
selection criteria to allocate funds for the Medi-Cal outreach and
enrollment activities with special emphasis targeting all of the
following populations:
(1) Persons with mental health disorder needs.
(2) Persons with substance use disorder needs.
(3) Persons who are homeless.
(4) Young men of color.
(5) Persons who are in county jail, in state prison, on state
parole, on county probation, or under postrelease community
supervision.
(6) Families of mixed-immigration status.
(7) Persons with limited English proficiency.
(e) (1) The funds allocated under this section shall be used only
for the Medi-Cal outreach and enrollment activities and may
supplement, but shall not supplant, existing local, state, and
foundation funding of county outreach and enrollment activities.
(2) Notwithstanding Section 10744 of the Welfare and Institutions
Code, the department may recoup or withhold all or part of an
allocation for failure to comply with any requirements or standards
set forth by the department for the purposes of this section.
(f) The department shall begin the payment for the outreach and
enrollment allocation program no later than February 1, 2014.
(g) Under the terms of the approved allocation for the outreach
and enrollment program, funded entities under this section shall not
receive payment for in-person assister payments for assisting
potential Medi-Cal enrollees.
(h) The department shall require progress reports, in a manner as
determined by the department, from those receiving allocations under
this section.
(i) To the extent federal funding is received for the services
specified in this section, reimbursements for costs incurred under
the approved allocations shall be made in compliance with federal
law.
(j) 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 by
means of all-county letters, provider bulletins, or similar
instructions.
(k) This section shall become inoperative on June 30, 2018.
SEC. 50. Section 5 of Chapter 361 of the Statutes of 2013 is
amended to read:
Sec. 5. (a) The Healthcare Outreach and Medi-Cal Enrollment
Account is hereby created in the Special Deposit Fund within the
State Treasury in order to collect and allocate non-General Fund
public or private grant funds, to be expended upon appropriation by
the Legislature, for the purposes of outreach to and enrollment of
targeted Medi-Cal populations and to compensate Medi-Cal in-person
assisters, as specified in Sections 70 and 71 of Chapter 23 of the
Statutes of 2013.
(b) There is hereby appropriated to the State Department of Health
Care Services the following sums to compensate eligible Medi-Cal
in-person assisters as specified in Section 70 of Chapter 23 of the
Statutes of 2013:
(1) The sum of fourteen million dollars ($14,000,000) from the
Healthcare Outreach and Medi-Cal Enrollment Account, to be available
for encumbrance or expenditure until June 30, 2018.
(2) The sum of fourteen million dollars ($14,000,000) from the
Federal Trust Fund, to be available for encumbrance or expenditure
until June 30, 2018.
(3) After June 30, 2015, the State Department of Health Care
Services is authorized to expend all or any portion of the remaining
funds targeted for payment of enrollment assistance for Medi-Cal
applications in the Healthcare Outreach and Medi-Cal Enrollment
Account that has been created within the Special Deposit Fund within
the State Treasury and any matching federal funds, as specified in
paragraph (2), for the funding of allocations for Medi-Cal Outreach
And Enrollment plans, as specified in Section 71 of Chapter 23 of the
Statutes of 2013, as amended by the act the added this paragraph.
(c) There is hereby appropriated to the State Department of Health
Care Services the following sums to provide allocations for outreach
and enrollment grants to eligible entities as specified in Section
71 of Chapter 23 of the Statutes of 2013:
(1) The sum of twelve million five hundred thousand dollars
($12,500,000) from the Healthcare Outreach and Medi-Cal Enrollment
Account, to be available for encumbrance or expenditure until June
30, 2018.
(2) The sum of twelve million five hundred thousand dollars
($12,500,000) from the Federal Trust Fund, to be available for
encumbrance or expenditure until June 30, 2018.
(d) Of the amounts appropriated in subdivisions (b) and (c), the
State Department of Health Care Services may expend in aggregate up
to five hundred thousand dollars ($500,000) annually in fiscal years
2013-14, 2014-15, and 2015-16, inclusive, to administer the
activities described in Sections 70 and 71 of Chapter 23 of the
Statutes of 2013, including funding for four three-year limited-term
positions, which are hereby authorized to be established. Any private
foundation funding expended by the department to administer the
activities under Sections 70 and 71 of Chapter 23 of the Statutes of
2013 shall be expended only for filled positions and administrative
expenses directly related to these sections.
(e) The State Department of Health Care Services may expend, in
aggregate, up to five hundred thousand dollars ($500,000) annually
for the 2016-17 and 2017-18 fiscal years, to administer the
activities described in Sections 70 and 71 of Chapter 23 of the
Statutes of 2013, and Section 1 of Chapter 551 of the Statutes of
2014, as amended by that act that added this subdivision. Any private
foundation funding expended by the department for administration
shall be expended only for the administrative expenses directly
related to Sections 70 and 71 of Chapter 23 of the Statutes of 2013,
and Section 1 of Chapter 551 of the Statutes of 2014.
