BILL NUMBER: SB 77 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JUNE 12, 2013
INTRODUCED BY Committee on Budget and Fiscal Review
JANUARY 10, 2013
An act relating to the Budget Act of 2013.
An act to amend Section 680 of the Business and Professions Code, to
amend S ections 6254, 26605.6, 26605.7, and 26605.8 of
the Government Code, to amend Sections 1180.6, 1250.2, 1254, 1254.1,
1266.1, 1275.1, 1275.5, 1324.9, 1373, 111792, 123870, 123929, 123940,
and 123955 of, and to add Section 104151 to, the Health and Safety
Code, to amend Sections 10125, 10127, 12693.70, 12698, 12737, and
12739.61 of the Insurance Code, and to amend Sections 359, 708,
4005.7, 4080, 5150, 5151, 5157, 5202, 5326.9, 5358, 5366.1, 5404,
5405, 5585.21, 5585.50, 5585.55, 5675, 5675.1, 5675.2, 5751.7, 5768,
5840, 5845, 5846, 5909, 6007, 6551, 7100, 14105.22, 14105.3,
14131.10, 14134, 14707.5, and 15911 of, to add Sections 14100.3,
14100.51, 14100.52, 14132.86, and 14132.89 to, to add Part
3.3 (commencing with Section 15800) to Division 9 of, to add and
repeal Section 14005.281 of, and to repeal Section 14131.07 of, the
Welfare and Institutions Code, relating to health, and making an
appropriation therefor, to take effect immediately, bill related to
the budget.
LEGISLATIVE COUNSEL'S DIGEST
SB 77, as amended, Committee on Budget and Fiscal Review.
Budget Act of 2013. Health.
(1) Existing law authorizes a sheriff to release a prisoner from a
county correctional facility for transfer to a medical care facility
or residential care facility upon the advice of a physician, as
specified, or if the sheriff determines that the prisoner would not
reasonably pose a threat to public safety and the prisoner, upon
diagnosis by the examining physician, is deemed to have a life
expectancy of 6 months or less, provided the sheriff gives specified
notice to the superior court. Existing law also authorizes the
sheriff to request the court to grant medical probation or to
resentence a prisoner to medical probation in lieu of jail time if
the prisoner is physically incapacitated with a medical condition
that renders the prisoner permanently unable to perform activities of
basic daily living, which has resulted in the prisoner requiring
24-hour care, and if that incapacitation did not exist at the time of
sentencing or if the prisoner would require acute long-term
inpatient rehabilitation services. Existing law requires a county
that chooses to implement these provisions to pay the nonfederal
share of a prisoner's or probationer's Medi-Cal costs for the period
that the individual would have otherwise been incarcerated or been on
medical probation. Existing law requires a county board of
supervisors to adopt a process to fund the nonfederal share of
Medi-Cal costs, as specified, before implementing the
above-referenced provisions and to notify the State Department of
Health Care Services of the process.
This bill would revise the conditions under which a county may
implement these release or medical probation provisions by requiring
the county to notify the department when a released prisoner has
applied for Medi-Cal or is returned to custody and to also pay the
nonfederal share of certain nonreimbursable medical costs paid by the
state, and state administrative costs, as specified. The bill would
specify the Legislature's intent that implementation of these
provisions would not result in increased costs to the General Fund
and should not jeopardize federal financial participation for the
Medi-Cal program.
(2) Existing law establishes the Long-Term Care Quality Assurance
Fund in the State Treasury and requires, beginning August 1, 2013,
all revenues received by the State Department of Health Care Services
categorized by the department as long-term quality assurance fees,
including specified fees on certain intermediate care facilities and
skilled nursing facilities, as specified, to be deposited into the
fund. Existing law requires the moneys in the fund to be available,
upon appropriation by the Legislature, for expenditure by the
department to provide supplemental Medi-Cal reimbursement for
intermediate care facility services, and to enhance federal financial
participation in the Medi-Cal program or to provide additional
reimbursement to, and to support facility quality improvement efforts
in, licensed skilled nursing facilities.
This bill would authorize the Controller to use the funds in the
Long-Term Quality Assurance Fund for cashflow loans to the General
Fund, as specified.
(3) Existing law requires the State Department of Health Care
Services to provide, no later than January 10 and May 14 of each
year, the fiscal committees of the Legislature with an estimate
package for the Every Woman Counts Program, as specified.
This bill would instead require that the reporting occur each year
no later than January 10 and concurrently with the May Revision of
the annual budget. The bill would additionally require that the
estimate package include a breakout of costs for specified clinical
service activities, policy changes, and fund information.
(4) Existing law, the Mental Health Services Act, an initiative
measure enacted by the voters as Proposition 63 at the November 2,
2004, statewide general election, funds a system of county mental
health plans for the provision of mental health services, as
specified. Among other things, the act establishes the Mental Health
Services Oversight and Accountability Commission to oversee the
administration of various parts of the Mental Health Services Act,
and requires that the commission administer its operations separate
and apart from the State Department of Health Care Services. The act
provides that the Legislature may clarify procedures and terms of the
act by majority vote.
This bill would require that the commission administer its
operations separate and apart from the California Health and Human
Services Agency. The bill would also make technical changes.
(5) 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,
including specialty mental health services and drug treatment
services. The Medi-Cal program is, in part, governed and funded by
federal Medicaid Program provisions.
This bill would require the department, by January 10 and
concurrently with the May Revision of the annual budget, to provide
to the fiscal committees of the Legislature specified fiscal
information with respect to the Medi-Cal Specialty Mental Health
Services Program and the Drug Medi-Cal Program. The bill also would
require the department to post this information on its Internet Web
site.
(6) Existing federal law requires the State Department of Health
Care Services to describe the Medi-Cal program in a state plan. Under
existing state law, the Director of Health Care Services has those
powers and duties necessary to conform to requirements for securing
approval of the state plan. Existing federal law authorizes the
Secretary of Health and Human Services to waive provisions of federal
Medicaid law under specified circumstances, including, among others,
when the secretary finds that the waiver would be cost effective and
efficient. Existing state law requires the department to seek a
variety of waivers of federal law, including, among others, to
implement objectives that may include better care coordination for
seniors, persons with disabilities, and children with special health
care needs.
This bill would require the department to post on its Internet Web
site all submitted state plan amendments and all federal waiver
applications and requests for new waivers, waiver amendments, and
waiver renewals and extensions, within 10 business days from the date
the department submits these documents for approval to the federal
Centers for Medicare and Medicaid Services (CMS). The bill would
require the department to also post on its Internet Web site approval
or denial letters, or, if applicable, withdrawal notifications, and
accompanying documents for all submitted state plan amendments and
federal waiver applications and requests within 10 business days from
the date the department receives notification of final approval or
denial from CMS, or, if applicable, within 10 business days from when
the department notifies CMS of the withdrawal. The bill would
require the department to post on its Internet Web site all pending
submitted state plan amendments and federal waiver requests, as
specified, that were submitted in 2009 and every year thereafter
unless already posted pursuant to these provisions.
(7) Existing law states the intent of the Legislature that the
State Department of Health Care Services develop Medi-Cal
reimbursement rates for clinical laboratory or laboratory services in
accordance with specified criteria. Existing law exempts from
compliance with a specified regulation laboratory providers
reimbursed pursuant to any payment reductions implemented pursuant to
these provisions for 12 months following the date of implementation
of this reduction.
This bill would extend the length of this exemption from 12 months
to 21 months. The bill also would extend the date by which
laboratory providers are required to submit certain data reports, for
the purposes of establishing reimbursement rates, by an additional 5
months. The bill would also make technical changes to those
provisions.
(8) Existing law authorizes the State Department of Health Care
Services to enter into contracts with providers licensed to dispense
dangerous drugs or devices, as specified, to provide specialized care
in the distribution of specialized drugs for Medi-Cal beneficiaries.
Existing law requires the department, when implementing those
provisions, to, among other things, consult current standards of
practice when executing a provider contract, contract with a
nonexclusive number of providers that meet the needs of the affected
population, and generate an annual report, as prescribed. Under
existing law, those provisions pertaining to specialized drugs become
inoperative 3 years after the date of implementation or July 1,
2013, whichever is earlier.
This bill would delete the provision making those provisions
inoperative and would delete the reporting requirement. This bill
would also make technical changes to those provisions.
(9) Existing law limits the total number of Medi-Cal physician
office and clinic visits to 7 visits per beneficiary per fiscal year,
except as specified.
This bill would delete these provisions.
(10) Existing law requires Medi-Cal beneficiaries to make
copayments for specified services and, upon federal approval,
existing law revises the copayment rates and makes other related
changes, as specified.
This bill would provide that these copayment requirements shall
not apply to certain preventive services or any approved adult
vaccines and their administration, as specified and that these
services shall be provided without any cost sharing by the
beneficiary.
(11) Existing law requires the State Department of Health Care
Services, in collaboration with specified entities, to create a plan
for a performance outcomes system for Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT) mental health services provided to
eligible Medi-Cal beneficiaries under 21 years of age.
This bill would require the department, by February 1, 2014, to
convene a stakeholder advisory committee for purposes, among other
things, of developing measures for screening and referring Medi-Cal
beneficiaries to mental health services and supports, and to make
recommendations regarding performance and outcome measures. The bill
would require the department to incorporate into the performance
outcomes system these screenings and referrals, and to provide an
updated performance outcomes system plan to the fiscal and
appropriate policy committees of the Legislature by October 1, 2014.
The bill would require the department to propose how to implement the
updated performance systems outcome plan by January 10, 2015.
(12) Existing law requires the State Department of Health Care
Services, to the extent federal participation is available pursuant
to an approved state plan amendment, to extend Medi-Cal benefits to
independent foster care adolescents, as defined.
This bill would require, until January 1, 2014, the department,
using general fund moneys to the extent federal funds are not
available, to maintain Medi-Cal eligibility for all former
independent foster care adolescents who, on or after July 1, 2013,
but no later than December 31, 2013, lose Medi-Cal coverage as a
result of attaining 21 years of age.
(13) Existing law provides for a schedule of benefits under the
Medi-Cal program, which includes all of the following: emergency and
essential diagnostic and restorative dental services, subject to
utilization controls, as specified, certain optional adult dental
benefits, and enteral nutrition products subject to the Medi-Cal list
of enteral nutrition products and utilization controls. Existing
law, except as specified, requires that the purchase of enteral
nutrition products be limited to those products administered through
a feeding tube.
This bill would, on May 1, 2014, or the effective date of any
necessary federal financial participation approvals, whichever is
later, provide specified dental services be included as a covered
medical benefit for persons 21 years of age or older, subject to
utilization controls. The bill, effective May 1, 2014, would also
provide that the purchase of prescribed enteral nutrition products is
a covered benefit, subject to the Medi-Cal list of enteral nutrition
products and utilization controls.
(14) Existing law requires the State Department of Health Care
Services, subject to federal approval, to authorize a local Low
Income Health Program (LIHP) to provide health care services to
eligible low-income individuals under certain circumstances. Existing
law requires the department, in consultation with participating
entities, as defined, to determine actuarially sound per enrollee
capitation rates for LIHPs, as specified, and to pay those rates to
the participating entity. Existing law requires that, if the
participating entity and the department reach an agreement regarding
reimbursement rates, the rate be applied no earlier than the first
day of the LIHP year in which the parties agree to the rate. Existing
law provides an exception to that provision with respect to the LIHP
year ending June 30, 2012.
This bill would delete the above-described exception.
(15) Under existing law, the State Department of Social Services
is responsible for the licensing of psychiatric health facilities, as
defined, and mental health rehabilitation centers, as described, and
the approval of certain 72-hour treatment and evaluation facilities.
Existing law requires the State Department of Social Services to
adopt regulations necessary to implement those provisions.
This bill would transfer, from the State Department of Social
Services, those responsibilities related to licensing and approval of
those facilities to the State Department of Health Care Services.
The bill would authorize the State Department of Health Care Services
to adopt regulations necessary to implement those responsibilities.
The bill would make various related, technical, and conforming
changes to reflect the transfer of those responsibilities.
(16) Existing law provides the Director of Health Care Services
with the authority and responsibility to monitor and approve special
treatment programs in skilled nursing facilities.
This bill would require the State Department of Health Care
Services to conduct annual certification inspections of special
treatment programs for the mentally disordered, as specified.
(17) Existing law requires the manufacturer of any cosmetic
product subject to regulation by the federal Food and Drug
Administration that is sold in this state to, on a schedule and in
electronic or other format, determined as specified, provide a
complete and accurate list of specified cosmetic products that, as of
the date of submission, are sold in the state and that contain any
ingredient that is a chemical identified as causing cancer or
reproductive toxicity. Existing law includes, among those chemicals
identified, any chemical contained in the product for purposes of
fragrance or flavoring, and any chemical identified by the phrase
"and other ingredients" and determined to be a trade secret, as
specified.
This bill would require the State Department of Public Health, on
or before December 31, 2013, to develop and make operational a
consumer-friendly, public Internet Web site that creates a database
of cosmetic product information collected pursuant to those
provisions. The bill would require that the database be searchable to
accommodate a wide range of users, including users with limited
technical and scientific literacy. The bill would require the
Internet Web site to include hypertext links to other educational and
informational Internet Web sites to enhance consumer understanding.
(18) Existing law establishes the Access for Infants and Mothers
(AIM) Program, administered by the Managed Risk Medical Insurance
Board. The board contracts with a variety of health plans and health
care delivery systems to provide health insurance coverage to
eligible persons who pay a subscriber contribution. An "AIM-linked
infant" is defined as any infant born to a woman enrolled in AIM
after June 30, 2004, and is eligible for health care coverage under
the Healthy Families Program. Existing law establishes the Healthy
Families Program administered by the board, and provides that
eligible subscribers, except certain AIM-linked infants, be
transitioned to the Medi-Cal program, no sooner than January 1, 2013.
This bill would terminate eligibility for coverage under the
Healthy Families Program for AIM-linked infants, and the board would
be required to cease providing health care coverage for those infants
on October 1, 2013, or when the State Department of Health Care
Services has implemented specified provisions, whichever occurs
later. The bill would require the board to coordinate with the State
Department of Health Care Services to implement the AIM-Linked
Infants Program, which would be created by the bill, including
transition of AIM-linked infants to the program. The bill would
require the State Department of Health Care Services to administer
the AIM-Linked Infants Program, as provided, to address the health
care needs of children formerly covered under the Healthy Families
Program. The bill would condition the implementation of these
provisions on the receipt of federal approvals and the availability
of federal financial participation. The bill would also make related
and conforming changes.
This bill would also revise the eligibility criteria for the AIM
Program by requiring that income be determined, counted, and valued
as required under a specified provision of federal law.
(19) Existing law establishes the California Major Risk Medical
Insurance Program, which is administered by the Managed Risk Medical
Insurance Board, to provide major risk medical coverage to persons
who, among other things, have been rejected for coverage by at least
one private health plan. Existing law requires the board to establish
program contribution amounts for each category of risk for each
participating health plan and requires that these amounts be based on
the average amount of subsidy funds required for the program as a
whole, to be determined in a specified manner. Existing law, for the
period commencing January 1, 2013, to December 31, 2013, inclusive,
additionally authorizes the program to further subsidize subscriber
contributions based on a specified percentage of the standard average
individual risk rate for comparable coverage, as specified. Existing
law requires the program to pay program contribution amounts to
participating health plans from the Major Risk Medical Insurance
Fund, a continuously appropriated fund.
This bill would delete the termination date for further
subsidization of subscriber contributions. By extending the duration
of these subsidies made from a continuously appropriated fund, the
bill would make an appropriation.
(20) Existing law requires the Managed Risk Medical Insurance
Board to manage a temporary high risk pool to provide health
coverage, until January 1, 2014, to specified individuals who have
preexisting conditions, consistent with the federal Patient
Protection and Affordable Care Act.
This bill would change the termination date to July 1, 2013,
except as required by the contract between the board and the United
States Department of Health and Human Services, and would no longer
require the board to conduct transition activities, as prescribed.
(21) Existing law establishes the California Health Benefit
Exchange (Exchange) within state government, specifies the powers and
duties of the executive board governing the Exchange, and requires
the board to facilitate the purchase of qualified health plans
through the Exchange by qualified individuals and small employers by
January 1, 2014. Existing law requires the board to undertake
outreach and enrollment activities that seek to assist enrollees and
potential enrollees with enrolling in the Exchange, and requires the
board to inform individuals of eligibility requirements for the
Medi-Cal program, the Healthy Families Program, or any applicable
state or local public program and, if, through screening of the
application by the Exchange, the Exchange determines that an
individual is eligible for of those programs, to enroll that
individual in the program.
This bill would require 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 payments to entities
and persons for Medi-Cal in-person enrollment assistance, 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 plans, as specified. The bill would require the State
Department of Health Care Services to immediately seek an equal
amount of federal matching funds. The bill would also provide for the
payment of those enrollment assistance payments, as specified.
(22) Existing law requires the State Department of Health Care
Services to seek a demonstration project or federal waiver of
Medicaid law to implement specified objectives, which may include
better care coordination for seniors, persons with disabilities, and
children with special health care needs.
This bill would require the department, commencing no later than
August 1, 2013, to convene a series of stakeholder meetings to
receive input from clients, family members, providers, counties, and
representatives of the Legislature concerning the development of the
Behavioral Health Services Plan as required by the Special Terms and
Conditions of California's Bridge to Reform Section 1115(a) Medicaid
Demonstration.
(23) Existing law provides specified health care coverage to
individuals under the AIDS Drug Assistance Program (ADAP) and under
federal Ryan White Act funded programs, which are administered by the
State Department of Public Health.
This bill would require the State Department of Public Health to
report to the Joint Legislative Budget Committee by October 1, 2013,
on whether any of the projections or assumptions used to develop the
ADAP estimated budget in the Budget Act of 2013 may result in an
inability of ADAP to provide services to ADAP eligible clients. If
the State Department of Public Health determines, before October 1,
2013, that ADAP is unable to provide services to ADAP eligible
clients, the bill would require the department to notify the
committee with 15 calendar days of making that determination.
(24) Existing law establishes the Infant Botulism Treatment and
Prevention Program and requires the State Department of Public Health
to administer this program.
This bill would require the State Department of Public Health, by
October 1, 2013, to submit to the fiscal and appropriate policy
committees of the Legislature a report describing how it plans to
address the findings and recommendations described in a report
relating to this program.
(25) This bill would reappropriate the balance of specified
funds appropriated in the Budget Act of 2012 to the Department of
Managed Health Care until June 30, 2014, to be used as specified,
thereby making an appropriation.
(26) This bill would declare that it is to take effect immediately
as a bill providing for appropriations related to the Budget Bill.
This bill would express the intent of the Legislature to enact
statutory changes relating to the Budget Act of 2013.
Vote: majority. Appropriation: no yes
. Fiscal committee: no yes .
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 680 of the Business
and Professions Code is amended to read:
680. (a) Except as otherwise provided in this section, a health
care practitioner shall disclose, while working, his or her name and
practitioner's license status, as granted by this state, on a name
tag in at least 18-point type. A health care practitioner in a
practice or an office, whose license is prominently displayed, may
opt to not wear a name tag. If a health care practitioner or a
licensed clinical social worker is working in a psychiatric setting
or in a setting that is not licensed by the state, the employing
entity or agency shall have the discretion to make an exception from
the name tag requirement for individual safety or therapeutic
concerns. In the interest of public safety and consumer awareness, it
shall be unlawful for any person to use the title "nurse" in
reference to himself or herself and in any capacity, except for an
individual who is a registered nurse or a licensed vocational nurse,
or as otherwise provided in Section 2800. Nothing in this section
shall prohibit a certified nurse assistant from using his or her
title.
(b) Facilities licensed by the State Department of Social Services
or , the State Department of Public
Health , or the State Department of Health Care Services
shall develop and implement policies to ensure that health care
practitioners providing care in those facilities are in compliance
with subdivision (a). The State Department of Social Services
and , the State Department of Public
Health , and the State Department of Health Care Services
shall verify through periodic inspections that the policies required
pursuant to subdivision (a) have been developed and implemented by
the respective licensed facilities.
(c) For purposes of this article, "health care practitioner" means
any person who engages in acts that are the subject of licensure or
regulation under this division or under any initiative act referred
to in this division.
SEC. 2. Section 6254 of the Government
Code is amended to read:
6254. Except as provided in Sections 6254.7 and 6254.13, nothing
in this chapter shall be construed to require disclosure of records
that are any of the following:
(a) Preliminary drafts, notes, or interagency or intra-agency
memoranda that are not retained by the public agency in the ordinary
course of business, if the public interest in withholding those
records clearly outweighs the public interest in disclosure.
(b) Records pertaining to pending litigation to which the public
agency is a party, or to claims made pursuant to Division 3.6
(commencing with Section 810), until the pending litigation or claim
has been finally adjudicated or otherwise settled.
(c) Personnel, medical, or similar files, the disclosure of which
would constitute an unwarranted invasion of personal privacy.
(d) Contained in or related to any of the following:
(1) Applications filed with any state agency responsible for the
regulation or supervision of the issuance of securities or of
financial institutions, including, but not limited to, banks, savings
and loan associations, industrial loan companies, credit unions, and
insurance companies.
(2) Examination, operating, or condition reports prepared by, on
behalf of, or for the use of, any state agency referred to in
paragraph (1).
(3) Preliminary drafts, notes, or interagency or intra-agency
communications prepared by, on behalf of, or for the use of, any
state agency referred to in paragraph (1).
(4) Information received in confidence by any state agency
referred to in paragraph (1).
(e) Geological and geophysical data, plant production data, and
similar information relating to utility systems development, or
market or crop reports, that are obtained in confidence from any
person.
(f) Records of complaints to, or investigations conducted by, or
records of intelligence information or security procedures of, the
office of the Attorney General and the Department of Justice, the
California Emergency Management Agency, and any state or local police
agency, or any investigatory or security files compiled by any other
state or local police agency, or any investigatory or security files
compiled by any other state or local agency for correctional, law
enforcement, or licensing purposes. However, state and local law
enforcement agencies shall disclose the names and addresses of
persons involved in, or witnesses other than confidential informants
to, the incident, the description of any property involved, the date,
time, and location of the incident, all diagrams, statements of the
parties involved in the incident, the statements of all witnesses,
other than confidential informants, to the victims of an incident, or
an authorized representative thereof, an insurance carrier against
which a claim has been or might be made, and any person suffering
bodily injury or property damage or loss, as the result of the
incident caused by arson, burglary, fire, explosion, larceny,
robbery, carjacking, vandalism, vehicle theft, or a crime as defined
by subdivision (b) of Section 13951, unless the disclosure would
endanger the safety of a witness or other person involved in the
investigation, or unless disclosure would endanger the successful
completion of the investigation or a related investigation. However,
nothing in this division shall require the disclosure of that portion
of those investigative files that reflects the analysis or
conclusions of the investigating officer.
Customer lists provided to a state or local police agency by an
alarm or security company at the request of the agency shall be
construed to be records subject to this subdivision.
Notwithstanding any other provision of this subdivision, state and
local law enforcement agencies shall make public the following
information, except to the extent that disclosure of a particular
item of information would endanger the safety of a person involved in
an investigation or would endanger the successful completion of the
investigation or a related investigation:
(1) The full name and occupation of every individual arrested by
the agency, the individual's physical description including date of
birth, color of eyes and hair, sex, height and weight, the time and
date of arrest, the time and date of booking, the location of the
arrest, the factual circumstances surrounding the arrest, the amount
of bail set, the time and manner of release or the location where the
individual is currently being held, and all charges the individual
is being held upon, including any outstanding warrants from other
jurisdictions and parole or probation holds.
(2) Subject to the restrictions imposed by Section 841.5 of the
Penal Code, the time, substance, and location of all complaints or
requests for assistance received by the agency and the time and
nature of the response thereto, including, to the extent the
information regarding crimes alleged or committed or any other
incident investigated is recorded, the time, date, and location of
occurrence, the time and date of the report, the name and age of the
victim, the factual circumstances surrounding the crime or incident,
and a general description of any injuries, property, or weapons
involved. The name of a victim of any crime defined by Section 220,
236.1, 261, 261.5, 262, 264, 264.1, 265, 266, 266a, 266b, 266c, 266e,
266f, 266j, 267, 269, 273a, 273d, 273.5, 285, 286, 288, 288a, 288.2,
288.3 (as added by Chapter 337 of the Statutes of 2006), 288.3 (as
added by Section 6 of Proposition 83 of the November 7, 2006,
statewide general election), 288.5, 288.7, 289, 422.6, 422.7, 422.75,
646.9, or 647.6 of the Penal Code may be withheld at the victim's
request, or at the request of the victim's parent or guardian if the
victim is a minor. When a person is the victim of more than one
crime, information disclosing that the person is a victim of a crime
defined in any of the sections of the Penal Code set forth in this
subdivision may be deleted at the request of the victim, or the
victim's parent or guardian if the victim is a minor, in making the
report of the crime, or of any crime or incident accompanying the
crime, available to the public in compliance with the requirements of
this paragraph.
(3) Subject to the restrictions of Section 841.5 of the Penal Code
and this subdivision, the current address of every individual
arrested by the agency and the current address of the victim of a
crime, where the requester declares under penalty of perjury that the
request is made for a scholarly, journalistic, political, or
governmental purpose, or that the request is made for investigation
purposes by a licensed private investigator as described in Chapter
11.3 (commencing with Section 7512) of Division 3 of the Business and
Professions Code. However, the address of the victim of any crime
defined by Section 220, 236.1, 261, 261.5, 262, 264, 264.1, 265, 266,
266a, 266b, 266c, 266e, 266f, 266j, 267, 269, 273a, 273d, 273.5,
285, 286, 288, 288a, 288.2, 288.3 (as added by Chapter 337 of the
Statutes of 2006), 288.3 (as added by Section 6 of Proposition 83 of
the November 7, 2006, statewide general election), 288.5, 288.7, 289,
422.6, 422.7, 422.75, 646.9, or 647.6 of the Penal Code shall remain
confidential. Address information obtained pursuant to this
paragraph may not be used directly or indirectly, or furnished to
another, to sell a product or service to any individual or group of
individuals, and the requester shall execute a declaration to that
effect under penalty of perjury. Nothing in this paragraph shall be
construed to prohibit or limit a scholarly, journalistic, political,
or government use of address information obtained pursuant to this
paragraph.
(g) Test questions, scoring keys, and other examination data used
to administer a licensing examination, examination for employment, or
academic examination, except as provided for in Chapter 3
(commencing with Section 99150) of Part 65 of Division 14 of Title 3
of the Education Code.
(h) The contents of real estate appraisals or engineering or
feasibility estimates and evaluations made for or by the state or
local agency relative to the acquisition of property, or to
prospective public supply and construction contracts, until all of
the property has been acquired or all of the contract agreement
obtained. However, the law of eminent domain shall not be affected by
this provision.
(i) Information required from any taxpayer in connection with the
collection of local taxes that is received in confidence and the
disclosure of the information to other persons would result in unfair
competitive disadvantage to the person supplying the information.
(j) Library circulation records kept for the purpose of
identifying the borrower of items available in libraries, and library
and museum materials made or acquired and presented solely for
reference or exhibition purposes. The exemption in this subdivision
shall not apply to records of fines imposed on the borrowers.
(k) Records, the disclosure of which is exempted or prohibited
pursuant to federal or state law, including, but not limited to,
provisions of the Evidence Code relating to privilege.
(l) Correspondence of and to the Governor or employees of the
Governor's office or in the custody of or maintained by the Governor'
s Legal Affairs Secretary. However, public records shall not be
transferred to the custody of the Governor's Legal Affairs Secretary
to evade the disclosure provisions of this chapter.
(m) In the custody of or maintained by the Legislative Counsel,
except those records in the public database maintained by the
Legislative Counsel that are described in Section 10248.
(n) Statements of personal worth or personal financial data
required by a licensing agency and filed by an applicant with the
licensing agency to establish his or her personal qualification for
the license, certificate, or permit applied for.
(o) Financial data contained in applications for financing under
Division 27 (commencing with Section 44500) of the Health and Safety
Code, where an authorized officer of the California Pollution Control
Financing Authority determines that disclosure of the financial data
would be competitively injurious to the applicant and the data is
required in order to obtain guarantees from the United States Small
Business Administration. The California Pollution Control Financing
Authority shall adopt rules for review of individual requests for
confidentiality under this section and for making available to the
public those portions of an application that are subject to
disclosure under this chapter.
(p) Records of state agencies related to activities governed by
Chapter 10.3 (commencing with Section 3512), Chapter 10.5 (commencing
with Section 3525), and Chapter 12 (commencing with Section 3560) of
Division 4, that reveal a state agency's deliberative processes,
impressions, evaluations, opinions, recommendations, meeting minutes,
research, work products, theories, or strategy, or that provide
instruction, advice, or training to employees who do not have full
collective bargaining and representation rights under these chapters.
Nothing in this subdivision shall be construed to limit the
disclosure duties of a state agency with respect to any other records
relating to the activities governed by the employee relations acts
referred to in this subdivision.
(q) (1) Records of state agencies related to activities governed
by Article 2.6 (commencing with Section 14081), Article 2.8
(commencing with Section 14087.5), and Article 2.91 (commencing with
Section 14089) of Chapter 7 of Part 3 of Division 9 of the Welfare
and Institutions Code, that reveal the special negotiator's
deliberative processes, discussions, communications, or any other
portion of the negotiations with providers of health care services,
impressions, opinions, recommendations, meeting minutes, research,
work product, theories, or strategy, or that provide instruction,
advice, or training to employees.
(2) Except for the portion of a contract containing the rates of
payment, contracts for inpatient services entered into pursuant to
these articles, on or after April 1, 1984, shall be open to
inspection one year after they are fully executed. If a contract for
inpatient services that is entered into prior to April 1, 1984, is
amended on or after April 1, 1984, the amendment, except for any
portion containing the rates of payment, shall be open to inspection
one year after it is fully executed. If the California Medical
Assistance Commission enters into contracts with health care
providers for other than inpatient hospital services, those contracts
shall be open to inspection one year after they are fully executed.
(3) Three years after a contract or amendment is open to
inspection under this subdivision, the portion of the contract or
amendment containing the rates of payment shall be open to
inspection.
(4) Notwithstanding any other provision of law, the entire
contract or amendment shall be open to inspection by the Joint
Legislative Audit Committee and the Legislative Analyst's Office. The
committee and that office shall maintain the confidentiality of the
contracts and amendments until the time a contract or amendment is
fully open to inspection by the public.
(r) Records of Native American graves, cemeteries, and sacred
places and records of Native American places, features, and objects
described in Sections 5097.9 and 5097.993 of the Public Resources
Code maintained by, or in the possession of, the Native American
Heritage Commission, another state agency, or a local agency.
(s) A final accreditation report of the Joint Commission on
Accreditation of Hospitals that has been transmitted to the State
Department of Health Care Services pursuant to subdivision (b) of
Section 1282 of the Health and Safety Code.
(t) Records of a local hospital district, formed pursuant to
Division 23 (commencing with Section 32000) of the Health and Safety
Code, or the records of a municipal hospital, formed pursuant to
Article 7 (commencing with Section 37600) or Article 8 (commencing
with Section 37650) of Chapter 5 of Part 2 of Division 3 of Title 4
of this code, that relate to any contract with an insurer or
nonprofit hospital service plan for inpatient or outpatient services
for alternative rates pursuant to Section 10133 of the Insurance
Code. However, the record shall be open to inspection within one year
after the contract is fully executed.
(u) (1) Information contained in applications for licenses to
carry firearms issued pursuant to Section 26150, 26155, 26170, or
26215 of the Penal Code by the sheriff of a county or the chief or
other head of a municipal police department that indicates when or
where the applicant is vulnerable to attack or that concerns the
applicant's medical or psychological history or that of members of
his or her family.
(2) The home address and telephone number of prosecutors, public
defenders, peace officers, judges, court commissioners, and
magistrates that are set forth in applications for licenses to carry
firearms issued pursuant to Section 26150, 26155, 26170, or 26215 of
the Penal Code by the sheriff of a county or the chief or other head
of a municipal police department.
(3) The home address and telephone number of prosecutors, public
defenders, peace officers, judges, court commissioners, and
magistrates that are set forth in licenses to carry firearms issued
pursuant to Section 26150, 26155, 26170, or 26215 of the Penal Code
by the sheriff of a county or the chief or other head of a municipal
police department.
(v) (1) Records of the Managed Risk Medical Insurance Board
and the State Department of Health Care Services related to
activities governed by Part 6.3 (commencing with Section 12695), Part
6.5 (commencing with Section 12700), Part 6.6 (commencing with
Section 12739.5), and Part 6.7 (commencing with Section 12739.70) of
Division 2 of the Insurance Code, and Chapter 2 (commencing with
Section 15850) of Part 3.3 of Division 9 of the Welfare and
Institutions Code, and that reveal any of the following:
(A) The deliberative processes, discussions, communications, or
any other portion of the negotiations with entities contracting or
seeking to contract with the board or the department ,
entities with which the board or the department is
considering a contract, or entities with which the board is
considering or enters into any other arrangement under which the
board or the department provides, receives, or arranges
services or reimbursement.
(B) The impressions, opinions, recommendations, meeting minutes,
research, work product, theories, or strategy of the board or its
staff or the department or its staff , or records that
provide instructions, advice, or training to their
employees.
(2) (A) Except for the portion of a contract that contains the
rates of payment, contracts entered into pursuant to Part 6.3
(commencing with Section 12695), Part 6.5 (commencing with Section
12700), Part 6.6 (commencing with Section 12739.5), or Part 6.7
(commencing with Section 12739.70) of Division 2 of the Insurance
Code, or Chapter 2.2 (commencing with Section 15850) of Part 3.3
of Division 9 of the Welfare and Institutions Code, on or
after July 1, 1991, shall be open to inspection one year after their
effective dates.
(B) If a contract that is entered into prior to July 1, 1991, is
amended on or after July 1, 1991, the amendment, except for any
portion containing the rates of payment, shall be open to inspection
one year after the effective date of the amendment.
(3) Three years after a contract or amendment is open to
inspection pursuant to this subdivision, the portion of the contract
or amendment containing the rates of payment shall be open to
inspection.
(4) Notwithstanding any other law, the entire contract or
amendments to a contract shall be open to inspection by the Joint
Legislative Audit Committee. The committee shall maintain the
confidentiality of the contracts and amendments thereto, until the
contracts or amendments to the contracts are open to inspection
pursuant to paragraph (3).
(w) (1) Records of the Managed Risk Medical Insurance Board
related to activities governed by Chapter 8 (commencing with Section
10700) of Part 2 of Division 2 of the Insurance Code, and that reveal
the deliberative processes, discussions, communications, or any
other portion of the negotiations with health plans, or the
impressions, opinions, recommendations, meeting minutes, research,
work product, theories, or strategy of the board or its staff, or
records that provide instructions, advice, or training to employees.
(2) Except for the portion of a contract that contains the rates
of payment, contracts for health coverage entered into pursuant to
Chapter 8 (commencing with Section 10700) of Part 2 of Division 2 of
the Insurance Code, on or after January 1, 1993, shall be open to
inspection one year after they have been fully executed.
(3) Notwithstanding any other law, the entire contract or
amendments to a contract shall be open to inspection by the Joint
Legislative Audit Committee. The committee shall maintain the
confidentiality of the contracts and amendments thereto, until the
contracts or amendments to the contracts are open to inspection
pursuant to paragraph (2).
(x) Financial data contained in applications for registration, or
registration renewal, as a service contractor filed with the Director
of Consumer Affairs pursuant to Chapter 20 (commencing with Section
9800) of Division 3 of the Business and Professions Code, for the
purpose of establishing the service contractor's net worth, or
financial data regarding the funded accounts held in escrow for
service contracts held in force in this state by a service
contractor.
(y) (1) Records of the Managed Risk Medical Insurance Board
related to activities governed by Part 6.2 (commencing with Section
12693) or Part 6.4 (commencing with Section 12699.50) of Division 2
of the Insurance Code, and that reveal any of the following:
(A) The deliberative processes, discussions, communications, or
any other portion of the negotiations with entities contracting or
seeking to contract with the board, entities with which the board is
considering a contract, or entities with which the board is
considering or enters into any other arrangement under which the
board provides, receives, or arranges services or reimbursement.
(B) The impressions, opinions, recommendations, meeting minutes,
research, work product, theories, or strategy of the board or its
staff, or records that provide instructions, advice, or training to
employees.
(2) (A) Except for the portion of a contract that contains the
rates of payment, contracts entered into pursuant to Part 6.2
(commencing with Section 12693) or Part 6.4 (commencing with Section
12699.50) of Division 2 of the Insurance Code, on or after January 1,
1998, shall be open to inspection one year after their effective
dates.
(B) If a contract entered into pursuant to Part 6.2 (commencing
with Section 12693) or Part 6.4 (commencing with Section 12699.50) of
Division 2 of the Insurance Code is amended, the amendment shall be
open to inspection one year after the effective date of the
amendment.
(3) Three years after a contract or amendment is open to
inspection pursuant to this subdivision, the portion of the contract
or amendment containing the rates of payment shall be open to
inspection.
(4) Notwithstanding any other law, the entire contract or
amendments to a contract shall be open to inspection by the Joint
Legislative Audit Committee. The committee shall maintain the
confidentiality of the contracts and amendments thereto until the
contract or amendments to a contract are open to inspection pursuant
to paragraph (2) or (3).
(5) The exemption from disclosure provided pursuant to this
subdivision for the contracts, deliberative processes, discussions,
communications, negotiations, impressions, opinions, recommendations,
meeting minutes, research, work product, theories, or strategy of
the board or its staff shall also apply to the contracts,
deliberative processes, discussions, communications, negotiations,
impressions, opinions, recommendations, meeting minutes, research,
work product, theories, or strategy of applicants pursuant to Part
6.4 (commencing with Section 12699.50) of Division 2 of the Insurance
Code.
(z) Records obtained pursuant to paragraph (2) of subdivision (f)
of Section 2891.1 of the Public Utilities Code.
(aa) A document prepared by or for a state or local agency that
assesses its vulnerability to terrorist attack or other criminal acts
intended to disrupt the public agency's operations and that is for
distribution or consideration in a closed session.
(ab) Critical infrastructure information, as defined in Section
131(3) of Title 6 of the United States Code, that is voluntarily
submitted to the California Emergency Management Agency for use by
that office, including the identity of the person who or entity that
voluntarily submitted the information. As used in this subdivision,
"voluntarily submitted" means submitted in the absence of the office
exercising any legal authority to compel access to or submission of
critical infrastructure information. This subdivision shall not
affect the status of information in the possession of any other state
or local governmental agency.
(ac) All information provided to the Secretary of State by a
person for the purpose of registration in the Advance Health Care
Directive Registry, except that those records shall be released at
the request of a health care provider, a public guardian, or the
registrant's legal representative.
(ad) The following records of the State Compensation Insurance
Fund:
(1) Records related to claims pursuant to Chapter 1 (commencing
with Section 3200) of Division 4 of the Labor Code, to the extent
that confidential medical information or other individually
identifiable information would be disclosed.
(2) Records related to the discussions, communications, or any
other portion of the negotiations with entities contracting or
seeking to contract with the fund, and any related deliberations.
(3) Records related to the impressions, opinions, recommendations,
meeting minutes of meetings or sessions that are lawfully closed to
the public, research, work product, theories, or strategy of the fund
or its staff, on the development of rates, contracting strategy,
underwriting, or competitive strategy pursuant to the powers granted
to the fund in Chapter
4 (commencing with Section 11770) of Part 3 of Division 2 of the
Insurance Code.
(4) Records obtained to provide workers' compensation insurance
under Chapter 4 (commencing with Section 11770) of Part 3 of Division
2 of the Insurance Code, including, but not limited to, any medical
claims information, policyholder information provided that nothing in
this paragraph shall be interpreted to prevent an insurance agent or
broker from obtaining proprietary information or other information
authorized by law to be obtained by the agent or broker, and
information on rates, pricing, and claims handling received from
brokers.
(5) (A) Records that are trade secrets pursuant to Section
6276.44, or Article 11 (commencing with Section 1060) of Chapter 4 of
Division 8 of the Evidence Code, including without limitation,
instructions, advice, or training provided by the State Compensation
Insurance Fund to its board members, officers, and employees
regarding the fund's special investigation unit, internal audit unit,
and informational security, marketing, rating, pricing,
underwriting, claims handling, audits, and collections.
(B) Notwithstanding subparagraph (A), the portions of records
containing trade secrets shall be available for review by the Joint
Legislative Audit Committee, the Bureau of State Audits, Division of
Workers' Compensation, and the Department of Insurance to ensure
compliance with applicable law.
(6) (A) Internal audits containing proprietary information and the
following records that are related to an internal audit:
(i) Personal papers and correspondence of any person providing
assistance to the fund when that person has requested in writing that
his or her papers and correspondence be kept private and
confidential. Those papers and correspondence shall become public
records if the written request is withdrawn, or upon order of the
fund.
(ii) Papers, correspondence, memoranda, or any substantive
information pertaining to any audit not completed or an internal
audit that contains proprietary information.
(B) Notwithstanding subparagraph (A), the portions of records
containing proprietary information, or any information specified in
subparagraph (A) shall be available for review by the Joint
Legislative Audit Committee, the Bureau of State Audits, Division of
Workers' Compensation, and the Department of Insurance to ensure
compliance with applicable law.
(7) (A) Except as provided in subparagraph (C), contracts entered
into pursuant to Chapter 4 (commencing with Section 11770) of Part 3
of Division 2 of the Insurance Code shall be open to inspection one
year after the contract has been fully executed.
(B) If a contract entered into pursuant to Chapter 4 (commencing
with Section 11770) of Part 3 of Division 2 of the Insurance Code is
amended, the amendment shall be open to inspection one year after the
amendment has been fully executed.
(C) Three years after a contract or amendment is open to
inspection pursuant to this subdivision, the portion of the contract
or amendment containing the rates of payment shall be open to
inspection.
(D) Notwithstanding any other law, the entire contract or
amendments to a contract shall be open to inspection by the Joint
Legislative Audit Committee. The committee shall maintain the
confidentiality of the contracts and amendments thereto until the
contract or amendments to a contract are open to inspection pursuant
to this paragraph.
(E) This paragraph is not intended to apply to documents related
to contracts with public entities that are not otherwise expressly
confidential as to that public entity.
(F) For purposes of this paragraph, "fully executed" means the
point in time when all of the necessary parties to the contract have
signed the contract.
This section shall not prevent any agency from opening its records
concerning the administration of the agency to public inspection,
unless disclosure is otherwise prohibited by law.
This section shall not prevent any health facility from disclosing
to a certified bargaining agent relevant financing information
pursuant to Section 8 of the National Labor Relations Act (29 U.S.C.
Sec. 158).
SEC. 3. Section 26605.6 of the
Government Code is amended to read:
26605.6. (a) The sheriff, or his or her designee, has the
authority, after conferring with a physician who has oversight for
providing medical care at a county jail, or that physician's
designee, to release from a county correctional facility, a prisoner
sentenced to a county jail if the sheriff determines that the
prisoner would not reasonably pose a threat to public safety and the
prisoner, upon diagnosis by the examining physician, is deemed to
have a life expectancy of six months or less.
(b) Before the release of any prisoner pursuant to this section,
the sheriff shall notify the presiding judge of the superior court of
his or her intention to release the prisoner. This notification
shall include:
(1) The prisoner's name.
(2) The offense or offenses for which the prisoner was
incarcerated, if applicable, and the pending charges, if applicable.
(3) The date of sentence, if applicable.
(4) The physician's diagnosis of the prisoner's condition.
(5) The physician's prognosis for the prisoner's recovery.
(6) The prisoner's address after release.
(c) (1) This section shall be implemented only to the extent that
a county that releases a prisoner pursuant to this section does both
of the following:
(A) Sends a letter to the State Department of Health Care Services
agreeing to do both of the following:
(i) Notify the State Department of Health Care Services, in
writing, when a prisoner released pursuant to this section has
applied for Medi-Cal.
(ii) Notify the State Department of Health Care Services, in
writing, if a prisoner released pursuant to this section, who is
Medi-Cal eligible, is returned to the custody of the sheriff.
(B) For the period of time that the offender would otherwise have
been incarcerated:
(i) Reimburses the State Department of Health Care Services for
the nonfederal share of the Medi-Cal costs and any medical costs paid
by the State Department of Health Care Services that are not
reimbursable pursuant to Title XIX or XXI of the federal Social
Security Act, for an offender released pursuant to this section.
(ii) Provides to the State Department of Health Care Services the
nonfederal share of the state's administrative costs associated with
this section.
(2) It is the intent of the Legislature that the implementation of
this section shall not result in increased costs to the General
Fund.
(3) Participation in the program under this section is voluntary
for purposes of all applicable federal law. This section shall be
implemented only to the extent that federal financial participation
for the Medi-Cal program is not jeopardized.
(c)
(d) Before a prisoner's compassionate release from a
county jail pursuant to this section, the sheriff, or his or her
designee, shall secure a placement option for the prisoner in the
community and, in consultation with the county welfare department or
another applicable county agency, examine the prisoner's eligibility
for federal Medicaid benefits or other medical coverage that might
assist in funding the prisoner's medical treatment while in the
community.
(d)
(e) (1) For any prisoner released pursuant to this
section who is eligible for Medi-Cal, the county shall continue to
pay the nonfederal share of the prisoner's Medi-Cal costs for the
period of time that the offender would have otherwise been
incarcerated.
(2) For any prisoner granted compassionate release pursuant to
this section who is ineligible for Medi-Cal, the county shall
consider whether the prisoner has private medical insurance or
sufficient income or assets to provide for his or her own medical
care. If the county determines that the prisoner can provide for his
or her own medical care, the county shall not be required to provide
the prisoner with medical care.