(f) This section shall become inoperative on June 30, 2020, and,
as of January 1, 2021, is repealed, unless a later enacted statute,
that becomes operative on or before January 1, 2021, deletes or
extends the dates on which it becomes inoperative and is repealed.
SEC. 51. Section 1 of Chapter 551 of the Statutes of 2014 is
amended to read:
Section 1. (a) (1) The State Department of Health Care Services
shall accept contributions by private foundations in the amount of at
least six million dollars ($6,000,000) for the purpose of providing
Medi-Cal renewal assistance payments starting January 1, 2015. These
contributions shall be deposited in the Healthcare Outreach and
Medi-Cal Enrollment Account that has been created in the Special
Deposit Fund within the State Treasury for the purposes specified in
this section.
(2) There is hereby appropriated to the State Department of Health
Care Services the following sums for the purposes specified in this
section:
(A) The sum of six million dollars ($6,000,000) from the
Healthcare Outreach and Medi-Cal Enrollment Account, to be available
for encumbrance or expenditure until June 30, 2018.
(B) The sum of six million dollars ($6,000,000) from the Federal
Trust Fund, to be available for encumbrance or expenditure until June
30, 2018.
(3) The department may expend a portion of the five hundred
thousand dollars ($500,000) authorized for expenditure in subdivision
(d) of Section 5 of Chapter 361 of the Statutes of 2013 to
administer the activities described in this section. Private
foundation funding expended by the department to administer the
activities described in this section shall be expended only for
filled positions and administrative expenses directly related to this
section.
(b) (1) Notwithstanding any other law, and in a manner that the
Director of the State Department of Health Care Services shall
provide, the department may make allocations to fund Medi-Cal renewal
assistance activities as described in this section.
(2) The department may determine the number of allocations and the
application process. The director may consult or obtain technical
assistance from private foundations in implementation of the
application and allocation process.
(3) The director may, at his or her discretion, give consideration
to distributing funds to community-based organizations in an area or
region of the state if a county or counties, acting jointly, do not
seek an allocation or if funds are made available.
(c) Renewal assistance payments shall be distributed to
community-based organizations providing renewal assistance to
Medi-Cal beneficiaries. Authorized payments shall be made to counties
by the department for distribution of funds to community-based
organizations. Counties may retain an amount for administrative costs
that have been approved by the department.
(d) The department, in collaboration with the County Welfare
Directors Association and legal services organizations, shall develop
renewal assistance training for employees of community-based
organizations that shall be consistent with the counties' human
services agencies Medi-Cal redetermination timeframes and process. In
order to be eligible for renewal assistance payments under this
section, the community-based organization's employees providing the
assistance shall have completed the renewal assistance training
developed under this subdivision.
(e) (1) The funds allocated under this section shall be used only
for the Medi-Cal renewal assistance activities and may supplement,
but shall not supplant, existing local, state, and foundation funding
of county renewal assistance activities.
(2) Notwithstanding Section 10744 of the Welfare and Institutions
Code, the department may recoup or withhold all or part of an
allocation for failure to comply with any requirements or standards
set forth by the department for the purposes of this section.
(f) The department shall require progress reports, in a manner as
determined by the department, from those receiving allocations under
this section.
(g) The department shall seek federal matching funds for the
contributions to the extent permissible for training, testing,
certifying, supporting, and compensating persons and entities
providing renewal assistance and for any other permissible renewal
assistance related activities and shall seek all necessary federal
approvals for purposes of obtaining federal funding for activities
conducted under this section.
(h) To the extent federal funding is received for the services
specified in this section, reimbursements for costs incurred under
the approved allocations shall be made in compliance with 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, interpret, or make specific this section by
means of all-county letters, provider bulletins, or similar
instructions.
(j) This section shall cease to be implemented when all of the
private contributions and any federal matching funds have been
exhausted.
SEC. 52. The sum of fifty million dollars ($50,000,000) is hereby
appropriated from the Health Home Program Account to the State
Department of Health Care Services for the purposes of implementing
the Health Home Program established pursuant to Article 3.9
(commencing with Section 14127) of Chapter 7 of Part 3 of Division 9
of the Welfare and Institutions Code. Notwithstanding Section 16304
of the Government Code, this appropriation shall be available for
encumbrance or expenditure until June 30, 2020.
SEC. 53. (a) For the 2015-16 fiscal year, and upon an
appropriation of funds by the Legislature for this purpose, the State
Department of Health Care Services shall provide a grant to health
benefit plans that meet all of the following requirements:
(1) The health benefit plan has a valid exemption letter from the
Internal Revenue Service pursuant to Section 501(c)(9) of the
Internal Revenue Code.