(e)
(f) This section shall not be construed as authorizing
the sheriff to refuse to receive and incarcerate a defendant or
sentenced individual who is not in need of immediate medical care or
who has a terminal medical condition.
(g) Notwithstanding any other law, the State Department of Health
Care Services may exempt individuals released pursuant to this
section from mandatory enrollment in managed health care, including
county-organized health plans and, as deemed necessary by the State
Department of Health Care Services, may determine the proper prior
authorization process for individuals who have been released pursuant
to this section.
(h) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2, the State Department of Health Care
Services, without taking any further regulatory action, shall
implement, interpret, and make specific this section by means of
provider bulletins, all-county letters, manuals, or similar
instructions until the time that regulations are adopted. Thereafter,
the department shall adopt regulations in accordance with Chapter
3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title
2. Six months after the effective date of the act that added this
subdivision, the department shall provide a status update to the
Legislature on its efforts to adopt the regulations. Thereafter,
notwithstanding Section 10231.5, the department shall report on the
status of this effort to the Legislature on an annual basis, until
the regulations have been adopted.
SEC. 4. Section 26605.7 of the
Government Code is amended to read:
26605.7. (a) The sheriff, or his or her designee, after
conferring with the physician who has oversight for providing medical
care, or the physician's designee, may request the court to grant
medical probation or to resentence a prisoner to medical probation in
lieu of jail time for any prisoner sentenced to a county jail under
either of the following circumstances:
(1) The prisoner is physically incapacitated with a medical
condition that renders the prisoner permanently unable to perform
activities of basic daily living, which has resulted in the prisoner
requiring 24-hour care, if that incapacitation did not exist at the
time of sentencing.
(2) The prisoner would require acute long-term inpatient
rehabilitation services.
(b) Before a prisoner's release to medical probation, the sheriff,
or his or her designee, shall secure a placement option for the
prisoner in the community and, in consultation with the county
welfare department or another applicable county agency, examine the
prisoner's eligibility for federal Medicaid benefits or other medical
coverage that might assist in funding the prisoner's medical
treatment while in the community.
(c) During the time on probation pursuant to this section, the
probation officer or court may, at any time, request a medical
reexamination of the probationer by a physician who has oversight for
providing medical care to prisoners in a county jail, or the
physician's designee. If the court determines, based on that medical
examination, that the probationer's medical condition has improved to
the extent that the probationer no longer qualifies for medical
probation, the court may return the probationer to the custody of the
sheriff.
(d) (1) For any probationer granted medical probation pursuant to
this section who is eligible for Medi-Cal, the county shall continue
to pay the nonfederal share of the probationer's Medi-Cal costs.
After a probationer is released from medical probation, the county
shall no longer be required to pay the nonfederal share of the
Medi-Cal costs.
(2) For any probationer granted medical probation pursuant to this
section who is ineligible for Medi-Cal, the county shall consider
whether the probationer has private medical insurance or sufficient
income or assets to provide for his or her own medical care. If the
county determines that the probationer can provide for his or her own
medical care, the county shall not be required to provide the
probationer with medical care.
(e) (1) This section shall be implemented only to the extent that
a court sentences a person to medical probation pursuant to this
section and the sheriff does both of the following:
(A) Sends a letter to the State Department of Health Care Services
agreeing to do both of the following:
(i) Notify the State Department of Health Care Services, in
writing, when a probationer released pursuant to this section has
applied for Medi-Cal.
(ii) Notify the State Department of Health Care Services, in
writing, if a probationer released pursuant to this section, who is
Medi-Cal eligible, is returned to the custody of the sheriff. The
chief probation officer shall notify the State Department of Health
Care Services, in writing, when a Medi-Cal eligible probationer's
term of medical probation ends.
(B) For the period of time the offender is on medical probation:
(i) Reimburses the State Department of Health Care Services for
the nonfederal share of the Medi-Cal costs and any medical costs paid
by the State Department of Health Care Services that are not
reimbursable pursuant to Title XIX or XXI of the federal Social
Security Act, for an offender released pursuant to this section.
(ii) Provides to the State Department of Health Care Services the
nonfederal share of the state's administrative costs associated with
this section.
(2) It is the intent of the Legislature that the implementation of
this section shall not result in increased costs to the General
Fund.
(3) Participation in the program under this section is voluntary
for purposes of all applicable federal law. This section shall be
implemented only to the extent that federal financial participation
for the Medi-Cal program is not jeopardized.
(f) Notwithstanding any other law, the State Department of Health
Care Services may exempt individuals released pursuant to this
section from mandatory enrollment in managed health care, including
county-organized health plans and, as deemed necessary by the State
Department of Health Care Services, may determine the proper prior
authorization process for individuals who have been released pursuant
to this section.
(g) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2, the State Department of Health Care
Services, without taking any further regulatory action, may
implement, interpret, and make specific this section by means of
provider bulletins, all-county letters, manuals, or similar
instructions until the time that regulations are adopted. Thereafter,
the department shall adopt regulations in accordance with Chapter
3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title
2. Six months after the effective date of the act that added this
subdivision, the department shall provide a status update to the
Legislature on its efforts to adopt the regulations. Thereafter,
notwithstanding Section 10231.5, the department shall report on the
status of this effort to the Legislature on an annual basis, until
the regulations have been adopted.
SEC. 5. Section 26605.8 of the
Government Code is amended to read:
26605.8. Before implementing Sections 26605.6 and 26605.7, the
county board of supervisors shall adopt a process to fund the
nonfederal share of Medi-Cal costs for the period of time that a
prisoner would have otherwise been incarcerated or for the period of
time that a probationer is on medical probation. The county board of
supervisors shall notify provide the
State Department of Health Care Services with written
notification of the process.
SEC. 6. Section 1180.6 of the Health
and Safety Code is amended to read:
1180.6. The State Department of Public Health, the State
Department of State Hospitals, the State Department of Social
Services, and the State Department of
Developmental Services , and the State Department of Health Care
Services shall annually provide information to the
Legislature, during Senate and Assembly budget committee hearings,
about the progress made in implementing this division. This
information shall include the progress of implementation and barriers
to achieving full implementation.
SEC. 7. Section 1250.2 of the Health
and Safety Code is amended to read:
1250.2. (a) (1) As defined in Section 1250,
"health facility" includes a "psychiatric health facility," defined
to mean a health facility, licensed by the State Department of
Social Health Care Services, that
provides 24-hour inpatient care for mentally disordered, incompetent,
or other persons described in Division 5 (commencing with Section
5000) or Division 6 (commencing with Section 6000) of the Welfare and
Institutions Code. This care shall include, but not be limited to,
the following basic services: psychiatry, clinical psychology,
psychiatric nursing, social work, rehabilitation, drug
administration, and appropriate food services for those persons whose
physical health needs can be met in an affiliated hospital or in
outpatient settings.
It
(2) It is the intent of the
Legislature that the psychiatric health facility shall provide a
distinct type of service to psychiatric patients in a 24-hour acute
inpatient setting. The State Department of Social
Health Care Services shall require regular utilization
reviews of admission and discharge criteria and lengths of stay in
order to assure that these patients are moved to less restrictive
levels of care as soon as appropriate.
(b) (1) The State Department of
Social Health Care Services may issue a special
permit to a psychiatric health facility for it to provide structured
outpatient services (commonly referred to as SOPS) consisting of
morning, afternoon, or full daytime organized programs, not exceeding
10 hours, for acute daytime care for patients admitted to the
facility. This subdivision shall not be construed as requiring a
psychiatric health facility to apply for a special permit to provide
these alternative levels of care.
The
(2) The Legislature recognizes
that, with access to structured outpatient services, as an
alternative to 24-hour inpatient care, certain patients would be
provided with effective intervention and less restrictive levels of
care. The Legislature further recognizes that, for certain patients,
the less restrictive levels of care eliminate the need for inpatient
care, enable earlier discharge from inpatient care by providing a
continuum of care with effective aftercare services, or reduce or
prevent the need for a subsequent readmission to inpatient care.
(c) Any reference in any statute to Section 1250 of the Health and
Safety Code shall be deemed and construed to also be a reference to
this section.
(d) Notwithstanding any other provision of law, and to the extent
consistent with federal law, a psychiatric health facility shall be
eligible to participate in the medicare program under Title XVIII of
the federal Social Security Act (42 U.S.C. Sec. 1395 et seq.), and
the medicaid program under Title XIX of the federal Social Security
Act (42 U.S.C. Sec. 1396 et seq.), if all of the following conditions
are met:
(1) The facility is a licensed facility.
(2) The facility is in compliance with all related statutes and
regulations enforced by the State Department of Social
Health Care Services, including regulations
contained in Chapter 9 (commencing with Section 77001) of Division 5
of Title 22 of the California Code of Regulations.
(3) The facility meets the definitions and requirements contained
in subdivisions (e) and (f) of Section 1861 of the federal Social
Security Act (42 U.S.C. Sec. 1395x(e) and (f)), including the
approval process specified in Section 1861(e)(7)(B) of the federal
Social Security Act (42 U.S.C. Sec. 1395x(e)(7)(B)), which requires
that the state agency responsible for licensing hospitals has assured
that the facility meets licensing requirements.
(4) The facility meets the conditions of participation for
hospitals pursuant to Part 482 of Title 42 of the Code of Federal
Regulations.
SEC. 8. Section 1254 of the Health and
Safety Code is amended to read:
1254. (a) Except as provided in subdivision (e), the state
department shall inspect and license health facilities. The state
department shall license health facilities to provide their
respective basic services specified in Section 1250. Except as
provided in Section 1253, the state department shall inspect and
approve a general acute care hospital to provide special services as
specified in Section 1255. The state department shall develop and
adopt regulations to implement the provisions contained in this
section.
(b) Upon approval, the state department shall issue a separate
license for the provision of the basic services enumerated in
subdivision (c) or (d) of Section 1250 whenever these basic services
are to be provided by an acute care hospital, as defined in
subdivision (a), (b), or (f) of that section, where the services
enumerated in subdivision (c) or (d) of Section 1250 are to be
provided in any separate freestanding facility, whether or not the
location of the separate freestanding facility is contiguous to the
acute care hospital. The same requirement shall apply to any new
freestanding facility constructed for the purpose of providing basic
services, as defined in subdivision (c) or (d) of Section 1250, by
any acute care hospital on or after January 1, 1984.
(c) (1) Those beds licensed to an acute care hospital which, prior
to January 1, 1984, were separate freestanding beds and were not
part of the physical structure licensed to provide acute care, and
which beds were licensed to provide those services enumerated in
subdivision (c) or (d) of Section 1250, are exempt from the
requirements of subdivision (b).
(2) All beds licensed to an acute care hospital and located within
the physical structure in which acute care is provided are exempt
from the requirements of subdivision (b) irrespective of the date of
original licensure of the beds, or the licensed category of the beds.
(3) All beds licensed to an acute care hospital owned and operated
by the State of California or any other public agency are exempt
from the requirements of subdivision (b).
(4) All beds licensed to an acute care hospital in a rural area as
defined by Chapter 1010, of the Statutes of 1982, are exempt from
the requirements of subdivision (b), except where there is a
freestanding skilled nursing facility or intermediate care facility
which has experienced an occupancy rate of 95 percent or less during
the past 12 months within a 25-mile radius or which may be reached
within 30 minutes using a motor vehicle.
(5) All beds licensed to an acute care hospital which meet the
criteria for designation within peer group six or eight, as defined
in the report entitled Hospital Peer Grouping for Efficiency
Comparison, dated December 20, 1982, and published by the California
Health Facilities Commission, and all beds in hospitals which have
fewer than 76 licensed acute care beds and which are located in a
census designation place of 15,000 or less population, are exempt
from the requirements of subdivision (b), except where there is a
free-standing skilled nursing facility or intermediate care facility
which has experienced an occupancy rate of 95 percent or less during
the past 12 months within a 25-mile radius or which may be reached
within 30 minutes using a motor vehicle.
(6) All beds licensed to an acute care hospital which has had a
certificate of need approved by a health systems agency on or before
July 1, 1983, are exempt from the requirements of subdivision (b).
(7) All beds licensed to an acute care hospital are exempt from
the requirements of subdivision (b), if reimbursement from the
Medi-Cal program for beds licensed for the provision of services
enumerated in subdivision (c) or (d) of Section 1250 and not
otherwise exempt does not exceed the reimbursement which would be
received if the beds were in a separately licensed facility.
(d) Except as provided in Section 1253, the state department shall
inspect and approve a general acute care hospital to provide special
services as specified in Section 1255. The state department shall
develop and adopt regulations to implement subdivisions (a) to (d),
inclusive, of this section.
(e) The State Department of Social Health
Care Services shall inspect and license psychiatric health
facilities. The State Department of Social
Health Care Services shall license psychiatric health
facilities to provide their basic services specified in Section
1250.2. The State Department of Social Health
Care Services shall develop and ,
adopt , or amend regulations to implement this
subdivision.
SEC. 9. Section 1254.1 of the Health
and Safety Code is amended to read:
1254.1. (a) The State Department of Social
Health Care Services shall license psychiatric health
facilities to provide their basic services specified in Section 1250.
(b) Any reference in any statute to Section 1254 shall be deemed
and construed to also be a reference to this section.
SEC. 10. Section 1266.1 of the Health
and Safety Code is amended to read:
1266.1. (a) Each new or renewal application for a license for a
psychiatric health facility shall be accompanied by a fee credited to
the State Department of Social Health Care
Services for its costs incurred in the review of psychiatric
health facility programs, in
connection with the licensing of these facilities. The
amount of the fees shall be determined and collected by the State
Department of Social Health Care
Services, but the total amount of the fees collected shall not exceed
the actual costs of licensure and review of psychiatric health
facility programs, including, but not limited to, the costs of
processing the application, inspection costs, and other related
costs.
(b) New or renewal licensure application fees for psychiatric
health facilities shall be collected by the State Department of
Social Health Care Services.
(c) The annual fees shall be waived for any psychiatric health
facility conducted, maintained, or operated by this state or any
state department, authority, bureau, commission, or officer, or by
the Regents of the University of California, or by a local hospital
district, city, county, or city and county.
(d) If additional private psychiatric health facilities seek new
licensure on or after January 1, 1991, the State Department of
Social Health Care Services may
increase the fees for all private psychiatric health facilities with
more than nine beds sufficient to accommodate the increased level of
workload and costs.
(e) (1) Any licensee desiring to obtain a special permit to offer
and provide structured outpatient services shall file an application
with the State Department of Social Health
Care Services.
(2) The application for a special permit, if any, shall be
submitted with each new or renewal application for a license for a
psychiatric health facility, and shall be accompanied by a reasonable
fee, as determined by the State Department of Social
Health Care Services, not to exceed the actual
costs of administration related to the special permit. An application
for a special permit submitted by a psychiatric health facility
operated by a public entity shall be exempt from the fee required
pursuant to this section for the issuance of the special permit.
(3) The State Department of Social Health
Care Services shall not issue a special permit unless the
applicant furnishes all of the following:
(A) Its annual licensing fee required pursuant to subdivision (a).
(B) A completed application submitted on forms furnished by the
department.
(C) A written agreement ensuring that the facility will have
additional staffing for the services to be provided under the special
permit, that the additional staffing will meet the same professional
standards as required by regulation for inpatient services, and that
a coordinator of these services will be appointed.
(D) Any other information or documentation as may be required by
the department for its proper and efficient administration and
enforcement of special permit services.
(4) The provision of structured outpatient services pursuant to a
special permit may be as an alternative to admission to inpatient
services, as aftercare services following discharge from inpatient
care, or as both.
SEC. 11. Section 1275.1 of the Health
and Safety Code is amended to read:
1275.1. (a) Notwithstanding any rules or regulations governing
other health facilities, the regulations developed by the State
Department of Social Health Care
Services , or a predecessor, for psychiatric health
facilities shall prevail. The regulations applying to psychiatric
health facilities shall prescribe standards of adequacy, safety, and
sanitation of the physical plant, of staffing with duly qualified
licensed personnel, and of services based on the needs of the persons
served thereby.
(b) The regulations shall include standards appropriate for two
levels of disorder:
(1) Involuntary ambulatory psychiatric patients.
(2) Voluntary ambulatory psychiatric patients.
For purposes of this subdivision, "ambulatory patients" shall
include, but not be limited to, deaf, blind, and physically
handicapped persons. Disoriented persons who are not bedridden or
confined to a wheelchair shall also be considered as ambulatory
patients.
(c) The regulations shall not require, but may permit building and
services requirements for hospitals which are only applicable to
physical health care needs of patients that can be met in an
affiliated hospital or in outpatient settings including, but not
limited to, such requirements as surgical, dietary, laboratory,
laundry, central supply, radiologic, and pharmacy.
(d) The regulations shall include provisions for an "open planning"
architectural concept.
(e) The regulations shall exempt from seismic requirements all
structures of Type V and of one-story construction.
(f) Standards for involuntary patients shall include provisions to
allow for restraint and seclusion of patients. These standards shall
provide for adequate safeguards for patient safety and protection of
patient rights.
(g) The regulations shall provide for the retention by the
psychiatric health facility of a consultant pharmacist, who shall
supervise and review pharmaceutical services within the facility and
perform any other services, including prevention of the unlawful
diversion of controlled substances subject to abuse, as the
state department State Department of Health Care
Services may by regulation require. Regulations adopted
pursuant to this subdivision shall take into consideration the
varying bed sizes of psychiatric health facilities.
SEC. 12. Section 1275.5 of the Health
and Safety Code is amended to read:
1275.5. (a) The regulations relating to the licensing of
hospitals, heretofore adopted by the State Department of Public
Health pursuant to former Chapter 2 (commencing with
Section 1400) of Division 2, and in effect immediately prior to July
1, 1973, shall remain in effect and shall be fully enforceable with
respect to any hospital required to be licensed by this chapter,
unless and until the regulations are readopted, amended, or repealed
by the director.
(b) The regulations relating to private institutions receiving or
caring for any mentally disordered persons, mentally
retarded intellectually disabled persons, and
other incompetent persons, heretofore adopted by the Department of
Mental Hygiene pursuant to Chapter 1 (commencing with Section 7000)
of Division 7 of the Welfare and Institutions Code, and in effect
immediately prior to July 1, 1973, shall remain in effect and shall
be fully enforceable with respect to any facility, establishment, or
institution for the reception and care of mentally disordered
persons, mentally retarded intellectually
disabled persons and other incompetent persons, required to be
licensed by the provisions of this chapter unless and until said
regulations are readopted, amended, or repealed by the director.
(c) (1) All regulations relating to the licensing of psychiatric
health facilities heretofore adopted by the State Department of
Health Services, pursuant to authority now vested in the State
Department of Mental Health Care Services
by Section 5652.5 4080 of the
Welfare and Institutions Code, and in effect immediately preceding
September 20, 1988, shall remain in effect and shall be fully
enforceable by the State Department of Mental
Health Care Services with respect to any facility or
program required to be licensed as a psychiatric health facility,
unless and until readopted, amended, or repealed by the Director of
Mental Health Care Services .
(2) The State Department of Social Health
Care Services shall succeed to and be vested with all duties,
powers, purposes, functions, responsibilities, and jurisdiction
of the State Department of Mental Health, described in
paragraph (1), as they relate to licensing psychiatric
health facilities.
SEC. 13. Section 1324.9 of the Health
and Safety Code is amended to read:
1324.9. (a) The Long-Term Care Quality Assurance Fund is hereby
created in the State Treasury. Moneys in the fund shall be available,
upon appropriation by the Legislature, for expenditure by the State
Department of Health Care Services for the purposes of this article
and Article 7.6 (commencing with Section 1324.20). Notwithstanding
Section 16305.7 of the Government Code, the fund shall contain all
interest and dividends earned on moneys in the fund.
(b) Notwithstanding any other law, beginning August 1, 2013, all
revenues received by the State Department of Health Care Services
categorized by the State Department of Health Care Services as
long-term care quality assurance fees shall be deposited into the
Long-Term Care Quality Assurance Fund. Revenue that shall be
deposited into this fund shall include quality assurance fees imposed
pursuant to this article and quality assurance fees imposed pursuant
to Article 7.6 (commencing with Section 1324.20).
(c) Notwithstanding any other law, the Controller may use the
funds in the Long-Term Care Quality Assurance Fund for cashflow loans
to the General Fund as provided in Sections 16310 and 16381 of the
Government Code.
SEC. 14. Section 1373 of the Health and
Safety Code is amended to read:
1373. (a) (1) A plan contract may not
provide an exception for other coverage if the other coverage is
entitlement to Medi-Cal benefits under Chapter 7 (commencing with
Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3
of Division 9 of the Welfare and Institutions Code, or Medicaid
benefits under Subchapter 19 (commencing with Section 1396) of
Chapter 7 of Title 42 of the United States Code.
Each
(2) Each plan contract shall be
interpreted not to provide an exception for the Medi-Cal or Medicaid
benefits.
A
(3) A plan contract shall not
provide an exemption for enrollment because of an applicant's
entitlement to Medi-Cal benefits under Chapter 7 (commencing with
Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3
of Division 9 of the Welfare and Institutions Code, or Medicaid
benefits under Subchapter 19 (commencing with Section 1396) of
Chapter 7 of Title 42 of the United States Code.
A
(4) A plan contract may not
provide that the benefits payable thereunder are subject to reduction
if the individual insured has entitlement to the Medi-Cal or
Medicaid benefits.
(b) (1) A plan contract that provides
coverage, whether by specific benefit or by the effect of general
wording, for sterilization operations or procedures shall not impose
any disclaimer, restriction on, or limitation of, coverage relative
to the covered individual's reason for sterilization.
As
(2) As used in this section,
"sterilization operations or procedures" shall have the same meaning
as that specified in Section 10120 of the Insurance Code.
(c) Every plan contract that provides coverage to the spouse or
dependents of the subscriber or spouse shall grant immediate accident
and sickness coverage, from and after the moment of birth, to each
newborn infant of any subscriber or spouse covered and to each minor
child placed for adoption from and after the date on which the
adoptive child's birth parent or other appropriate legal authority
signs a written document, including, but not limited to, a health
facility minor release report, a medical authorization form, or a
relinquishment form, granting the subscriber or spouse the right to
control health care for the adoptive child or, absent this written
document, on the date there exists evidence of the subscriber's or
spouse's right to control the health care of the child placed for
adoption. No plan may be entered into or amended if it contains any
disclaimer, waiver, or other limitation of coverage relative to the
coverage or insurability of newborn infants of, or children placed
for adoption with, a subscriber or spouse covered as required by this
subdivision.
(d) (1) Every plan contract that provides that coverage of a
dependent child of a subscriber shall terminate upon attainment of
the limiting age for dependent children specified in the plan, shall
also provide that attainment of the limiting age shall not operate to
terminate the coverage of the child while the child is and continues
to meet both of the following criteria:
(A) Incapable of self-sustaining employment by reason of a
physically or mentally disabling injury, illness, or condition.
(B) Chiefly dependent upon the subscriber for support and
maintenance.
(2) The plan shall notify the subscriber that the dependent child'
s coverage will terminate upon attainment of the limiting age unless
the subscriber submits proof of the criteria described in
subparagraphs (A) and (B) of paragraph (1) to the plan within 60 days
of the date of receipt of the notification. The plan shall send this
notification to the subscriber at least 90 days prior to the date
the child attains the limiting age. Upon receipt of a request by the
subscriber for continued coverage of the child and proof of the
criteria described in subparagraphs (A) and (B) of paragraph (1), the
plan shall determine whether the child meets that criteria before
the child attains the limiting age. If the plan fails to make the
determination by that date, it shall continue coverage of the child
pending its determination.
(3) The plan may subsequently request information about a
dependent child whose coverage is continued beyond the limiting age
under this subdivision but not more frequently than annually after
the two-year period following the child's attainment of the limiting
age.
(4) If the subscriber changes carriers to another plan or to a
health insurer, the new plan or insurer shall continue to provide
coverage for the dependent child. The new plan or insurer may request
information about the dependent child initially and not more
frequently than annually thereafter to determine if the child
continues to satisfy the criteria in subparagraphs (A) and (B) of
paragraph (1). The subscriber shall submit the information requested
by the new plan or insurer within 60 days of receiving the request.
(5) (A) Except as set forth in subparagraph (B), under no
circumstances shall the limiting age be less than 26 years of age
with respect to plan years beginning on or after September 23, 2010.
(B) For plan years beginning before January 1, 2014, a group
health care service plan contract that qualifies as a grandfathered
health plan under Section 1251 of the federal Patient Protection and
Affordable Care Act (Public Law 111-148) and that makes available
dependent coverage of children may exclude from coverage an adult
child who has not attained 26 years of age only if the adult child is
eligible to enroll in an eligible employer-sponsored health plan, as
defined in Section 5000A(f)(2) of the Internal Revenue Code, other
than a group health plan of a parent.
(C) (i) With respect to a child (I) whose coverage under a group
or individual plan contract ended, or who was denied or not eligible
for coverage under a group or individual plan contract, because under
the terms of the contract the availability of dependent coverage of
children ended before the attainment of 26 years of age, and (II) who
becomes eligible for that coverage by reason of the application of
this paragraph, the health care service plan shall give the child an
opportunity to enroll that shall continue for at least 30 days. This
opportunity and the notice described in clause (ii) shall be provided
not later than the first day of the first plan year beginning on or
after September 23, 2010, consistent with 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 additional federal guidance or
regulations issued by the United States Secretary of Health and Human
Services.
(ii) The health care service plan shall provide written notice
stating that a dependent described in clause (i) who has not attained
26 years of age is eligible to enroll in the plan for coverage. This
notice may be provided to the dependent's parent on behalf of the
dependent. If the notice is included with other enrollment materials
for a group plan, the notice shall be prominent.
(iii) In the case of an individual who enrolls under this
subparagraph, coverage shall take effect no later than the first day
of the first plan year beginning on or after September 23, 2010.
(iv) A dependent enrolling in a group health plan for coverage
pursuant to this subparagraph shall be treated as a special enrollee
as provided under the rules of Section 146.117(d) of Title 45 of the
Code of Federal Regulations. The health care service plan shall offer
the recipient of the notice all of the benefit packages available to
similarly situated individuals who did not lose coverage by reason
of cessation of dependent status. Any difference in benefits or
cost-sharing requirements shall constitute a different benefit
package. A dependent enrolling in a group health plan for coverage
pursuant to this subparagraph shall not be required to pay more for
coverage than similarly situated individuals who did not lose
coverage by reason of cessation of dependent status.
(D) Nothing in this section shall require a health care service
plan to make coverage available for a child of a child receiving
dependent coverage. Nothing in this section shall be construed to
modify the definition of "dependent" as used in the Revenue and
Taxation Code with respect to the tax treatment of the cost of
coverage.
(e) A plan contract that provides coverage, whether by specific
benefit or by the effect of general wording, for both an employee and
one or more covered persons dependent upon the employee and provides
for an extension of the coverage for any period following a
termination of employment of the employee shall also provide that
this extension of coverage shall apply to dependents upon the same
terms and conditions precedent as applied to the covered employee,
for the same period of time, subject to payment of premiums, if any,
as required by the terms of the policy and subject to any applicable
collective bargaining agreement.
(f) A group contract shall not discriminate against handicapped
persons or against groups containing handicapped persons. Nothing in
this subdivision shall preclude reasonable provisions in a plan
contract against liability for services or reimbursement of the
handicap condition or conditions relating thereto, as may be allowed
by rules of the director.
(g) Every group contract shall set forth the terms and conditions
under which subscribers and enrollees may remain in the plan in the
event the group ceases to exist, the group contract is terminated, or
an individual subscriber leaves the group, or the enrollees'
eligibility status changes.
(h) (1) A health care service plan or specialized health care
service plan may provide for coverage of, or for payment for,
professional mental health services, or vision care services, or for
the exclusion of these services. If the terms and conditions include
coverage for services provided in a general acute care hospital or an
acute psychiatric hospital as defined in Section 1250 and do not
restrict or modify the choice of providers, the coverage shall extend
to care provided by a psychiatric health facility as defined in
Section 1250.2 operating pursuant to licensure by the State
Department of Social Health Care
Services. A health care service plan that offers outpatient mental
health services but does not cover these services in all of its group
contracts shall communicate to prospective group contractholders as
to the availability of outpatient coverage for the treatment of
mental or nervous disorders.
(2) No plan shall prohibit the member from selecting any
psychologist who is licensed pursuant to the Psychology Licensing Law
(Chapter 6.6 (commencing with Section 2900) of Division 2 of the
Business and Professions Code), any optometrist who is the holder of
a certificate issued pursuant to Chapter 7 (commencing with Section
3000) of Division 2 of the Business and Professions Code or, upon
referral by a physician and surgeon licensed pursuant to the Medical
Practice Act (Chapter 5 (commencing with Section 2000) of Division 2
of the Business and Professions Code), (A) any marriage and family
therapist who is the holder of a license under Section 4980.50 of the
Business and Professions Code, (B) any licensed clinical social
worker who is the holder of a license under Section 4996 of the
Business and Professions Code, (C) any registered nurse licensed
pursuant to Chapter 6 (commencing with Section 2700) of Division 2 of
the Business and Professions Code, who possesses a master's degree
in psychiatric-mental health nursing and is listed as a
psychiatric-mental health nurse by the Board of Registered Nursing,
(D) any advanced practice registered nurse certified as a clinical
nurse specialist pursuant to Article 9 (commencing with Section 2838)
of Chapter 6 of Division 2 of the Business and Professions Code who
participates in expert clinical practice in the specialty of
psychiatric-mental health nursing, to perform the particular services
covered under the terms of the plan, and the certificate holder is
expressly authorized by law to perform these services, or (E) any
professional clinical counselor who is the holder of a license under
Chapter 16 (commencing with Section 4999.10) of Division 2 of the
Business and Professions Code.
(3) Nothing in this section shall be construed to allow any
certificate holder or licensee enumerated in this section to perform
professional mental health services beyond his or her field or fields
of competence as established by his or her education, training, and
experience.
(4) For the purposes of this section:
(A) "Marriage and family therapist" means a licensed marriage and
family therapist who has received specific instruction in assessment,
diagnosis, prognosis, and counseling, and psychotherapeutic
treatment of premarital, marriage, family, and child relationship
dysfunctions, which is equivalent to the instruction required for
licensure on January 1, 1981.
(B) "Professional clinical counselor" means a licensed
professional clinical counselor who has received specific instruction
in assessment, diagnosis, prognosis, counseling, and
psychotherapeutic treatment of mental and emotional disorders, which
is equivalent to the instruction required for licensure on January 1,
2012.
(5) Nothing in this section shall be construed to allow a member
to select and obtain mental health or psychological or vision care
services from a certificate holder or licenseholder who is not
directly affiliated with or under contract to the health care service
plan or specialized health care service plan to which the member
belongs. All health care service plans and individual practice
associations that offer mental health benefits shall make reasonable
efforts to make available to their members the services of licensed
psychologists. However, a failure of a plan or association to comply
with the requirements of the preceding sentence shall not constitute
a misdemeanor.
(6) As used in this subdivision, "individual practice association"
means an entity as defined in subsection (5) of Section 1307 of the
federal Public Health Service Act (42 U.S.C. Sec. 300e-1(5)).
(7) Health care service plan coverage for professional mental
health services may include community residential treatment services
that are alternatives to inpatient care and that are directly
affiliated with the plan or to which enrollees are referred by
providers affiliated with the plan.
(i) If the plan utilizes arbitration to settle disputes, the plan
contracts shall set forth the type of disputes subject to
arbitration, the process to be utilized, and how it is to be
initiated.
(j) A plan contract that provides benefits that accrue after a
certain time of confinement in a health care facility shall specify
what constitutes a day of confinement or the number of consecutive
hours of confinement that are requisite to the commencement of
benefits.
(k) If a plan provides coverage for a dependent child who is over
26 years of age and enrolled as a full-time student at a secondary or
postsecondary educational institution, the following shall apply:
(1) Any break in the school calendar shall not disqualify the
dependent child from coverage.
(2) If the dependent child takes a medical leave of absence, and
the nature of the dependent child's injury, illness, or condition
would render the dependent child incapable of self-sustaining
employment, the provisions of subdivision (d) shall apply if the
dependent child is chiefly dependent on the subscriber for support
and maintenance.
(3) (A) If the dependent child takes a medical leave of absence
from school, but the nature of the dependent child's injury, illness,
or condition does not meet the requirements of paragraph (2), the
dependent child's coverage shall not terminate for a period not to
exceed 12 months or until the date on which the coverage is scheduled
to terminate pursuant to the terms and conditions of the plan,
whichever comes first. The period of coverage under this paragraph
shall commence on the first day of the medical leave of absence from
the school or on the date the physician and surgeon determines the
illness prevented the dependent child from attending school,
whichever comes first. Any break in the school calendar shall not
disqualify the dependent child from coverage under this paragraph.
(B) Documentation or certification of the medical necessity for a
leave of absence from school shall be submitted to the plan at least
30 days prior to the medical leave of absence from the school, if the
medical reason for the absence and the absence are foreseeable, or
30 days after the start date of the medical leave of absence from
school and shall be considered prima facie evidence of entitlement to
coverage under this paragraph.
(4) This subdivision shall not apply to a specialized health care
service plan or to a Medicare supplement plan.
SEC. 15. Section 104151 is added to the
Health and Safety Code , to read:
104151. Notwithstanding Section 10231.5 of the Government Code,
each year, by no later than January 10 and concurrently with the
release of the May Revision, the State Department of Health Care
Services shall provide the fiscal committees of the Legislature with
an estimate package for the Every Woman Counts Program. This estimate
package shall include all significant assumptions underlying
the estimate for the Every Woman
Counts Program's current-year and budget-year proposals, and shall
contain concise information identifying applicable estimate
components, such as caseload; a breakout of costs, including, but not
limited to, clinical service activities, including office visits and
consults, screening mammograms, diagnostic mammograms, diagnostic
breast procedures, case management, and other clinical services;
policy changes; contractor information; General Fund, special fund,
and federal fund information; and other assumptions necessary to
support the estimate.
SEC. 16. Section 111792 of the Health
and Safety Code is amended to read:
111792. (a) Commencing January 1, 2007, the
The manufacturer of any cosmetic product subject to
regulation by the federal Food and Drug Administration that is sold
in this state shall, on a schedule and in electronic or other format,
as determined by the division, provide the division with a complete
and accurate list of its cosmetic products that, as of the date of
submission, are sold in the state and that contain any ingredient
that is a chemical identified as causing cancer or reproductive
toxicity, including any chemical that meets either of the following
conditions:
(1) A chemical contained in the product for purposes of fragrance
or flavoring.
(2) A chemical identified by the phrase "and other ingredients"
and determined to be a trade secret pursuant to the procedure
established in Part 20 and Section 720.8 of Part 720 of Title 21 of
the Code of Federal Regulations. Any ingredient identified pursuant
to this paragraph shall be considered to be a trade secret and shall
be treated by the division in a manner consistent with the
requirements of Part 20 and Part 720 of Title 21 of the Code of
Federal Regulations. Any ingredients considered to be a trade secret
shall not be subject to the California Public Records Act (Chapter
3.5 (commencing with Section 6250) of Division 7 of Title 1 of the
Government Code) for the purposes of this section.
(b) Any information submitted pursuant to subdivision (a) shall
identify each chemical both by name and Chemical Abstract Service
number and shall specify the product or products in which the
chemical is contained.
(c) If an ingredient identified pursuant to this section
subsequently is removed from the product in which it was contained,
is removed from the list of chemicals known to cause cancer or
reproductive toxicity published under Section 25249.8, or is no
longer a chemical identified as causing cancer or reproductive
toxicity by an authoritative body, the manufacturer of the product
containing the ingredient shall submit the new information to the
division. Upon receipt of new information, the division, after
verifying the accuracy of that information, shall revise the
manufacturer's information on record with the division to reflect the
new information. The manufacturer shall not be under obligation to
submit subsequent information on the presence of the ingredient in
the product unless subsequent changes require submittal of the
information.
(d) This section shall not apply to any manufacturer of cosmetic
products with annual aggregate sales of cosmetic products, both
within and outside of California, of less than one million dollars
($1,000,000), based on the manufacturer's most recent tax year
filing.
(e) On or before December 31, 2013, the State Department of Public
Health shall develop and make operational a consumer-friendly,
public Internet Web site that creates a database of the information
collected pursuant to this section. The database shall be searchable
to accommodate a wide range of users, including users with limited
technical and scientific literacy. Data shall be presented in an
educational manner with, among other things, hypertext links that
explain the meanings of technical terms, including, but not limited
to, "carcinogenic" and "reproductive toxicity." The Internet Web site
shall be designed to be easily navigable and to enable users to
compare and contrast products and reportable ingredients. The
Internet Web site shall include hypertext links to other educational
and informational Internet Web sites to enhance consumer
understanding.
SEC. 17. Section 123870 of the Health
and Safety Code is amended to read:
123870. (a) The department shall establish standards of financial
eligibility for treatment services under the California Children's
Services Program (CCS program).
(1) Financial eligibility for treatment services under this
program shall be limited to persons in families with an adjusted
gross income of forty thousand dollars ($40,000) or less in the most
recent tax year, as calculated for California state income tax
purposes. If a person is enrolled in the Healthy Families Program
(Part 6.2 (commencing with Section 12693) of Division 2 of the
Insurance Code), the financial documentation required for that
program in Section 2699.6600 of Title 10 of the California Code of
Regulations may be used instead of the person's California state
income tax return. If a person is enrolled in the Medi-Cal program
pursuant to Section 14005.26 of the Welfare and Institutions Code,
or enrolled in the AIM-Linked Infants Program pursuant to
Chapter 2 (commencing with Section 15850) of Part 3.3 of Division 9
of the Welfare and Institutions Code, the financial
documentation required to establish eligibility for the
Medi-Cal program respective programs may be used
instead of the person's California state income tax return. However,
the director may authorize treatment services for persons in
families with higher incomes if the estimated cost of care to the
family in one year is expected to exceed 20 percent of the family's
adjusted gross income.
(2) Children enrolled in the Healthy Families Program, or
enrolled in the Medi-Cal program pursuant to Section
14005.26 of the Welfare and Institutions Code, or the AIM-Linked
Infants Program pursuant to Chapter 2 (commencing with Section
15850) of Part 3.3 of Division 9 of the Welfare and Institutions
Code, who have a CCS program eligible medical condition under
Section 123830, and whose families do not meet the financial
eligibility requirements of paragraph (1), shall be deemed
financially eligible for CCS program benefits.
(b) Necessary medical therapy treatment services under the
California Children's Services Program rendered in the public schools
shall be exempt from financial eligibility standards and enrollment
fee requirements for the services when rendered to any handicapped
child whose educational or physical development would be impeded
without the services.
(c) All counties shall use the uniform standards for financial
eligibility and enrollment fees established by the department. All
enrollment fees shall be used in support of the California Children's
Services Program.
(d) Annually, every family with a child eligible to receive
services under this article shall pay a fee of twenty dollars ($20),
that shall be in addition to any other program fees for which the
family is liable. This assessment shall not apply to any child who is
eligible for full scope Medi-Cal benefits without a share of cost,
for children receiving therapy through the California Children's
Services Program as a related service in their individualized
education plans, for children from families having incomes of less
than 100 percent of the federal poverty level, or for children
covered under the Healthy Families Program or the AIM-Linked
Infants Program .
SEC. 18. Section 123929 of the Health
and Safety Code is amended to read:
123929. (a) Except as otherwise provided in this section and
Section 14133.05 of the Welfare and Institutions Code, California
Children's Services Program services provided pursuant to this
article require prior authorization by the department or its
designee. Prior authorization is contingent on determination by the
department or its designee of all of the following:
(1) The child receiving the services is confirmed to be medically
eligible for the CCS program.
(2) The provider of the services is approved in accordance with
the standards of the CCS program.
(3) The services authorized are medically necessary to treat the
child's CCS-eligible medical condition.
(b) Effective July 1, 2004, the The
department or its designee may approve a request for a treatment
authorization that is otherwise in conformance with subdivision (a)
for services for a child participating in the Healthy Families
Program or the AIM-Linked Infants Program pursuant to
clause (ii) of subparagraph (A) of paragraph (6) of subdivision (a)
of Section 12693.70 of the Insurance Code or Chapter 2
(commencing with Section 15850) of Part 3.3 of
Division 9 of the Welfare and Institutions Code , received by
the department or its designee after the requested treatment has been
provided to the child.
(c) Effective July 1, 2004, if If a
provider of services who meets the requirements of paragraph (2) of
subdivision (a) incurs costs for services described in paragraph (3)
of subdivision (a) to treat a child described in subdivision (b) who
is subsequently determined to be medically eligible for the CCS
program as determined by the department or its designee, the
department may reimburse the provider for those costs. Reimbursement
under this section shall conform to the requirements of Section
14105.18 of the Welfare and Institutions Code.
SEC. 19. Section 123940 of the Health
and Safety Code is amended to read:
123940. (a) (1) Annually, the board of supervisors shall
appropriate a sum of money for services for handicapped children of
the county, including diagnosis, treatment, and therapy services for
physically handicapped children in public schools, equal to 25
percent of the actual expenditures for the county program under this
article for the 1990-91 fiscal year, except as specified in paragraph
(2).
(2) If the state certifies that a smaller amount is needed in
order for the county to pay 25 percent of costs of the county's
program from this source. The smaller amount certified by the state
shall be the amount that the county shall appropriate.
(b) In addition to the amount required by subdivision (a), the
county shall allocate an amount equal to the amount determined
pursuant to subdivision (a) for purposes of this article from
revenues allocated to the county pursuant to Chapter 6 (commencing
with Section 17600) of Division 9 of the Welfare and Institutions
Code.
(c) (1) The state shall match county expenditures for this article
from funding provided pursuant to subdivisions (a) and (b).
(2) County expenditures shall be waived for payment of services
for children who are eligible pursuant to paragraph (2) of
subdivision (a) of Section 123870.
(d) The county may appropriate and expend moneys in addition to
those set forth in subdivision (a) and (b) and the state shall match
the expenditures, on a dollar-for-dollar basis, to the extent that
state funds are available for this article.
(e) County appropriations under subdivisions (a) and (b) shall
include county financial participation in the nonfederal share of
expenditures for services for children who are enrolled in the
Medi-Cal program pursuant to Section 14005.26 of the Welfare and
Institutions Code, or the AIM-Linked Infants Program pursuant to
Chapter 2 (commencing with Section 15850) of Part 3.3 of
Division 9 of the Welfare and Institutions Code, and who are
eligible for services under this article pursuant to paragraph (1) of
subdivision (a) of Section 123870, to the extent that federal
financial participation is available at the enhanced federal
reimbursement rate under Title XXI of the federal Social Security Act
(42 U.S.C. Sec. 1397aa et seq.) and funds are appropriated for the
California Children's Services Program in the State Budget.
(f) Nothing in this section shall require the county to expend
more than the amount set forth in subdivision (a) plus the amount set
forth in subdivision (b) nor shall it require the state to expend
more than the amount of the match set forth in subdivision (c).
(g) 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 further regulatory action, shall implement
this section by means of California Children's Services numbered
letters.
SEC. 20. Section 123955 of the Health
and Safety Code is amended to read:
123955. (a) The state and the counties shall share in the cost of
administration of the California Children's Services Program at the
local level.
(b) (1) The director shall adopt regulations establishing minimum
standards for the administration, staffing, and local implementation
of this article subject to reimbursement by the state.
(2) The standards shall allow necessary flexibility in the
administration of county programs, taking into account the
variability of county needs and resources, and shall be developed and
revised jointly with state and county representatives.
(c) The director shall establish minimum standards for
administration, staffing and local operation of the program subject
to reimbursement by the state.
(d) Until July 1, 1992, reimbursable administrative costs, to be
paid by the state to counties, shall not exceed 4.1 percent of the
gross total expenditures for diagnosis, treatment and therapy by
counties as specified in Section 123940.
(e) Beginning July 1, 1992, this subdivision shall apply with
respect to all of the following:
(1) Counties shall be reimbursed by the state for 50 percent of
the amount required to meet state administrative standards for that
portion of the county caseload under this article that is ineligible
for Medi-Cal to the extent funds are available in the State Budget
for the California Children's Services Program.
(2) Counties shall be reimbursed by the state for 50 percent of
the nonfederal share of the amount required to meet state
administrative standards for that portion of the county caseload
under this article that is enrolled in the Medi-Cal program pursuant
to Section 14005.26 of the Welfare and Institutions Code or the
AIM-Linked Infants Program pursuant to Chapter 2
(commencing with Section 15850) of Part 3.3 of Division 9 of the
Welfare and Institutions Code, and who are eligible for
services under this article pursuant to subdivision (a) of Section
123870, to the extent that federal financial participation is
available at the enhanced federal reimbursement rate under Title XXI
of the federal Social Security Act (42 U.S.C. Sec. 1397aa et seq.)
and funds are appropriated for the California Children's Services
Program in the State Budget.
(3) On or before September 15 of each year, each county program
implementing this article shall submit an application for the
subsequent fiscal year that provides information as required by the
state to determine if the county administrative staff and budget meet
state standards.
(4) The state shall determine the maximum amount of state funds
available for each county from state funds appropriated for CCS
county administration. If the amount appropriated for any fiscal year
in the Budget Act for county administration under this article
differs from the amounts approved by the department, each county
shall submit a revised application in a form and at the time
specified by the department.
(f) The department and counties shall maximize the use of federal
funds for administration of the programs implemented pursuant to this
article, including using state and county funds to match funds
claimable under Title XIX or Title XXI of the federal Social Security
Act (42 U.S.C. Sec. 1396 et seq.; 42 U.S.C. Sec. 1397aa et seq.).