(2) The health benefit plan is a multiemployer plan, as defined in
Section 3(37) of the federal Employee Retirement Income Security Act
of 1974 (29 U.S.C. Sec. 1002(37)(A)).
(3) The health benefit plan is funded by contributions made by
agricultural employers, as defined in subdivision (c) of the Section
1140.4 of the Labor Code, where 85 percent or more of the plan's
eligible participants are agricultural employees, as defined in
subdivision (b) of Section 1140.4 of the Labor Code, for work
performed and covered under a collective bargaining agreement.
(b) On or before September 1, 2015, the State Department of Health
Care Services shall pay the funds allocated pursuant to this section
to the health plan that meets the criteria set forth in this
section. The funds shall be used to provide health care coverage for
agricultural employees and dependents.
(c) The payment set forth in subdivision (b) shall not require the
State Department of Health Care Services to contract with the
recipient of the funds nor shall the payment of funds be subject to
the requirements of Part 2 (commencing with Section 10100) of
Division 2 of the Public Contract Code.
SEC. 54. (a) For the 2015-16 fiscal year, and upon an
appropriation of funds by the Legislature for this purpose, the State
Department of Health Care Services shall provide a grant to LifeLong
Medical Care, a federally qualified health center in Contra Costa
County.
(b) On or before September 1, 2015, the State Department of Health
Care Services shall pay the funds allocated pursuant to this section
to LifeLong Medical Care. The funds shall be considered a grant to
be used to support LifeLong Medical Care and are not a payment for
services.
(c) To the extent allowable by federal law, the grant received
pursuant to subdivision (b) is not income for the purposes of the
prospective payment system rate setting or rate reconciliations that
are conducted by the State Department of Health Care Services for
LifeLong Medical Care.
(d) The grant made pursuant to subdivision (b) does not require
the State Department of Health Care Services to contract with the
recipient of the funds, nor is the grant subject to the requirements
of Part 2 (commencing with Section 10100) of Division 2 of the Public
Contract Code.
SEC. 55. (a) For the 2015-16 fiscal year, the California Health
Facilities Financing Authority (CHFFA) may authorize up to three
million dollars ($3,000,000) in unencumbered funds, as appropriated
in Item 0977-101-0001 for Mental Health Wellness Grants, of Section
2.00 of the Budget Act of 2013, to develop peer respite sites.
(b) Any grant awards authorized by CHFFA for peer respite
sites shall be used to expand local resources for the development,
capital, equipment acquisition, and applicable program startup or
expansion costs to increase bed capacity for peer respite support
services. This may include, but not be limited to, the purchase of
property, purchase of equipment, and the remodeling or construction
of housing for the purposes of operating a peer respite site.
(c) Any recipient of a grant to develop peer respite sites shall
adhere to all applicable laws relating to scope of practice,
licensure, certification, staffing, and building codes.
(d) CHFFA may adopt emergency regulations relating to grants for
peer respite sites, including emergency regulations that define
eligible costs, and determine minimum and maximum grant amounts. The
adoption, amendments, or repeal of these regulations shall be in
accordance with the Administrative Procedure Act (Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code) and shall be deemed to be an emergency and
necessary for the immediate preservation of the public peace, health,
safety, or general welfare.
SEC. 56. The Office of System Integration shall report to the
Legislature by April 1, 2017, on the feasibility, benefits, costs,
and risks of installing the Modified Adjusted Gross Income (MAGI)
Eligibility Decision Engine in one, two, or all of the Statewide
Automated Welfare System consortia systems.
SEC. 57. The Legislature finds and declares that the sections of
this act that amend Section 120962 of the Health and Safety Code and
Section 19548.2 of the Revenue and Taxation Code impose a limitation
on the public's right of access to the meetings of public bodies or
the writings of public officials and agencies within the meaning of
Section 3 of Article I of the California Constitution. Pursuant to
that constitutional provision, the Legislature makes the following
findings to demonstrate the interest protected by this limitation and
the need for protecting that interest:
In order to continue to protect the confidentiality of public
health records under specified provisions of this act, the
limitations on the public's right of access imposed under this act
are necessary.
SEC. 58. The Legislature finds and declares that a special law is
necessary and that a general law cannot be made applicable within the
meaning of Section 16 of Article IV of the California Constitution
because of the unique circumstances regarding providing urgent care
to the citizens of Contra Costa County.
SEC. 59. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution for
certain costs that may be incurred by a local agency or school
district because, in that regard, this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.
However, if the Commission on State Mandates determines that this
act contains other costs mandated by the state, reimbursement to
local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division 4 of
Title 2 of the Government Code.
SEC. 60. This act is a bill providing for appropriations related
to the Budget Bill within the meaning of subdivision (e) of Section
12 of Article IV of the California Constitution, has been identified
as related to the budget in the Budget Bill, and shall take effect
immediately.