SEC. 21. Section 10125 of the Insurance
Code is amended to read:
10125. (a) On and after January 1, 1974, every insurer issuing
group disability insurance which covers hospital, medical, or
surgical expenses shall offer coverage for expenses incurred as a
result of mental or nervous disorders, under the terms and conditions
which may be agreed upon between the group policyholder and the
insurer. If the terms and conditions include coverage for inpatient
care for nervous or mental disorders, the coverage shall extend to
treatment provided at all of the following facilities:
(1) A general acute care hospital as defined in subdivision (a) of
Section 1250 of the Health and Safety Code.
(2) An acute psychiatric hospital as defined in subdivision (b) of
Section 1250 of the Health and Safety Code.
(3) A psychiatric health facility as defined by Section 1250.2 of
the Health and Safety Code operating pursuant to licensure by the
State Department of Social Health Care
Services.
Nothing in this subdivision prohibits an insurer which
that negotiates and enters into a contract with
a professional or institutional provider for alternative rates of
payment pursuant to Sections Section
10133 and 11512 of this code from restricting or
modifying the choice of providers.
(b) Every insurer shall communicate to prospective group
policyholders as to the availability of outpatient coverage for the
treatment of mental or nervous disorders. Every insurer shall
communicate the availability of that coverage to all group
policyholders and to all prospective group policyholders with whom
they are negotiating. This coverage may include community residential
treatment services, as described in former Section 5458
of the Welfare and Institutions Code, which
that are alternatives to institutional care.
SEC. 22. Section 10127 of the Insurance
Code is amended to read:
10127. On and after January 1, 1974, every self-insured employee
welfare benefit plan which that
provides coverage for hospital, medical, or surgical expenses shall
offer coverage for expenses incurred as a result of mental or nervous
disorders, under the terms and conditions which may be agreed upon
between the self-insured welfare benefit plan and the member. If the
terms and conditions include coverage for services provided in a
general acute care hospital, or an acute psychiatric hospital as
defined in Section 1250 of the Health and Safety Code, and do not
restrict or modify the choice of providers, the coverage shall extend
to care provided by a psychiatric health facility, as defined by
Section 1250.2 of the Health and Safety Code, operating pursuant to
licensure by the State Department of Social
Health Care Services. Every plan shall communicate to
prospective members as to the availability of outpatient coverage for
the treatment of mental or nervous disorders. Every self-insured
welfare benefit plan shall communicate the availability of this
coverage to all members and prospective members. This coverage may
include community residential treatment services, as described in
former Section 5458 of the Welfare and Institutions Code,
which that are alternatives to
institutional care.
SEC. 23. Section 12693.70 of the
Insurance Code is amended to read:
12693.70. To be eligible to participate in the program, an
applicant shall meet all of the following requirements:
(a) Be an applicant applying on behalf of an eligible child, which
means a child who is all of the following:
(1) Less than 19 years of age. An application may be made on
behalf of a child not yet born up to three months prior to the
expected date of delivery. Coverage shall begin as soon as
administratively feasible, as determined by the board, after the
board receives notification of the birth. However, no child less than
12 months of age shall be eligible for coverage until 90 days after
the enactment of the Budget Act of 1999.
(2) Not eligible for no-cost full-scope Medi-Cal or Medicare
coverage at the time of application.
(3) In compliance with Sections 12693.71 and 12693.72.
(4) A child who meets citizenship and immigration status
requirements that are applicable to persons participating in the
program established by Title XXI of the Social Security Act, except
as specified in Section 12693.76.
(5) A resident of the State of California pursuant to Section 244
of the Government Code; or, if not a resident pursuant to Section 244
of the Government Code, is physically present in California and
entered the state with a job commitment or to seek employment,
whether or not employed at the time of application to or after
acceptance in, the program.
(6) (A) In either of the following:
(i) In a family with an annual or monthly household income equal
to or less than 200 percent of the federal poverty level.
(ii) (I) When implemented by the board,
subject to subdivision (b) of Section 12693.765 and pursuant to this
section, a child under the age of two years who was delivered by a
mother enrolled in the Access for Infants and Mothers Program as
described in Part 6.3 (commencing with Section 12695). Commencing
July 1, 2007, eligibility under this subparagraph shall not include
infants during any time they are enrolled in employer-sponsored
health insurance or are subject to an exclusion pursuant to Section
12693.71 or 12693.72, or are enrolled in the full scope of benefits
under the Medi-Cal program at no share of cost. For purposes of this
clause, any infant born to a woman whose enrollment in the Access for
Infants and Mothers Program begins after June 30, 2004, shall be
automatically enrolled in the Healthy Families Program, except during
any time on or after July 1, 2007, that the infant is enrolled in
employer-sponsored health insurance or is subject to an exclusion
pursuant to Section 12693.71 or 12693.72, or is enrolled in the full
scope of benefits under the Medi-Cal program at no share of cost.
Except as otherwise specified in this section, this enrollment shall
cover the first 12 months of the infant's life. At the end of the 12
months, as a condition of continued eligibility, the applicant shall
provide income information. The infant shall be disenrolled if the
gross annual household income exceeds the income eligibility standard
that was in effect in the Access for Infants and Mothers Program at
the time the infant's mother became eligible, or following the
two-month period established in Section 12693.981 if the infant is
eligible for Medi-Cal with no share of cost. At the end of the second
year, infants shall again be screened for program eligibility
pursuant to this section, with income eligibility evaluated pursuant
to clause (i), subparagraphs (B) and (C), and paragraph (2) of
subdivision (a).
(II) Effective on October 1, 2013, or
when the State Department of Health Care Services has implemented
Chapter 2 (commencing with Section 15850) of Part 3.3 of Division 9
of the Welfare and Institutions Code, whichever is later, eligibility
for coverage in the program pursuant to this clause shall terminate.
The board shall coordinate with the State Department of
Health Care Services to implement Chapter 2 (commencing with Secti
on 15850) of Part 3.3 of Division 9 of the Welfare and
Institutions Code, including transition of subscribers to the
AIM-Linked Infants Program. The State Department of Health Care
Services shall administer the AIM-Linked Infants Program, pursuant to
Chapter 2 (commencing with Section 15850) of Part 3.3 of Division 9
of the Welfare and Institutions Code, to address the health care
needs of children formerly covered pursuant to this clause.
(B) All income over 200 percent of the federal poverty level but
less than or equal to 250 percent of the federal poverty level shall
be disregarded in calculating annual or monthly household income.
(C) In a family with an annual or monthly household income greater
than 250 percent of the federal poverty level, any income deduction
that is applicable to a child under Medi-Cal shall be applied in
determining the annual or monthly household income. If the income
deductions reduce the annual or monthly household income to 250
percent or less of the federal poverty level, subparagraph (B) shall
be applied.
(b) The applicant shall agree to remain in the program for six
months, unless other coverage is obtained and proof of the coverage
is provided to the program.
(c) An applicant shall enroll all of the applicant's eligible
children in the program.
(d) In filing documentation to meet program eligibility
requirements, if the applicant's income documentation cannot be
provided, as defined in regulations promulgated by the board, the
applicant's signed statement as to the value or amount of income
shall be deemed to constitute verification.
(e) An applicant shall pay in full any family contributions owed
in arrears for any health, dental, or vision coverage provided by the
program within the prior 12 months.
(f) By January 2008, the board, in consultation with stakeholders,
shall implement processes by which applicants for subscribers may
certify income at the time of annual eligibility review, including
rules concerning which applicants shall be permitted to certify
income and the circumstances in which supplemental information or
documentation may be required. The board may terminate using these
processes not sooner than 90 days after providing notification to the
Chair of the Joint Legislative Budget Committee. This notification
shall articulate the specific reasons for the termination and shall
include all relevant data elements that are applicable to document
the reasons for the termination. Upon the request of the Chair of the
Joint Legislative Budget Committee, the board shall promptly provide
any additional clarifying information regarding implementation of
the processes required by this subdivision.
SEC. 24. Section 12698 of the Insurance
Code is amended to read:
12698. To be eligible to participate in the program, a person
shall meet all of the following requirements:
(a) Be a resident of the state. A person who is a member of a
federally recognized California Indian tribe is a resident of the
state for these purposes.
(b) (1) Until the first day of the second month following the
effective date of the amendment made to this subdivision in 1994,
have a household income that does not exceed 250 percent of the
official federal poverty level unless the board determines that the
program funds are adequate to serve households above that level.
(2) Upon the first day of the second month following the effective
date of the amendment made to this subdivision in 1994, have a
household income that is above 200 percent of the official federal
poverty level but does not exceed 250 percent of the official federal
poverty level unless the board determines that the program funds are
adequate to serve households above the 250 percent of the official
federal poverty level.
(c) Pay an initial subscriber contribution of not more than fifty
dollars ($50), and agree to the payment of the complete subscriber
contribution. A federally recognized California Indian tribal
government may make the initial and complete subscriber contributions
on behalf of a member of the tribe only if a contribution on behalf
of members of federally recognized California Indian tribes does not
limit or preclude federal financial participation under Title XXI of
the Social Security Act. If a federally recognized California Indian
tribal government makes a contribution on behalf of a member of the
tribe, the tribal government shall ensure that the subscriber is made
aware of all the health plan options available in the county where
the member resides.
(d) Effective January 1, 2014, when determining eligibility for
benefits under the program, income shall be determined, counted, and
valued in accordance with the requirements of Section 1397bb(b)(1)(B)
of Title 42 of the United States Code as added by the federal
Patient Protection and Affordable Care Act (Public Law 111-148) and
as amended by the federal Health Care and Education Reconciliation
Act of 2010 (Public Law 111-152) and any subsequent amendments.
SEC. 25. Section 12737 of the Insurance
Code is am ended to read:
12737. (a) The board shall establish program contribution amounts
for each category of risk for each participating health plan. The
program contribution amounts shall be based on the average amount of
subsidy funds required for the program as a whole. To determine the
average amount of subsidy funds required, the board shall calculate a
loss ratio, including all medical costs, administration fees, and
risk payments, for the program in the prior calendar year. The loss
ratio shall be calculated using 125 percent of the standard average
individual rates for comparable coverage as the denominator, and all
medical costs, administration fees, and risk payments as the
numerator. The average amount of subsidy funds required is calculated
by subtracting 100 percent from the program loss ratio. For purposes
of calculating the program loss ratio, no participating health plan'
s loss ratio shall be less than 100 percent and participating health
plans with fewer than 1,000 program members shall be excluded from
the calculation.
Subscriber contributions shall be established to encourage members
to select those health plans requiring subsidy funds at or below the
program average subsidy. Subscriber contribution amounts shall be
established so that no subscriber receives a subsidy greater than the
program average subsidy, except that:
(1) In all areas of the state, at least one plan shall be
available to program participants at an average subscriber
contribution of 125 percent of the standard average individual rates
for comparable coverage.
(2) No subscriber contribution shall be increased by more than 10
percent above 125 percent of the standard average individual rates
for comparable coverage.
(3) Subscriber contributions for participating health plans
joining the program after January 1, 1997, shall be established at
125 percent of the standard average individual rates for comparable
coverage for the first two benefit years the plan participates in the
program.
(b) The program shall pay program contribution amounts to
participating health plans from the Major Risk Medical Insurance
Fund.
(c) For the period commencing Commencing
January 1, 2013, to December 31, 2013, inclusive,
in addition to the amount of subsidy funds required
pursuant to subdivision (a), the program may further subsidize
subscriber contributions so that the amount paid by each subscriber
is below 125 percent of the standard average individual risk rate for
comparable coverage but no less than 100 percent of the standard
average individual risk rate for comparable coverage. For purposes of
calculating premiums for the following products, any reference to,
or use of, subscriber contributions, premiums, average premiums, or
amounts paid by subscribers in the program shall be construed to mean
subscriber contributions as described in subdivision (a) without
application of the additional subsidies permitted by this
subdivision:
(1) Standard benefit plans pursuant to Section 10127.16 and
Section 1373.622 of the Health and Safety Code.
(2) Health benefit plans and health care service plan contracts
for federally eligible defined individuals pursuant to Sections
10901.3 and 10901.9 and Sections 1399.805 and 1399.811 of the Health
and Safety Code.
(3) Conversion coverage pursuant to Section 12682.1 and Section
1373.6 of the Health and Safety Code.
SEC. 26. Section 12739.61 of the
Insurance Code is amended to read:
12739.61. The board shall cease to provide coverage through the
program on January 1, 2014, July 1, 2013,
except as required by the contract between the board and the United
States Department of Health and Human Services, and at that
time shall cease to operate the program except as required to
complete payments to, or payment reconciliations with, participating
health plans or other contractors, process appeals, or conduct other
necessary transition termination
activities , including, but not limited to, transition of
subscribers into an exchange or exchanges established pursuant to the
federal Patient Protection and Affordable Care Act (Public Law
111-148) .
SEC. 27. Section 359 of the Welfare and
Institutions Code is amended to read:
359. (a) Whenever a minor who appears to be
a danger to himself or others as a result of the use of narcotics
(as defined in Section 11001 of the Health and Safety Code)
, as defined in Section 110 19 of the
Health and Safety Code, or a restricted dangerous drug (as
defined in former Section 11901 of the Health and Safety
Code), is brought before any judge of the juvenile court, the judge
may continue the hearing and proceed pursuant to this section. The
court may order the minor taken to a facility designated by the
county and approved by the State Department of Social
Health Care Services as a facility for 72-hour
treatment and evaluation. Thereupon the provisions of Section 11922
of the Health and Safety Code shall apply, except that the
professional person in charge of the facility shall make a written
report to the court concerning the results of the evaluation of the
minor.
If
(b) If the professional person in
charge of the facility for 72-hour evaluation and treatment reports
to the juvenile court that the minor is not a danger to himself or
others as a result of the use of narcotics or restricted dangerous
drugs or that the minor does not require 14-day intensive treatment,
or if the minor has been certified for not more than 14 days of
intensive treatment and the certification is terminated, the minor
shall be released if the juvenile court proceedings have been
dismissed; referred for further care and treatment on a voluntary
basis, subject to the disposition of the juvenile court proceedings;
or returned to the juvenile court, in which event the court shall
proceed with the case pursuant to this chapter.
Any
(c) Any expenditure for the
evaluation or intensive treatment of a minor under this section shall
be considered an expenditure made under Part 2 (commencing with
Section 5600) of Division 5, and shall be reimbursed by the state as
are other local expenditures pursuant to that part.
SEC. 28. Section 708 of the Welfare and
Institutions Code is amended to read:
708. (a) Whenever a minor who appears to be
a danger to himself or herself or others as a result of the use of
controlled substances (as defined in Division 10 (commencing with
Section 11000) of the Health and Safety Code), is brought before any
judge of the juvenile court, the judge may continue the hearing and
proceed pursuant to this section. The court may order the minor taken
to a facility designated by the county and approved by the State
Department of Social Health Care
Services as a facility for 72-hour treatment and evaluation.
Thereupon the provisions of Section 5343 of the Welfare and
Institutions Code shall apply, except that the professional
person in charge of the facility shall make a written report to the
court concerning the results of the evaluation of the minor.
If
(b) If the professional person in
charge of the facility for 72-hour evaluation and treatment reports
to the juvenile court that the minor is not a danger to himself or
herself or others as a result of the use of controlled substances or
that the minor does not require 14-day intensive treatment, or if the
minor has been certified for not more than 14 days of intensive
treatment and the certification is terminated, the minor shall be
released if the juvenile court proceedings have been dismissed;
referred for further care and treatment on a voluntary basis, subject
to the disposition of the juvenile court proceedings; or returned to
the juvenile court, in which event the court shall proceed with the
case pursuant to this chapter.
Any
(c) Any expenditure for the
evaluation or intensive treatment of a minor under this section shall
be considered an expenditure made under Part 2 (commencing with
Section 5600) of Division 5, and shall be reimbursed by the state as
are other local expenditures pursuant to that part.
SEC. 29. Section 4005.7 of the Welfare
and Institutions Code is amended to read:
4005.7. All regulations heretofore adopted by the State
Department of Mental Health , and its successor, pursuant
to authority vested in the State Department of Social
Health Care Services by Section 4005.1 and in
effect immediately preceding the operative date of the act that
added amended this section in the
first year of the 2013-14 Regular Session shall remain in
effect and shall be fully enforceable unless and until readopted,
amended, or repealed by the Director of Social
Health Care Services.
SEC. 30. Section 4080 of the Welfare
and Institutions Code is amended to read:
4080. (a) Psychiatric health facilities, as defined in Section
1250.2 of the Health and Safety Code, shall only be licensed by the
State Department of Social Health Care
Services subsequent to application by counties, county contract
providers, or other organizations pursuant to this part.
(b) (1) For counties or county contract providers that choose to
apply, the local mental health director shall first present to the
local mental health advisory board for its review an explanation of
the need for the facility and a description of the services to be
provided. The local mental health director shall then submit to the
governing body the explanation and description. The governing body,
upon its approval, may submit the application to the State Department
of Social Health Care Services.
(2) Other organizations that will be applying for licensure and do
not intend to use any Bronzan-McCorquodale funds pursuant to Section
5707 shall submit to the local mental health director and the
governing body in the county in which the facility is to be located a
written and dated proposal of the services to be provided. The local
mental health director and governing body shall have 30 days during
which to provide any advice and recommendations regarding licensure,
as they deem appropriate. At any time after the 30-day period, the
organizations may then submit their applications, along with the
mental health director's and governing body's advice and
recommendations, if any, to the State Department of Social
Health Care Services.
(c) The State Fire Marshal and other appropriate state agencies,
to the extent required by law, shall cooperate fully with the State
Department of Social Health Care
Services to ensure that the State Department of Social
Health Care Services approves or disapproves the
licensure applications not later than 90 days after the application
submission by a county, county contract provider, or other
organization.
(d) Every psychiatric health facility and program for which a
license has been issued shall be periodically inspected by a
multidisciplinary team appointed or designated by the State
Department of Social Health Care
Services. The inspection shall be conducted no less than once every
two years and as often as necessary to ensure the quality of care
provided. During the inspections the review team shall offer such
advice and assistance to the psychiatric health facility as it deems
appropriate.
(e) (1) The program aspects of a psychiatric health facility that
shall be reviewed and may be approved by the State Department of
Social Health Care Services shall
include, but not be limited to:
(A) Activities programs.
(B) Administrative policies and procedures.
(C) Admissions, including provisions for a mental evaluation.
(D) Discharge planning.
(E) Health records content.
(F) Health records services.
(G) Interdisciplinary treatment teams.
(H) Nursing services.
(I) Patient rights.
(J) Pharmaceutical services.
(K) Program space requirements.
(L) Psychiatrist and clinical psychological services.
(M) Rehabilitation services.
(N) Restraint and seclusion.
(O) Social work services.
(P) Space, supplies, and equipment.
(Q) Staffing standards.
(R) Unusual occurrences.
(S) Use of outside resources, including agreements with general
acute care hospitals.
(T) Linguistic access and cultural competence.
(U) Structured outpatient services to be provided under special
permit.
(2) The State Department of Social Health
Care Services has the sole authority to grant program
flexibility.
(f) Commencing July 1, 2012, 2013,
the State Department of Social Health Care
Services shall may adopt
regulations regarding psychiatric health facilities that
shall include, but not be limited to, all of the following:
(1) Procedures by which the State Department of Social
Health Care Services shall review and may
approve the program and facility requesting licensure as a
psychiatric health facility as being in compliance with program
standards established by the department.
(2) Procedures by which the Director of Social
Health Care Services shall approve, or deny approval of,
the program and facility licensed as a psychiatric health facility
pursuant to this section.
(3) Provisions for site visits by the State Department of
Social Health Care Services for the purpose of
reviewing a facility's compliance with program and facility
standards.
(4) Provisions for the State Department of Social
Health Care Services for any administrative
proceeding regarding denial, suspension, or revocation of a
psychiatric health facility license.
(5) Procedures for the appeal of an administrative finding or
action pursuant to paragraph (4) of this subdivision and subdivision
(j).
(g) Regulations shall may be adopted
by the State Department of Social Health
Care Services , which shall that
establish standards for pharmaceutical services in psychiatric health
facilities. Licensed psychiatric health facilities shall be exempt
from requirements to obtain a separate pharmacy license or permit.
(h) (1) It is the intent of the Legislature that the State
Department of Social Health Care
Services shall license the facility in order to establish innovative
and more competitive and specialized acute care services.
(2) The State Department of Social Health
Care Services shall review and may approve the
program aspects of public or private facilities, with the exception
of those facilities that are federally certified or accredited by a
nationally recognized commission that accredits health care
facilities, only if the average per diem charges or costs of service
provided in the facility is approximately 60 percent of the average
per diem charges or costs of similar psychiatric services provided in
a general hospital.
(3) (A) When a private facility is accredited by a nationally
recognized commission that accredits health care facilities, the
State Department of Social Health Care
Services shall review and may approve the program aspects only if the
average per diem charges or costs of service provided in the
facility do not exceed approximately 75 percent of the average per
diem charges or costs of similar psychiatric service provided in a
psychiatric or general hospital.
(B) When a private facility serves county patients, the State
Department of Social Health Care
Services shall review and may approve the program aspects only if the
facility is federally certified by the federal Centers for Medicare
and Medicaid Services and serves a population mix that includes a
proportion of Medi-Cal patients sufficient to project an overall cost
savings to the county, and the average per diem charges or costs of
service provided in the facility do not exceed approximately 75
percent of the average per diem charges or costs of similar
psychiatric service provided in a psychiatric or general hospital.
(4) When a public facility is federally certified by the federal
Centers for Medicare and Medicaid Services and serves a population
mix that includes a proportion of Medi-Cal patients sufficient to
project an overall program cost savings with certification, the State
Department of Social Health Care
Services shall approve the program aspects only if the average per
diem charges or costs of service provided in the facility do not
exceed approximately 75 percent of the average per diem charges or
costs of similar psychiatric service provided in a psychiatric or
general hospital.
(5) (A) The State Department of Health Care Services may set a
lower rate for private or public facilities than that required by
paragraph (3) or paragraph (4),
respectively if so required by the federal Centers for
Medicare and Medicaid Services as a condition for the receipt of
federal matching funds.
(B) This section does not impose any obligation on any private
facility to contract with a county for the provision of services to
Medi-Cal beneficiaries, and any contract for that purpose is subject
to the agreement of the participating facility.
(6) (A) In using the guidelines specified in this subdivision, the
State Department of Social Health Care
Services shall take into account local conditions affecting the
costs or charges.
(B) In those psychiatric health facilities authorized by special
permit to offer structured outpatient services not exceeding 10
daytime hours, the following limits on per diem rates shall apply:
(i) The per diem charge for patients in both a morning and an
afternoon program on the same day shall not exceed 60 percent of the
facility's authorized per diem charge for inpatient services.
(ii) The per diem charge for patients in either a morning or
afternoon program shall not exceed 30 percent of the facility's
authorized per diem charge for inpatient services.
(i) The licensing fees charged for these facilities shall be
credited to the State Department of Social
Health Care Services for its costs incurred in the review of
psychiatric health facility programs, in connection with the
licensing of these facilities.
(j) (1) The State Department of Social
Health Care Services shall establish a system for the
imposition of prompt and effective civil sanctions against
psychiatric health facilities in violation of the laws and
regulations of this state pertaining to psychiatric health
facilities. If the State Department of Social
Health Care Services determines that there is or has been a
failure, in a substantial manner, on the part of a psychiatric health
facility to comply with the laws and regulations, the Director of
Social Health Care Services may impose
the following sanctions:
(A) Cease and desist orders.
(B) Monetary sanctions, which may be imposed in addition to the
penalties of suspension, revocation, or cease and desist orders. The
amount of monetary sanctions permitted to be imposed pursuant to this
subparagraph shall not be less than fifty dollars ($50) nor more
than one hundred dollars ($100) multiplied by the licensed bed
capacity, per day, for each violation. However, the monetary sanction
shall not exceed three thousand dollars ($3,000) per day. A facility
that is assessed a monetary sanction under this subparagraph, and
that repeats the deficiency, may, in accordance with the regulations
adopted pursuant to this subdivision, be subject to immediate
suspension of its license until the deficiency is corrected.
(2) The State Department of Social Health
Care Services shall may adopt
regulations necessary to implement this subdivision and paragraph (5)
of subdivision (f) 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).
(k) Proposed changes in the standards or regulations affecting
health facilities that serve the mentally disordered shall be
effected only with the review and coordination of the California
Health and Human Services Agency.
(l) In psychiatric health facilities where the clinical director
is not a physician, a psychiatrist, or if one is temporarily not
available, a physician shall be designated who shall direct those
medical treatments and services that can only be provided by, or
under the direction of, a physician.
SEC. 31. Section 5150 of the Welfare
and Institutions Code is amended to read:
5150. (a) When any person, as a result of
mental disorder, is a danger to others, or to himself or herself, or
gravely disabled, a peace officer, member of the attending staff, as
defined by regulation, of an evaluation facility designated by the
county, designated members of a mobile crisis team provided
by Section 5651.7, or other professional person designated
by the county may, upon probable cause, take, or cause to be taken,
the person into custody and place him or her in a facility designated
by the county and approved by the State Department of
Social Health Care Services as a facility for
72-hour treatment and evaluation.
The
(b) The facility shall require an
application in writing stating the circumstances under which the
person's condition was called to the attention of the officer, member
of the attending staff, or professional person, and stating that the
officer, member of the attending staff, or professional person has
probable cause to believe that the person is, as a result of mental
disorder, a danger to others, or to himself or herself, or gravely
disabled. If the probable cause is based on the statement of a person
other than the officer, member of the attending staff, or
professional person, the person shall be liable in a civil action for
intentionally giving a statement which he or she knows to be false.
SEC. 32. Section 5151 of the Welfare
and Institutions Code is amended to read:
5151. (a) If the facility for 72-hour
treatment and evaluation admits the person, it may detain him or her
for evaluation and treatment for a period not to exceed 72 hours.
Saturdays, Sundays, and holidays may be excluded from the 72-hour
period if the State Department of Social
Health Care Services certifies for each facility that
evaluation and treatment services cannot reasonably be made available
on those days. The certification by the department is subject to
renewal every two years. The department shall
may adopt regulations defining criteria for determining
whether a facility can reasonably be expected to make evaluation and
treatment services available on Saturdays, Sundays, and holidays.
Prior
(b) Prior to admitting a person
to the facility for 72-hour treatment and evaluation pursuant to
Section 5150, the professional person in charge of the facility or
his or her designee shall assess the individual in person to
determine the appropriateness of the involuntary detention.
If
(c) If in the judgment of the
professional person in charge of the facility providing evaluation
and treatment, or his or her designee, the person can be properly
served without being detained, he or she shall be provided
evaluation, crisis intervention, or other inpatient or outpatient
services on a voluntary basis.
Nothing
(d) Nothing in this section shall
be interpreted to prevent a peace officer from delivering
individuals to a designated facility for assessment under Section
5150. Furthermore, the preadmission assessment requirement of this
section shall not be interpreted to require peace officers to perform
any additional duties other than those specified in Sections 5150.1
and 5150.2.
SEC. 33. Section 5157 of the Welfare
and Institutions Code is amended to read:
5157. (a) Each person, at the time he or she is first taken into
custody under provisions of Section 5150, shall be provided, by the
person who takes such other person into custody, the following
information orally. The information shall be in substantially the
following form:
My name is ___________________________________ .
I am a ______________________________
(peace officer, mental health
______________ .
professional)
with ________________________ .
(name of agency)
You are not under criminal arrest, but I am
taking you for examination by mental health
professionals at _____________________________ .
____________________
(name of facility)
You will be told your rights by the mental
health staff.
If taken into custody at his or her residence,
the person shall also be told the following
information in substantially the following form:
You may bring a few personal items with you
which I will have to approve. You can make a
phone call and/or leave a note to tell your
friends and/or family where you have been taken.
(b) The designated facility shall keep, for each patient
evaluated, a record of the advisement given pursuant to subdivision
(a) which shall include:
(1) Name of person detained for evaluation.
(2) Name and position of peace officer or mental health
professional taking person into custody.
(3) Date.
(4) Whether advisement was completed.
(5) If not given or completed, the mental health professional at
the facility shall either provide the information specified in
subdivision (a), or include a statement of good cause, as defined by
regulations of the State Department of Social
Health Care Services, which shall be kept with the patient's
medical record.
(c) Each person admitted to a designated facility for 72-hour
evaluation and treatment shall be given the following information by
admission staff at the evaluation unit. The information shall be
given orally and in writing and in a language or modality accessible
to the person. The written information shall be available in the
person's native language or the language which is the person's
principal means of communication. The information shall be in
substantially the following form:
My name is ____________________________________.
My position here is____________________________.
You are being placed into the psychiatric unit
because it is our professional opinion that as
a result of mental disorder, you are likely to:
(check
applicable)
harm yourself
____
harm someone else
____
be unable to take care of your
own
food, clothing, and housing needs
____
We feel this is true because
________________________________________________
(herewith a listing of the facts upon which the
allegation of dangerous
or gravely disabled due to mental disorder is
based, including pertinent
facts arising from the admission interview.)
You will be held on the ward for a period up
to 72
hours.
This does not include weekends or holidays.
Your 72-hour period will begin ____________
(day
__________________
and time.)
During these 72 hours you will be evaluated by
the hospital staff, and you may be given
treatment, including medications. It is
possible for you to be released before the end
of the 72 hours. But if the staff decides that
you need continued treatment you can be
held for a longer period of time. If you are
held longer than 72 hours you have the right to
a lawyer and a qualified interpreter and a
hearing before a judge. If you are unable to
pay for the lawyer, then one will be provided
free.
(d) For each patient admitted for 72-hour evaluation and
treatment, the facility shall keep with the patient's medical record
a record of the advisement given pursuant to subdivision (c) which
shall include:
(1) Name of person performing advisement.
(2) Date.
(3) Whether advisement was completed.
(4) If not completed, a statement of good cause.
If the advisement was not completed at admission, the advisement
process shall be continued on the ward until completed. A record of
the matters prescribed by subdivisions (a), (b), and (c) shall be
kept with the patient's medical record.
SEC. 34. Section 5202 of the Welfare and
Institutions Code is amended to read:
5202. The person or agency designated by the county shall prepare
the petition and all other forms required in the proceeding, and
shall be responsible for filing the petition. Before filing the
petition, the person or agency designated by the county shall request
the person or agency designated by the county and approved by the
State Department of Social H ealth
Care Services to provide prepetition screening to determine
whether there is probable cause to believe the allegations. The
person or agency providing prepetition screening shall conduct a
reasonable investigation of the allegations and make a reasonable
effort to personally interview the subject of the petition. The
screening shall also determine whether the person will agree
voluntarily to receive crisis intervention services or an evaluation
in his own home or in a facility designated by the county and
approved by the State Department of Social
Health Care Services. Following prepetition screening, the
person or agency designated by the county shall file the petition if
satisfied that there is probable cause to believe that the person is,
as a result of mental disorder, a danger to others, or to himself or
herself, or gravely disabled, and that the person will not
voluntarily receive evaluation or crisis intervention.
If the petition is filed, it shall be accompanied by a report
containing the findings of the person or agency designated by the
county to provide prepetition screening. The prepetition screening
report submitted to the superior court shall be confidential and
shall be subject to the provisions of Section 5328.
SEC. 35. Section 5326.9 of the Welfare
and Institutions Code is amended to read:
5326.9. (a) Any alleged or suspected violation of the rights
described in Chapter 2 (commencing with Section 5150) shall be
investigated by the local director of mental health, or his or her
designee. Violations of Sections 5326.2 to 5326.8, inclusive,
concerning patients involuntarily detained for evaluation or
treatment under this part, or as a voluntary patient for psychiatric
evaluation or treatment to a health facility, as defined in Section
1250 of the Health and Safety Code, in which psychiatric evaluation
or treatment is offered, shall also be investigated by the Director
of Health Care Services, or his or her designee. Violations of
Sections 5326.2 to 5326.8, inclusive, concerning persons committed to
a state hospital shall also be investigated by the Director of State
Hospitals, or his or her designee. If it is determined by the local
director of mental health, the Director of Health Care Services, or
the Director of State Hospitals that a right has been violated, a
formal notice of violation shall be issued.
(b) Either the local director of mental health or the Director of
Health Care Services, upon issuing a notice of violation, may take
any or all of the following action:
(1) Assign a specified time period during which the violation
shall be corrected.
(2) Referral to the Medical Board of California or other
professional licensing agency. Such board shall investigate further,
if warranted, and shall subject the individual practitioner to any
penalty the board finds necessary and is authorized to impose.
(3) Make a recommendation to the State Department of
Social Services to revoke the approval of the county facility
designation. The local director of mental health may revoke
Revoke a facility's designation and
authorization under Section 5404 to evaluate and treat persons
detained involuntarily.
(4) Refer any violation of law to a local district attorney or the
Attorney General for prosecution in any court with jurisdiction.
(c) The Director of State Hospitals, upon issuing a notice of
violation, may take any or all of the following actions:
(1) Assign a specified time period during which the violation
shall be corrected.
(2) Make a referral to the Medical Board of California or other
professional licensing agency. The board or agency shall investigate
further, if warranted, and shall subject the individual practitioner
to any penalty the board finds necessary and is authorized to impose.
(3) Refer any violation of law to a local district attorney or the
Attorney General for prosecution in any court with jurisdiction.
(d) Any physician who intentionally violates Sections 5326.2 to
5326.8, inclusive, shall be subject to a civil penalty of not more
than five thousand dollars ($5,000) for each violation. The penalty
may be assessed and collected in a civil action brought by the
Attorney General in a superior court. Such intentional violation
shall be grounds for revocation of license.
(e) Any person or facility found to have knowingly violated the
provisions of the first paragraph of Section 5325.1 or to have denied
without good cause any of the rights specified in Section 5325 shall
pay a civil penalty, as determined by the court, of fifty dollars
($50) per day during the time in which the violation is not
corrected, commencing on the day on which a notice of violation was
issued, not to exceed one thousand dollars ($1,000), for each and
every violation, except that any liability under this provision shall
be offset by an amount equal to a fine or penalty imposed for the
same violation under the provisions of Sections 1423 to 1425,
inclusive, or 1428 of the Health and Safety Code. These penalties
shall be deposited in the general fund of the county in which the
violation occurred. The local district attorney or the Attorney
General shall enforce this section in any court with jurisdiction.
Where the State Department of Public Health, under the provisions of
Sections 1423 to 1425, inclusive, of the Health and Safety Code,
determines that no violation has occurred, the provisions of
paragraph (4) of subdivision (b) shall not apply.
(f) The remedies provided by this subdivision shall be in addition
to and not in substitution for any other remedies which an
individual may have under law.
SEC. 36. Section 5358 of the Welfare and
Institutions Code is amended to read:
5358. (a) (1) When ordered by the court after the hearing
required by this section, a conservator appointed pursuant to this
chapter shall place his or her conservatee as follows:
(A) For a conservatee who is gravely disabled, as defined in
subparagraph (A) of paragraph (1) of subdivision (h) of Section 5008,
in the least restrictive alternative placement, as designated by the
court.
(B) For a conservatee who is gravely disabled, as defined in
subparagraph (B) of paragraph (1) of subdivision (h) of Section 5008,
in a placement that achieves the purposes of treatment of the
conservatee and protection of the public.
(2) The placement may include a medical, psychiatric, nursing, or
other state-licensed facility, or a state hospital, county hospital,
hospital operated by the Regents of the University of California, a
United States government hospital, or other nonmedical facility
approved by the State Department of Social
Health Care Services or an agency accredited by the State
Department of Health Care Services, or in addition to any of the
foregoing, in cases of chronic alcoholism, to a county alcoholic
treatment center.
(b) A conservator shall also have the right, if specified in the
court order, to require his or her conservatee to receive treatment
related specifically to remedying or preventing the recurrence of the
conservatee's being gravely disabled, or to require his or her
conservatee to receive routine medical treatment unrelated to
remedying or preventing the recurrence of the conservatee's being
gravely disabled. Except in emergency cases in which the conservatee
faces loss of life or serious bodily injury, no surgery shall be
performed upon the conservatee without the conservatee's prior
consent or a court order obtained pursuant to Section 5358.2
specifically authorizing that surgery.
(c) (1) For a conservatee who is gravely disabled, as defined in
subparagraph (A) of paragraph (1) of subdivision (h) of Section 5008,
if the conservatee is not to be placed in his or her own home or the
home of a relative, first priority shall be to placement in a
suitable facility as close as possible to his or her home or the home
of a relative. For the purposes of this section, suitable facility
means the least restrictive residential placement available and
necessary to achieve the purpose of treatment. At the time that the
court considers the report of the officer providing conservatorship
investigation specified in Section 5356, the court shall consider
available placement alternatives. After considering all the evidence
the court shall determine the least restrictive and most appropriate
alternative placement for the conservatee. The court shall also
determine those persons to be notified of a change of placement. The
fact that a person for whom conservatorship is recommended is not an
inpatient shall not be construed by the court as an indication that
the person does not meet the criteria of grave disability.
(2) For a conservatee who is gravely disabled, as defined in
subparagraph (B) of paragraph (1) of subdivision (h) of Section 5008,
first priority shall be placement in a facility that achieves the
purposes of treatment of the conservatee and protection of the
public. The court shall determine the most appropriate placement for
the conservatee. The court shall also determine those persons to be
notified of a change of placement, and additionally require the
conservator to notify the district attorney or attorney representing
the originating county prior to any change of placement.
(3) For any conservatee, if requested, the local mental health
director shall assist the conservator or the court in selecting a
placement facility for the conservatee. When a conservatee who is
receiving services from the local mental health program is placed,
the conservator shall inform the local mental health director of the
facility's location and any movement of the conservatee to another
facility.
(d) (1) Except for a conservatee who is gravely disabled, as
defined in subparagraph (B) of paragraph (1) of subdivision (h) of
Section 5008, the conservator may transfer his or her conservatee to
a less restrictive alternative placement without a further hearing
and court approval. In any case in which a conservator has reasonable
cause to believe that his or her conservatee is in need of immediate
more restrictive placement because the condition of the conservatee
has so changed that the conservatee poses an immediate and
substantial danger to himself or herself or others, the conservator
shall have the right to place his or her conservatee in a more
restrictive facility or hospital. Notwithstanding Section 5328, if
the change of placement is to a placement more restrictive than the
court-determined placement, the conservator shall provide written
notice of the change of placement and the reason therefor to the
court, the conservatee's attorney, the county patient's rights
advocate and any other persons designated by the court pursuant to
subdivision (c).
(2) For a conservatee who is gravely disabled, as defined in
subparagraph (B) of paragraph (1) of subdivision (h) of Section 5008,
the conservator may not transfer his or her conservatee without
providing written notice of the proposed change of placement and the
reason therefor to the court, the conservatee's attorney, the county
patient's rights advocate, the district attorney of the county that
made the commitment, and any other persons designated by the court to
receive notice. If any person designated to receive notice objects
to the proposed transfer within 10 days after receiving notice, the
matter shall be set for a further hearing and court approval. The
notification and hearing is not required for the transfer of persons
between state hospitals.
(3) At a hearing where the conservator is seeking placement to a
less restrictive alternative placement pursuant to paragraph (2), the
placement shall not be approved where it is determined by a
preponderance of the evidence that the placement poses a threat to
the safety of the public, the conservatee, or any other individual.
(4) A hearing as to placement to a less restrictive alternative
placement, whether requested pursuant to paragraph (2) or pursuant to
Section 5358.3, shall be granted no more frequently than is provided
for in Section 5358.3.
SEC. 37. Section 5366.1 of the Welfare
and Institutions Code is amended to read:
5366.1. (a) Any person detained as of June
30, 1969, under court commitment, in a private institution, a county
psychiatric hospital, facility of the Veterans Administration, or
other agency of the United States government, community mental health
service, or detained in a state hospital or facility of the Veterans
Administration upon application of a local health officer, pursuant
to former Section 5567 or Sections 6000 to 6019, inclusive, as they
read immediately preceding July 1, 1969, may be detained, after
January 1, 1972, for a period no longer than 180 days, except as
provided in this section.
Any
(b) Any person detained pursuant
to this section on the effective date of this section shall be
evaluated by the facility designated by the county and approved by
the State Department of Social Health Care
Services pursuant to Section 5150 as a facility for 72-hour
treatment and evaluation. The evaluation shall be made at the request
of the person in charge of the institution in which the person is
detained. If in the opinion of the professional person in charge of
the evaluation and treatment facility or his or her designee, the
evaluation of the person can be made by the professional person or
his or her designee at the institution in which the person is
detained, the person shall not be required to be evaluated at the
evaluation and treatment facility, but shall be evaluated at the
institution where he or she is detained, or other place to determine
if the person is a danger to others, himself or herself, or gravely
disabled as a result of mental disorder.
Any
(c) Any person evaluated under
this section shall be released from the institution in which he or
she is detained immediately upon completion of the evaluation if in
the opinion of the professional person in charge of the evaluation
and treatment facility, or his or her designee, the person evaluated
is not a danger to others, or to himself or herself, or gravely
disabled as a result of mental disorder, unless the person agrees
voluntarily to remain in the institution in which he or she has been
detained.
If
(d) If in the opinion of the
professional person in charge of the facility or his or her designee,
the person evaluated requires intensive treatment or recommendation
for conservatorship, the professional person or his or her designee
shall proceed under Article 4 (commencing with Section 5250) of
Chapter 2, or under Chapter 3 (commencing with Section 5350), of Part
1 of Division 5.
If
(e) If it is determined from the
evaluation that the person is gravely disabled and a recommendation
for conservatorship is made, and if the petition for conservatorship
for the person is not filed by June 30, 1972, the court commitment or
detention under a local health officer application for the person
shall terminate and the patient shall be released unless he or she
agrees to accept treatment on a voluntary basis.
SEC. 38. Section 5404 of the Welfare
and Institutions Code is amended to read:
5404. (a) Each county may designate facilities, which are not
hospitals or clinics, as 72-hour evaluation and treatment facilities
and as 14-day intensive treatment facilities if the facilities meet
those requirements as the Director of Social
Health Care Services shall may
establish by regulation. The Director of Social
Health Care Services shall encourage the use by counties
of appropriate facilities, which are not hospitals or clinics, for
the evaluation and treatment of patients pursuant to this part.
(b) All regulations relating to the approval of facilities
designated by the county for 72-hour treatment and evaluation and
14-day intensive treatment facilities, heretofore adopted by the
State Department of Mental Health , or a successor , shall
remain in effect and shall be fully enforceable by the State
Department of Social Health Care
Services with respect to any facility or program required to be
approved as a facility for 72-hour treatment and evaluation and
14-day intensive treatment facilities, unless and until readopted,
amended, or repealed by the Director of Social
Health Care Services. The State Department of
Social Health Care Services shall succeed to and
be vested with all duties, powers, purposes, functions,
responsibilities, and jurisdiction of the State Department of Mental
Health , or a successor, as they relate to approval of
facilities for 72-hour treatment and evaluation and 14-day intensive
treatment facilities.
SEC. 39. Section 5405 of the Welfare
and Institutions Code is amended to read:
5405. (a) This section shall apply to each facility licensed by
the State Department of Social Health Care
Services, or its delegated agent, on or after January 1, 2003.
For purposes of this section, "facility" means psychiatric health
facilities, as defined in Section 1250.2 of the Health and Safety
Code, licensed pursuant to Chapter 9 (commencing with Section 77001)
of Division 5 of Title 22 of the California Code of Regulations and
mental health rehabilitation centers licensed pursuant to Chapter 3.5
(commencing with Section 781.00) of Division 1 of Title 9 of the
California Code of Regulations.
(b) (1) (A) Prior to the initial licensure or first renewal of a
license on or after January 1, 2003, of any person to operate or
manage a facility specified in subdivision (a), the applicant or
licensee shall submit fingerprint images and related information
pertaining to the applicant or licensee to the Department of Justice
for purposes of a criminal record check, as specified in paragraph
(2), at the expense of the applicant or licensee. The Department of
Justice shall provide the results of the criminal record check to the
department State Department of Health Care
Services . The department State
Department of Health Care Services may take into consideration
information obtained from or provided by other government agencies.
The department State Department of Health
Care Services shall determine whether the applicant or licensee
has ever been convicted of a crime specified in subdivision (c). The
applicant or licensee shall submit fingerprint images and related
information each time the position of administrator, manager, program
director, or fiscal officer of a facility is filled and prior to
actual employment for initial licensure or an individual who is
initially hired on or after January 1, 2003. For purposes of this
subdivision, "applicant" and "licensee" include the administrator,
manager, program director, or fiscal officer of a facility.
(B) Commencing July 1, 2012, 2013,
upon the employment of, or contract with or for, any direct care
staff, the direct care staff person or licensee shall submit
fingerprint images and related information pertaining to the direct
care staff person to the Department of Justice for purposes of a
criminal record check, as specified in paragraph (2), at the expense
of the direct care staff person or licensee. The Department of
Justice shall provide the results of the criminal record check to the
department State Department of Health Care
Services . The department State
Department of Health Care Service s shall determine
whether the direct care staff person has ever been convicted of a
crime specified in subdivision (c). The department
State Department of Health Care Services shall notify the
licensee of these results. No direct client contact by the trainee
or newly hired staff, or by any direct care contractor shall occur
prior to clearance by the department State
Department of Health Care Services unless the trainee, newly
hired employee, contractor, or employee of the contractor is
constantly supervised.
(C) Commencing July 1, 2012, 2013,
any contract for services provided directly to patients or residents
shall contain provisions to ensure that the direct services
contractor submits to the Department of Justice fingerprint images
and related information pertaining to the direct services contractor
for submission to the State Department of Social
Health Care Services for purposes of a criminal record
check, as specified in paragraph (2), at the expense of the direct
services contractor or licensee. The Department of Justice shall
provide the results of the criminal record check to the
department State Department of Health Care Services
. The department State Department of
Health Care Services shall determine whether the direct
services contractor has ever been convicted of a crime specified in
subdivision (c). The department State
Department of Health Care Services shall notify the licensee of
these results.
(2) If the applicant, licensee, direct care staff person, or
direct services contractor specified in paragraph (1) has resided in
California for at least the previous seven years, the applicant,
licensee, direct care staff person, or direct services contractor
shall only submit one set of fingerprint images and related
information to the Department of Justice. The Department of Justice
shall charge a fee sufficient to cover the reasonable cost of
processing the fingerprint submission. Fingerprints and related
information submitted pursuant to this subdivision include
fingerprint images captured and transmitted electronically. When
requested, the Department of Justice shall forward one set of
fingerprint images to the Federal Bureau of Investigation for the
purpose of obtaining any record of previous convictions or arrests
pending adjudication of the applicant, licensee, direct care staff
person, or direct services contractor. The results of a criminal
record check provided by the Department of Justice shall contain
every conviction rendered against an applicant, licensee, direct care
staff person, or direct services contractor, and every offense for
which the applicant, licensee, direct care staff person, or direct
services contractor is presently awaiting trial, whether the person
is incarcerated or has been released on bail or on his or her own
recognizance pending trial. The department
State Department of the
Health Care Services shall request subsequent arrest
notification from the Department of Justice pursuant to Section
11105.2 of the Penal Code.
(3) An applicant and any other person specified in this
subdivision, as part of the background clearance process, shall
provide information as to whether or not the person has any prior
criminal convictions, has had any arrests within the past 12-month
period, or has any active arrests, and shall certify that, to the
best of his or her knowledge, the information provided is true. This
requirement is not intended to duplicate existing requirements for
individuals who are required to submit fingerprint images as part of
a criminal background clearance process. Every applicant shall
provide information on any prior administrative action taken against
him or her by any federal, state, or local government agency and
shall certify that, to the best of his or her knowledge, the
information provided is true. An applicant or other person required
to provide information pursuant to this section that knowingly or
willfully makes false statements, representations, or omissions may
be subject to administrative action, including, but not limited to,
denial of his or her application or exemption or revocation of any
exemption previously granted.
(c) (1) The State Department of Social
Health Care Services shall deny any application for any
license, suspend or revoke any existing license, and disapprove or
revoke any employment or contract for direct services, if the
applicant, licensee, employee, or direct services contractor has been
convicted of, or incarcerated for, a felony defined in subdivision
(c) of Section 667.5 of, or subdivision (c) of Section 1192.7 of, the
Penal Code, within the preceding 10 years.
(2) The application for licensure or renewal of any license shall
be denied, and any employment or contract to provide direct services
shall be disapproved or revoked, if the criminal record of the person
includes a conviction in another jurisdiction for an offense that,
if committed or attempted in this state, would have been punishable
as one or more of the offenses referred to in paragraph (1).
(d) (1) The State Department of Social
Health Care Services may approve an application for, or renewal
of, a license, or continue any employment or contract for direct
services, if the person has been convicted of a misdemeanor offense
that is not a crime upon the person of another, the nature of which
has no bearing upon the duties for which the person will perform as a
licensee, direct care staff person, or direct services contractor.
In determining whether to approve the application, employment, or
contract for direct services, the department shall take into
consideration the factors enumerated in paragraph (2).
(2) Notwithstanding subdivision (c), if the criminal record of a
person indicates any conviction other than a minor traffic violation,
the State Department of Social Health Care
Services may deny the application for license or renewal, and
may disapprove or revoke any employment or contract for direct
services. In determining whether or not to deny the application for
licensure or renewal, or to disapprove or revoke any employment or
contract for direct services, the department shall take into
consideration the following factors:
(A) The nature and seriousness of the offense under consideration
and its relationship to the person's employment, duties, and
responsibilities.
(B) Activities since conviction, including employment or
participation in therapy or education, that would indicate changed
behavior.
(C) The time that has elapsed since the commission of the conduct
or offense and the number of offenses.
(D) The extent to which the person has complied with any terms of
parole, probation, restitution, or any other sanction lawfully
imposed against the person.
(E) Any rehabilitation evidence, including character references,
submitted by the person.
(F) Employment history and current employer recommendations.
(G) Circumstances surrounding the commission of the offense that
would demonstrate the unlikelihood of repetition.
(H) The granting by the Governor of a full and unconditional
pardon.
(I) A certificate of rehabilitation from a superior court.
(e) Denial, suspension, or revocation of a license, or disapproval
or revocation of any employment or contract for direct services
specified in subdivision (c) and paragraph (2) of subdivision (d) are
not subject to appeal, except as provided in subdivision (f).
(f) After a review of the record, the director may grant an
exemption from denial, suspension, or revocation of any license, or
disapproval of any employment or contract for direct services, if the
crime for which the person was convicted was a property crime that
did not involve injury to any person and the director has substantial
and convincing evidence to support a reasonable belief that the
person is of such good character as to justify issuance or renewal of
the license or approval of the employment or contract.
(g) A plea or verdict of guilty, or a conviction following a plea
of nolo contendere shall be deemed a conviction within the meaning of
this section. The State Department of Social
Health Care Services may deny any application, or deny,
suspend, or revoke a license, or disapprove or revoke any employment
or contract for direct services based on a conviction specified in
subdivision (c) when the judgment of conviction is entered or when an
order granting probation is made suspending the imposition of
sentence.
(h) (1) For purposes of this section, "direct care staff" means
any person who is an employee, contractor, or volunteer who has
contact with other patients or residents in the provision of
services. Administrative and licensed personnel shall be considered
direct care staff when directly providing program services to
participants.
(2) An additional background check shall not be required pursuant
to this section if the direct care staff or licensee has received a
prior criminal history background check while working in a mental
health rehabilitation center or psychiatric health facility licensed
by the State Department of Social Health Care
Services, and provided the department has maintained continuous
subsequent arrest notification on the individual from the Department
of Justice since the prior criminal background check was initiated.
(3) When an application is denied on the basis of a conviction
pursuant to this section, the State Department of Social
Health Care Services shall provide the
individual whose application was denied with notice, in writing, of
the specific grounds for the proposed denial.
SEC. 40. Section 5585.21 of the Welfare
and Institutions Code is amended to read:
5585.21. The Director of Social Health
Care Services may promulgate regulations as necessary to
implement and clarify the provisions of this part as they relate to
minors.
SEC. 41. Section 5585.50 of the Welfare
and Institutions Code is amended to read:
5585.50. (a) When any minor, as a result of
mental disorder, is a danger to others, or to himself or herself, or
gravely disabled and authorization for voluntary treatment is not
available, a peace officer, member of the attending staff, as defined
by regulation, of an evaluation facility designated by the county,
designated members of a mobile crisis team provided by
Section 5651.7, or other professional person designated by
the county may, upon probable cause, take, or cause to be taken, the
minor into custody and place him or her in a facility designated by
the county and approved by the State Department of Social
Health Care Services as a facility for 72-hour
treatment and evaluation of minors. The facility shall make every
effort to notify the minor's parent or legal guardian as soon as
possible after the minor is detained.
The
(b) The facility shall require an
application in writing stating the circumstances under which the
minor's condition was called to the attention of the officer, member
of the attending staff, or professional person, and stating that the
officer, member of the attending staff, or professional person has
probable cause to believe that the minor is, as a result of mental
disorder, a danger to others, or to himself or herself, or gravely
disabled and authorization for voluntary treatment is not available.
If the probable cause is based on the statement of a person other
than the officer, member of the attending staff, or professional
person, the person shall be liable in a civil action for
intentionally giving a statement which he or she knows to be false.
SEC. 42. Section 5585.55 of the Welfare
and Institutions Code is amended to read:
5585.55. The minor committed for involuntary treatment under this
part shall be placed in a mental health facility
designated by the county and approved by the State Department of
Social Health Care Services as a
facility for 72-hour evaluation and treatment. Except as provided for
in Section 5751.7, each county shall ensure that minors under 16
years of age are not held with adults receiving psychiatric treatment
under the provisions of the Lanterman-Petris-Short Act (Part 1
(commencing with Section 5000)).
SEC. 43. Section 5675 of the Welfare and
Institutions Code is amended to read:
5675. (a) Mental health rehabilitation centers shall only be
licensed by the State Department of Social
Health Care Services subsequent to application by counties,
county contract providers, or other organizations. In the application
for a mental health rehabilitation center, program evaluation
measures shall include, but not be limited to:
(1) That the clients placed in the facilities show improved global
assessment scores, as measured by preadmission and postadmission
tests.
(2) That the clients placed in the facilities demonstrate improved
functional behavior as measured by preadmission and postadmission
tests.
(3) That the clients placed in the facilities have reduced
medication levels as determined by comparison of preadmission and
postadmission records.
(b) The State Department of Social Health
Care Services shall conduct annual licensing inspections of
mental health rehabilitation centers.
(c) All regulations relating to the licensing of mental health
rehabilitation centers, heretofore adopted by the State Department of
Mental Health, or its successor,
shall remain in effect and shall be fully enforceable by the State
Department of Social Health Care
Services with respect to any facility or program required to be
licensed as a mental health rehabilitation center, unless and until
readopted, amended, or repealed by the Director of Social
Health Care Services. The State Department of
Social Health Care Services shall
succeed to and be vested with all duties, powers, purposes,
functions, responsibilities, and jurisdiction of the State Department
of Mental Health , and its successor, if any, as they
relate to licensing mental health rehabilitation centers.
SEC. 44. Section 5675.1 of the Welfare
and Institutions Code is amended to read:
5675.1. (a) In accordance with subdivision (b), the
State Department of Social Services and the State
Department of Health Care Services may establish a system for the
imposition of prompt and effective civil sanctions for long-term care
facilities licensed or certified by those departments
the department , including facilities licensed
under the provisions of Sections 5675 and 5768, and including
facilities certified as providing a special treatment program under
Sections 72443 to 72474, 72475,
inclusive, of Title 22 of the California Code of Regulations.
(b) If the departments determine
department determines that there is or has been a failure, in a
substantial manner, on the part of any such facility to comply with
the applicable laws and regulations, the directors
director may impose the following sanctions:
(1) A plan of corrective action that addresses all failure
identified by the departments department
and includes timelines for correction.
(2) A facility that is issued a plan of corrective action, and
that fails to comply with the plan and repeats the deficiency, may be
subject to immediate suspension of its license or certification,
until the deficiency is corrected, when failure to comply with the
plan of correction may cause a health or safety risk to residents.
(c) The departments department may
also establish procedures for the appeal of an administrative action
taken pursuant to this section, including a plan of corrective action
or a suspension of license or certification.
SEC. 45. Section 5675.2 of the Welfare
and Institutions Code is amended to read:
5675.2. (a) There is hereby created in the State Treasury the
Mental Health Facility Licensing Fund, from which money, upon
appropriation by the Legislature in the Budget Act, shall be expended
by the State Department of Social Health
Care Services to fund administrative and other activities in
support of the mental health licensing and certification functions of
the State Department of Social Health Care
Services. The Mental Health Facility Licensing Fund is the
successor to the Licensing and Certification Fund, Mental Health,
which fund is hereby abolished. All references in any law to the
Licensing and Certification Fund, Mental Health shall be deemed to
refer to the Mental Health Facility Licensing Fund.
(b) Commencing January 1, 2005, each new and renewal application
for a license to operate a mental health rehabilitation center shall
be accompanied by an application or renewal fee.
(c) The amount of the fees shall be determined and collected by
the State Department of Social Health Care
Services, but the total amount of the fees collected shall not
exceed the actual costs of licensure and regulation of the centers,
including, but not limited to, the costs of processing the
application, inspection costs, and other related costs.
(d) Each license or renewal issued pursuant to this chapter shall
expire 12 months from the date of issuance. Application for renewal
of the license shall be accompanied by the necessary fee and shall be
filed with the department at least 30 days prior to the expiration
date. Failure to file a timely renewal may result in expiration of
the license.
(e) License and renewal fees collected pursuant to this section
shall be deposited into the Mental Health Facility Licensing Fund.
(f) Fees collected by the State Department of Social
Health Care Services pursuant to this section
shall be expended by the State Department of Social
Health Care Services for the purpose of ensuring
the health and safety of all individuals providing care and
supervision by licensees and to support activities of the department,
including, but not limited to, monitoring facilities for compliance
with applicable laws and regulations.
(g) The State Department of Social Health
Care Services may make additional charges to the facilities if
additional visits are required to ensure that corrective action is
taken by the licensee.
SEC. 46. Section 5751.7 of the Welfare
and Institutions Code is amended to read:
5751.7. (a) For the purposes of this part
and the Lanterman-Petris-Short Act (Part 1 (commencing with Section
5000)), the State Department of Social Health
Care Services and the State Department of State Hospitals
shall ensure that, whenever feasible, minors shall not be admitted
into psychiatric treatment with adults if the health facility has no
specific separate housing arrangements, treatment staff, and
treatment programs designed to serve children or adolescents. The
Director of Social Health Care Services
shall provide waivers to counties, upon their request, if this policy
creates undue hardship in any county due to inadequate or
unavailable alternative resources. In granting the waivers, the
Director of Social Health Care Services
shall require the county to establish specific treatment protocols
and administrative procedures for identifying and providing
appropriate treatment to minors admitted with adults.
However,
(b) However, notwithstanding any
other provision of law, no minor may be admitted for psychiatric
treatment into the same treatment ward as any adult receiving
treatment who is in the custody of any jailor for a violent crime, is
a known registered sex offender, or has a known history of, or
exhibits inappropriate, sexual, or other violent behavior which would
present a threat to the physical safety of minors.
SEC. 47. Section 5768 of the Welfare
and Institutions Code is amended to read:
5768. (a) Notwithstanding any other provision of law, except as
to requirements relating to fire and life safety of persons with
mental illness, the State Department of Social
Health Care Services, in its discretion, may permit new
programs to be developed and implemented without complying with
licensure requirements established pursuant to existing state law.
(b) Any program developed and implemented pursuant to subdivision
(a) shall be reviewed at least once each six months, as determined by
the State Department of Social Health Care
Services.
(c) The State Department of Social Health
Care Services may establish appropriate licensing requirements
for these new programs upon a determination that the programs should
be continued.
(d) Within six years, any program shall require a licensure
category if it is to be continued. However, in the event that any
agency other than the State Department of Social
Health Care Services is responsible for developing a
licensure category and fails to do so within the six years, the
program may continue to be developed and implemented pursuant to
subdivisions (a) and (b) until such time that the licensure category
is established.
(e) (1) A nongovernmental entity proposing a program shall submit
a program application and plan to the local mental health director
that describes at least the following components: clinical treatment
programs, activity programs, administrative policies and procedures,
admissions, discharge planning, health records content, health
records service, interdisciplinary treatment teams, client
empowerment, patient rights, pharmaceutical services, program space
requirements, psychiatric and psychological services, rehabilitation
services, restraint and seclusion, space, supplies, equipment, and
staffing standards. If the local mental health director determines
that the application and plan are consistent with local needs and
satisfactorily address the above components, he or she may approve
the application and plan and forward them to the department.
(2) Upon the State Department of Social
Health Care Services' approval, the local mental health
director shall implement the program and shall be responsible for
regular program oversight and monitoring. The department shall be
notified in writing of the outcome of each review of the program by
the local mental health director, or his or her designee, for
compliance with program requirements. The department shall retain
ultimate responsibility for approving the method for review of each
program, and the authority for determining the appropriateness of the
local program's oversight and monitoring activities.
(f) Governmental entities proposing a program shall submit a
program application and plan to the State Department of
Social Health Care Services that describes at
least the components described in subdivision (e). Upon approval, the
department shall be responsible for program oversight and
monitoring.
(g) Implementation of a program shall be contingent upon the State
Department of Social Health Care
Services' approval, and the department may reject applications or
require modifications as it deems necessary. The department shall
respond to each proposal within 90 days of receipt.
(h) The State Department of Social Health
Care Services shall submit an evaluation to the Legislature of
all pilot projects authorized pursuant to this section within five
years of the commencement of operation of the pilot project,
determining the effectiveness of that program or facility, or both,
based on, but not limited to, changes in clinical indicators with
respect to client functions.
SEC. 48. Section 5840 of the Welfare
and Institutions Code is amended to read:
5840. (a) The State Department of Health Care Services, in
coordination with counties, shall establish a program designed to
prevent mental illnesses from becoming severe and disabling. The
program shall emphasize improving timely access to services for
underserved populations.
(b) The program shall include the following components:
(1) Outreach to families, employers, primary care health care
providers, and others to recognize the early signs of potentially
severe and disabling mental illnesses.
(2) Access and linkage to medically necessary care provided by
county mental health programs for children with severe mental
illness, as defined in Section 5600.3, and for adults and seniors
with severe mental illness, as defined in Section 5600.3, as early in
the onset of these conditions as practicable.
(3) Reduction in stigma associated with either being diagnosed
with a mental illness or seeking mental health services.
(4) Reduction in discrimination against people with mental
illness.
(c) The program shall include mental health services similar to
those provided under other programs effective in preventing mental
illnesses from becoming severe, and shall also include components
similar to programs that have been successful in reducing the
duration of untreated severe mental illnesses and assisting people in
quickly regaining productive lives.
(d) The program shall emphasize strategies to reduce the following
negative outcomes that may result from untreated mental illness:
(1) Suicide.
(2) Incarcerations.
(3) School failure or dropout.
(4) Unemployment.
(5) Prolonged suffering.
(6) Homelessness.
(7) Removal of children from their homes.
(e) Prevention and early intervention funds may be used to broaden
the provision of community-based mental health services by adding
prevention and early intervention services or activities to these
services.
(f) In consultation with mental health stakeholders, and
consistent with guidelines regulations
from the Mental Health Services Oversight and Accountability
Commission, pursuant to Section 5846, the department shall revise the
program elements in Section 5840 applicable to all county mental
health programs in future years to reflect what is learned about the
most effective prevention and intervention programs for children,
adults, and seniors.
SEC. 49. Section 5845 of the Welfare
and Institutions Code is amended to read:
5845. (a) The Mental Health Services Oversight and Accountability
Commission is hereby established to oversee Part 3 (commencing with
Section 5800), the Adult and Older Adult Mental Health System of Care
Act; Part 3.1 (commencing with Section 5820), Human Resources,
Education, and Training Programs; Part 3.2 (commencing with Section
5830), Innovative Programs; Part 3.6 (commencing with Section 5840),
Prevention and Early Intervention Programs; and Part 4 (commencing
with Section 5850), the Children's Mental Health Services Act. The
commission shall replace the advisory committee established pursuant
to Section 5814. The commission shall consist of 16 voting members as
follows:
(1) The Attorney General or his or her designee.
(2) The Superintendent of Public Instruction or his or her
designee.
(3) The Chairperson of the Senate Health and Human Services
Committee or another member of the Senate selected by the President
pro Tempore of the Senate.
(4) The Chairperson of the Assembly Health Committee or another
member of the Assembly selected by the Speaker of the Assembly.
(5) Two persons with a severe mental illness, a family member of
an adult or senior with a severe mental illness, a family member of a
child who has or has had a severe mental illness, a physician
specializing in alcohol and drug treatment, a mental health
professional, a county sheriff, a superintendent of a school
district, a representative of a labor organization, a representative
of an employer with less than 500 employees and a representative of
an employer with more than 500 employees, and a representative of a
health care services plan or insurer, all appointed by the Governor.
In making appointments, the Governor shall seek individuals who have
had personal or family experience with mental illness.
(b) Members shall serve without compensation, but shall be
reimbursed for all actual and necessary expenses incurred in the
performance of their duties.
(c) The term of each member shall be three years, to be staggered
so that approximately one-third of the appointments expire in each
year.
(d) In carrying out its duties and responsibilities, the
commission may do all of the following:
(1) Meet at least once each quarter at any time and location
convenient to the public as it may deem appropriate. All meetings of
the commission shall be open to the public.
(2) Within the limit of funds allocated for these purposes,
pursuant to the laws and regulations governing state civil service,
employ staff, including any clerical, legal, and technical assistance
as may appear necessary. The commission shall administer its
operations separate and apart from the State Department of Health
Care Services and the California Health and Human Services
Agency .
(3) Establish technical advisory committees such as a committee of
consumers and family members.
(4) Employ all other appropriate strategies necessary or
convenient to enable it to fully and adequately perform its duties
and exercise the powers expressly granted, notwithstanding any
authority expressly granted to any officer or employee of state
government.
(5) Enter into contracts.
(6) Obtain data and information from the State Department of
Health Care Services, the Office of Statewide Health Planning and
Development, or other state or local entities that receive Mental
Health Services Act funds, for the commission to
utilize in its oversight, review, training and
technical assistance, accountability, and evaluation capacity
regarding projects and programs supported with Mental Health Services
Act funds.
(7) Participate in the joint state-county decisionmaking process,
as contained in Section 4061, for training, technical assistance, and
regulatory resources to meet the mission and goals of the state's
mental health system.
(8) Develop strategies to overcome stigma and discrimination, and
accomplish all other objectives of Part 3.2 (commencing with Section
5830), 3.6 (commencing with Section 5840), and the other provisions
of the act establishing this commission.
(9) At any time, advise the Governor or the Legislature regarding
actions the state may take to improve care and services for people
with mental illness.
(10) If the commission identifies a critical issue related to the
performance of a county mental health program, it may refer the issue
to the State Department of Health Care Services pursuant to Section
5655.
(11) Assist in providing technical assistance to accomplish the
purposes of the Mental Health Services Act, Part 3 (commencing with
Section 5800), and Part 4 (commencing with Section 5850) in
collaboration with the State Department of Health Care Services and
in consultation with the California Mental Health Directors
Association.
(12) Work in collaboration with the State Department of Health
Care Services and the California Mental Health Planning Council, and
in consultation with the California Mental Health Directors
Association, in designing a comprehensive joint plan for a
coordinated evaluation of client outcomes in the community-based
mental health system, including, but not limited to, parts listed in
subdivision (a). The California Health and Human Services Agency
shall lead this comprehensive joint plan effort.
SEC. 50. Section 5846 of the Welfare and
Institutions Code is amended to read:
5846. (a) The commission shall issue guidelines for
adopt regulations for programs and expenditures
pursuant to Part 3.2 (commencing with Section 5830), for innovative
programs, and Part 3.6 (commencing with Section 5840), for prevention
and early intervention , no later than 180 days before the
fiscal year for which the funds will apply .
(b) Any regulations adopted by the department pursuant to Section
5898 shall be consistent with the commission's regulations.
(b)
(c) The commission may provide technical assistance to
any county mental health plan as needed to address concerns or
recommendations of the commission or when local programs could
benefit from technical assistance for improvement of their plans.
(c)
(d) The commission shall ensure that the perspective
and participation of diverse community members reflective of
California populations and others suffering from severe mental
illness and their family members is a significant factor in all of
its decisions and recommendations.
SEC. 51. Section 5909 of the Welfare
and Institutions Code is amended to read:
5909. (a) The Director of Health Care
Services shall retain the authority and responsibility to monitor and
approve special treatment programs in skilled nursing facilities in
accordance with Sections 72443 to 72474 72475
, inclusive, of Title 22 of the California Code of
Regulations.
(b) The State Department of Health Care Services shall conduct
annual certification inspections of special treatment programs for
the mentally disordered for the purpose of approving the special
treatment programs that are located in skilled nursing facilities
licensed pursuant to Section 1265 of the Health and Safety Code.
SEC. 52. Section 6007 of the Welfare
and Institutions Code is amended to read:
6007. Any person detained as of June 30, 1969, in a private
institution, pursuant to former Sections 6030 to 6033, inclusive, as
they read immediately preceding July 1, 1969, on the certification of
one physician, may be detained after July 1, 1969, for a period no
longer than 90 days.
Any
person detained as of June 30, 1969, in a private institution,
pursuant to such sections, on the certification of two physicians,
may be detained after July 1, 1969, for a period no longer than 180
days.
Any
6007. (a) Any person
detained pursuant to this section after July 1, 1969,
shall be evaluated by the facility designated by the county
and approved by the State Department of Social
Health Care Services pursuant to Section 5150 as a
facility for 72-hour treatment and evaluation. The evaluation shall
be made at the request of the person in charge of the private
institution in which the person is detained or by one of the
physicians who signed the certificate. If in the opinion of the
professional person in charge of the evaluation and treatment
facility or his or her designee, the evaluation of the person can be
made by the professional person or his or her designee at the private
institution in which the person is detained, the person shall not be
required to be evaluated at the evaluation and treatment facility,
but shall be evaluated at the private institution to determine if the
person is a danger to others, himself or herself, or gravely
disabled as a result of mental disorder.
Any
(b) Any person evaluated under
this section shall be released from the private institution
immediately upon completion of the evaluation if in the opinion of
the professional person in charge of the evaluation and treatment
facility, or his or her designee, the person evaluated is not a
danger to others, or to himself or herself, or gravely disabled as a
result of mental disorder, unless the person agrees voluntarily to
remain in the private institution.
If
(c) If in the opinion of the
professional person in charge of the facility or his or her designee,
the person evaluated requires intensive treatment or recommendation
for conservatorship, the professional person or his or her designee
shall proceed under Article 4 (commencing with Section 5250) of
Chapter 2, or under Chapter 3 (commencing with Section 5350), of Part
1 of Division 5.
SEC. 53. Section 6551 of the Welfare
and Institutions Code is amended to read:
6551. (a) If the court is in doubt as to
whether the person is mentally disordered or mentally
retarded intellectually disabled , the court
shall order the person to be taken to a facility designated by the
county and approved by the State Department of Social
Health Care Services as a facility
for 72-hour treatment and evaluation. Thereupon, Article 1
(commencing with Section 5150) of Chapter 2 of Part 1 of Division 5
applies, except that the professional person in charge of the
facility shall make a written report to the court concerning the
results of the evaluation of the person's mental condition. If the
professional person in charge of the facility finds the person is, as
a result of mental disorder, in need of intensive treatment, the
person may be certified for not more than 14 days of involuntary
intensive treatment if the conditions set forth in subdivision (c) of
Section 5250 and subdivision (b) of Section 5260 are complied with.
Thereupon, Article 4 (commencing with Section 5250) of Chapter 2 of
Part 1 of Division 5 shall apply to the person. The person may be
detained pursuant to Article 4.5 (commencing with Section 5260), or
Article 4.7 (commencing with Section 5270.10), or Article 6
(commencing with Section 5300) of Part 1 of Division 5 if that
article applies.
If
(b) If the professional person in
charge of the facility finds that the person is mentally
retarded intellectually disabled , the juvenile
court may direct the filing in any other court of a petition for the
commitment of a minor as a mentally retarded
an intellectually disabled person to the State Department of
Developmental Services for placement in a state hospital. In such
case, the juvenile court shall transmit to the court in which the
petition is filed a copy of the report of the professional person in
charge of the facility in which the minor was placed for observation.
The court in which the petition for commitment is filed may accept
the report of the professional person in lieu of the appointment, or
subpoenaing, and testimony of other expert witnesses appointed by the
court, if the laws applicable to such commitment proceedings provide
for the appointment by court of medical or other expert witnesses or
may consider the report as evidence in addition to the testimony of
medical or other expert witnesses.
If
(c ) If the
professional person in charge of the facility for 72-hour evaluation
and treatment reports to the juvenile court that the minor is not
affected with any mental disorder requiring intensive treatment or
mental retardation intellectual disability
, the professional person in charge of the facility shall
return the minor to the juvenile court on or before the expiration of
the 72-hour period and the court shall proceed with the case in
accordance with the Juvenile Court Law.
Any
(d) Any expenditure for the
evaluation or intensive treatment of a minor under this section shall
be considered an expenditure made under Part 2 (commencing with
Section 5600) of Division 5 and shall be reimbursed by the state as
are other local expenditures pursuant to that part.
The
(e) The jurisdiction of the
juvenile court over the minor shall be suspended during the time that
the minor is subject to the jurisdiction of the court in which the
petition for postcertification treatment of an imminently dangerous
person or the petition for commitment of a mentally retarded
an intellectually disabled person is filed or
under remand for 90 days for intensive treatment or commitment
ordered by the court.
SEC. 54. Section 7100 of the Welfare
and Institutions Code is amended to read:
7100. (a) The board of supervisors of each
county may maintain in the county hospital or in any other hospital
situated within or without the county or in any other psychiatric
health facility situated within or without the county, suitable
facilities and nonhospital or hospital service for the detention,
supervision, care, and treatment of persons who are mentally
disordered or developmentally disabled, or who are alleged to be
such.
The
(b) The county may contract with
public or private hospitals for those facilities and hospital service
when they are not suitably available in any institution, psychiatric
facility, or establishment maintained or operated by the county.
The
(c) The facilities and services
for the mentally disordered and allegedly mentally disordered shall
be subject to the approval of the State Department of Social
Health Care Services, and the facilities and
services for the developmentally disabled and allegedly
developmentally disabled shall be subject to the approval of the
State Department of Developmental Services. The professional person
having charge and control of the hospital or psychiatric health
facility shall allow the department whose approval is required to
make investigations thereof as it deems necessary at any time.
Nothing
(d) Nothing in this chapter means
that mentally disordered or developmentally disabled persons may not
be detained, supervised, cared for, or treated, subject to the right
of inquiry or investigation by the department, in their own homes,
or the homes of their relatives or friends, or in a licensed
establishment.
SEC. 55. Section 14005.281 is added to the
Welfare and Institutions Code , immediately following
Section 14005.28, to read:
14005.281. (a) The department shall maintain eligibility for all
former independent foster care adolescents who were receiving
services pursuant to Section 14005.28 on or after July 1, 2013, but
no later than December 31, 2013, and lost Medi-Cal coverage as a
result of attaining 21 years of age.
(b) Subdivision (a) shall be implemented using state general funds
to the extent federal financial participation is not available.
(c) This section shall remain in effect only until January 1,
2014, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2014, deletes or extends
that date.
SEC. 56. Section 14100.3 is added to the
Welfare and Institutions Code , to read:
14100.3. (a) The State Department of Health Care Services shall
post on its Internet Web site all submitted state plan amendments and
all federal waiver applications and requests for new waivers, waiver
amendments, and waiver renewals and extensions, within 10 business
days from the date the department submits these documents for
approval to the federal Centers for Medicare and Medicaid Services
(CMS).
(b) The department shall post on its Internet Web site final
approval or denial letters and accompanying documents for all
submitted state plan amendments and federal waiver applications and
requests within 10 business days from the date the department
receives notification of final approval or denial from CMS.
(c) If the department notifies CMS of the withdrawal of a
submitted state plan amendment or federal waiver application or
request, as described in subdivisions (a) and (b), the department
shall post on its Internet Web site the withdrawal notification
within 10 business days from the date the department notifies CMS of
the withdrawal.
(d) Unless already posted on the Internet Web site pursuant to
subdivisions (a) to (c), inclusive, the department shall post on its
Internet Web site all pending submitted state plan amendments and
federal waiver applications and requests, that the department
submitted to CMS in 2009 and every year thereafter.
SEC. 57. Section 14100.51 is added to the
Welfare and Institutions Code , immediately following
Section 14100.5, to read:
14100.51. (a) Each year, by no later than January 10 and
concurrently with the release of the May Revision, the State
Department of Health Care Services shall provide to the fiscal
committees of the Legislature supplemental fiscal information for the
Medi-Cal Specialty Mental Health Services Program. This supplemental
fiscal information shall include service-type descriptions, children'
s and adults' caseload and fiscal forecast by service type, a
detailed explanation of changes to these forecasts, fiscal charts
containing children's and adults' claim costs and unduplicated client
counts, and summary fiscal charts with current-year and budget-year
proposals.
(b) For purposes of making the information described in
subdivision (a) available to the public, the department shall post
this information on its Internet Web site.
SEC. 58. Section 14100.52 is added to the
Welfare and Institutions Code , immediately following
Section 14100.51, to read:
14100.52. (a) Each year, by no later than January 10 and
concurrently with the release of the May Revision, the State
Department of Health Care Services shall provide to the fiscal
committees of the Legislature supplemental fiscal information for the
Drug Medi-Cal Program. This supplemental fiscal information shall
include adult, minor-consent, child, and perinatal unique client
counts and summary fiscal charts with current-year and budget-year
proposals.
(b) For purposes of making the information described in
subdivision (a) available to the public, the department shall post
this information on its Internet Web site.
SEC. 59. Section 14105.22 of the
Welfare and Institutions Code is amended to read:
14105.22. (a) (1) Reimbursement for clinical laboratory or
laboratory services, as defined in Section 51137.2 of Title 22 of the
California Code of Regulations, may shall
not exceed 80 percent of the lowest maximum allowance
established by the federal Medicare Program for the same or similar
services.
(2) This subdivision shall be implemented only until the new rate
methodology under subdivision (b) is approved by the federal Centers
for Medicare and Medicaid Services (CMS).
(b) (1) It is the intent of the Legislature that the department
develop reimbursement rates for clinical laboratory or laboratory
services that are comparable to the payment amounts received from
other payers for clinical laboratory or laboratory services.
Development of these rates will enable the department to reimburse
clinical laboratory or laboratory service providers in compliance
with state and federal law.
(2) (A) The provisions of Section 51501(a) of Title 22 of the
California Code of Regulations shall not apply to laboratory
providers reimbursed under the new rate methodology developed for
clinical laboratories or laboratory services pursuant to this
subdivision.
(B) In addition to subparagraph (A), laboratory providers
reimbursed under any payment reductions implemented pursuant to this
section shall not be subject to the provisions of Section 51501(a) of
Title 22 of the California Code of Regulations for 12
21 months following the date of implementation
of this reduction.
(3) Reimbursement to providers for clinical laboratory or
laboratory services shall not exceed the lowest of the following:
(A) The amount billed.
(B) The charge to the general public.
(C) Eighty percent of the lowest maximum allowance established by
the federal Medicare Program for the same or similar services.
(D) A reimbursement rate based on an average of the lowest amount
that other payers and other state Medicaid programs are paying for
similar clinical laboratory or laboratory services.
(4) (A) In addition to the payment reductions implemented pursuant
to Section 14105.192, payments shall be reduced by up to 10 percent
for clinical laboratory or laboratory services, as defined in Section
51137.2 of Title 22 of the California Code of Regulations, for dates
of service on and after July 1, 2012. The payment reductions
pursuant to this paragraph shall continue until the new rate
methodology under this subdivision has been approved by CMS.
(B) Notwithstanding subparagraph (A), the Family Planning, Access,
Care, and Treatment (Family PACT) Program pursuant to subdivision
(aa) of Section 14132 shall be exempt from the payment reduction
specified in this section.
(5) (A) For purposes of establishing reimbursement rates for
clinical laboratory or laboratory services based on the lowest
amounts other payers are paying providers for similar clinical
laboratory or laboratory services, laboratory service providers shall
submit data reports within six 11
months of the date the act that added this paragraph becomes
effective and annually thereafter. The data initially
provided shall be for the 2011 calendar year, and for each
subsequent year, shall be based on the previous calendar year
and shall specify the provider's lowest amounts other payers are
paying, including other state Medicaid programs and private
insurance, minus discounts and rebates. The specific data required
for submission under this subparagraph and the format for the data
submission shall be determined and specified by the department after
receiving stakeholder input pursuant to paragraph (7).
(B) The data submitted pursuant to subparagraph (A) may be used to
determine reimbursement rates by procedure code based on an average
of the lowest amount other payers are paying providers for similar
clinical laboratory or laboratory services, excluding significant
deviations of cost or volume factors and with consideration to
geographical areas. The department shall have the discretion to
determine the specific methodology and factors used in the
development of the lowest average amount under this subparagraph to
ensure compliance with federal Medicaid law and regulations as
specified in paragraph (10).
(C) For purposes of subparagraph (B), the department may contract
with a vendor for the purposes of collecting payment data reports
from clinical laboratories, analyzing payment information, and
calculating a proposed rate.
(D) The proposed rates calculated by the vendor described in
subparagraph (C) may be used in determining the lowest reimbursement
rate for clinical laboratories or laboratory services in accordance
with paragraph (3).
(E) Data reports submitted to the department shall be certified by
the provider's certified financial officer or an authorized
individual.
(F) Clinical laboratory providers that fail to submit data reports
within 30 working days from the time requested by the department
shall be subject to the suspension provisions of subdivisions (a) and
(c) of Section 14123.
(6) Data reports provided to the department pursuant to this
section shall be confidential and shall be exempt from disclosure
under the California Public Records Act (Chapter 3.5 (commencing with
Section 6250) of Division 7 of Title 1 of the Government Code).
(7) The department shall seek stakeholder input on the ratesetting
methodology.
(8) (A) Notwithstanding Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code, the
department shall, without taking any further regulatory action,
implement, interpret, or make specific this section by means of
provider bulletins or similar instructions until regulations are
adopted. It is the intent of the Legislature that the department have
temporary authority as necessary to implement program changes until
completion of the regulatory process.
(B) The department shall adopt emergency regulations no later than
July 1, 2014. The department may readopt any emergency regulation
authorized by this section that is the same as or substantially
equivalent to an emergency regulation previously adopted pursuant to
this section. The initial adoption of emergency regulations
implementing the amendments to this section and the one readoption of
emergency regulations authorized by this section shall be deemed an
emergency and necessary for the immediate preservation of the public
peace, health, safety, or general welfare. Initial emergency
regulations and the one readoption of emergency regulations
authorized by this section shall be exempt from review by the Office
of Administrative Law.
(C) The initial emergency regulations and the one readoption of
emergency regulations authorized by this section shall be submitted
to the Office of Administrative Law for filing with the Secretary of
State and each shall remain in effect for no more than 180 days, by
which time final regulations may be adopted.
(9) To the extent that the director determines that the new
methodology or payment reductions are not consistent with the
requirements of Section 1396a(a)(30)(A) of Title 42 of the United
States Code, the department may revert to the methodology under
subdivision (a) to ensure access to care is not compromised.
(10) (A) The department shall implement this section in a manner
that is consistent with federal Medicaid law and regulations. The
director shall seek any necessary federal approvals for the
implementation of this section. This section shall be implemented
only to the extent that federal approval is obtained.
(B) In determining whether federal financial participation is
available, the director shall determine whether the rates and
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.
(C) To the extent that the director determines that the rates and
payments do not comply with applicable federal Medicaid requirements
or that federal financial participation is not available with respect
to any reimbursement rate, the director retains the discretion not
to implement that rate or payment and may revise the rate or payment
as necessary to comply with federal Medicaid requirements. The
department shall notify the Joint Legislative Budget Committee 10
days prior to revising the rate or payment to comply with federal
Medicaid requirements.
SEC. 60. Section 14105.3 of the Welfare
and Institutions Code is amended to read:
14105.3. (a) The department is considered to be the purchaser,
but not the dispenser or distributor, of prescribed drugs under the
Medi-Cal program for the purpose of enabling the department to obtain
from manufacturers of prescribed drugs the most favorable price for
those drugs furnished by one or more manufacturers, based upon the
large quantity of the drugs purchased under the Medi-Cal program, and
to enable the department, notwithstanding any other provision of
state law, to obtain from the manufacturers discounts, rebates, or
refunds based on the quantities purchased under the program, insofar
as may be permissible under federal law. Nothing in this section
shall interfere with usual and customary distribution practices in
the drug industry.
(b) The department may enter into exclusive or nonexclusive
contracts on a bid or negotiated basis with manufacturers,
distributors, dispensers, or suppliers of appliances, durable medical
equipment, medical supplies, and other product-type health care
services and with laboratories for clinical laboratory services for
the purpose of obtaining the most favorable prices to the state and
to assure adequate quality of the product or service. Except as
provided in subdivision (f), this subdivision shall not apply to
prescribed drugs dispensed by pharmacies licensed pursuant to Article
7 (commencing with Section 4110) of Chapter 9 of Division 2 of the
Business and Professions Code.
(c) Notwithstanding subdivision (b), the department may not enter
into a contract with a clinical laboratory unless the clinical
laboratory operates in conformity with Chapter 3 (commencing with
Section 1200) of Division 2 of the Business
and Professions Code and the regulations adopted
thereunder, and Section 263a of Title 42 of the United States Code
and the regulations adopted thereunder.
(d) The department shall contract with manufacturers of
single-source drugs on a negotiated basis, and with manufacturers of
multisource drugs on a bid or negotiated basis.
(e) In order to ensure and improve access by Medi-Cal
beneficiaries to both hearing aid appliances and provider services,
and to ensure that the state obtains the most favorable prices, the
department, by June 30, 2008, shall enter into exclusive or
nonexclusive contracts, on a bid or negotiated basis, for purchasing
hearing aid appliances.
(f) In order to provide specialized care in the distribution of
specialized drugs, as identified by the department and that include,
but are not limited to, blood factors and immunizations, the
department may enter into contracts with providers licensed to
dispense dangerous drugs or devices pursuant to Chapter 9 (commencing
with Section 4000) of Division 2 of the Business and Professions
Code, for programs that qualify for federal funding pursuant to the
medicaid Medicaid state plan, or
waivers , and the programs authorized by Article 5
(commencing with Section 123800) of Chapter 3 of Part 2 of, and
Article 1 (commencing with Section 125125) of Chapter 2 of Part 5 of,
Division 106 of the Health and Safety Code, in accordance with this
subdivision.
(1) The department shall, for purposes of ensuring proper patient
care, consult current standards of practice when executing a provider
contract.
(2) The department shall, for purposes of ensuring quality of care
to people with unique conditions requiring specialty drugs, contract
with a nonexclusive number of providers that meets
meet the needs of the affected population,
covers all geographic regions in California, and reflects the
distribution of the specialty drug in the community. The department
may use a single provider in the event the product manufacturer
designates a sole-source delivery mechanism. The department shall
consult with interested parties and appropriate stakeholders in
implementing this section with respect to all of the following:
(A) Notifying stakeholder representatives of the potential
inclusion or exclusion of drugs in the specialty pharmacy program.
(B) Allowing for written input regarding the potential inclusion
or exclusion of drugs into the specialty pharmacy program.
(C) Scheduling at least one public meeting regarding the potential
inclusion or exclusion of drugs into the specialty pharmacy program.
(D) Obtaining a recommendation from the Medi-Cal Drug Utilization
Review Advisory Committee, established pursuant to Section 1927 of
the federal Social Security Act (42 U.S.C. Sec. 1396r-8), on the
inclusion or exclusion of drugs into the specialty pharmacy program
distribution based on clinical best practices related to each drug
considered.
(3) For purposes of this subdivision, the definition of "blood
factors" has the same meaning as that term is defined in Section
14105.86.
(4) The department shall make every reasonable effort to ensure
all medically necessary clotting factor therapies are available for
the treatment of people with bleeding disorders.
(5) The department shall generate an annual report, published
publicly six months after the end of the first and second years after
implementation, which shall include, but not be limited to, all of
the following information:
(A) The number and geographic distribution of participating
providers.
(B) The number and geographic distribution of beneficiaries
receiving specialty drugs, including on a per-provider basis.
(C) A summary of problems and complaints received regarding the
specialty pharmacy program.
(D) An evaluation of hospital and emergency services before and
after implementation for the targeted patient population.
(E) Results of patient satisfaction surveys.
(F) The cost-effectiveness of the program.
(6) This subdivision shall become inoperative three years after
the date of implementation, as provided pursuant to a notice to the
public issued by the department, or until July 1, 2013, whichever is
earlier.
(g) The department may contract with an intermediary to establish
provider contracts pursuant to this section for programs that qualify
for federal funding pursuant to the Medicaid state plan ,
or waivers , and the programs authorized by Article 5
(commencing with Section 123800) of Chapter 3 of Part 2 of, and
Article 1 (commencing with Section 125125) of Chapter 2 of Part 5 of,
Division 106 of the Health and Safety Code.
(h) In carrying out contracting activity for this or any section
associated with the Medi-Cal list of contract drugs, notwithstanding
Section 19130 of the Government Code, the department may contract,
either directly or through the fiscal intermediary, for pharmacy
consultant staff necessary to accomplish the contracting process or
treatment authorization request reviews. The fiscal intermediary
contract, including any contract amendment, system change pursuant to
a change order, and project or systems development notice shall be
exempt from Part 2 (commencing with Section 10100) of Division 2 of
the Public Contract Code and any policies, procedures, or regulations
authorized by these provisions.
(i) In order to achieve maximum cost savings
savings, the Legislature hereby determines that an
expedited contract process for contracts under this section is
necessary. Therefore, contracts under this section shall be exempt
from Chapter 2 (commencing with Section 10290) of Part 2 of Division
2 of the Public Contract Code.
(j) For purposes of implementing the contracting provisions
specified in this section, the department shall do all of the
following:
(1) Ensure adequate access for Medi-Cal patients to quality
laboratory testing services in the geographic regions of the state
where contracting occurs.
(2) Consult with the statewide association of clinical
laboratories and other appropriate stakeholders on the implementation
of the contracting provisions specified in this section to ensure
maximum access for Medi-Cal patients consistent with the savings
targets projected by the 2002-03 budget conference committee for
clinical laboratory services provided under the Medi-Cal program.
(3) Consider which types of laboratories are appropriate for
implementing the contracting provisions specified in this section,
including independent laboratories, outreach laboratory programs of
hospital-based laboratories, clinic laboratories, physician office
laboratories, and group practice laboratories.
SEC. 61. Section 14131.07 of the
Welfare and Institutions Code is repealed.
14131.07. (a) Notwithstanding any other provision of this chapter
or Chapter 8 (commencing with Section 14200), the total number of
physician office and clinic visits for physician services provided by
a physician, or under the direction of a physician, that are a
covered benefit under the Medi-Cal program shall be limited to seven
visits per beneficiary per fiscal year, excepting visits that meet
the conditions set forth in subdivision (b). For purposes of this
limit, a visit shall include physician services provided at any
federally qualified health center, rural health clinic, community
clinic, outpatient clinic, and hospital outpatient department. The
department may seek input from consumer organizations and the
provider community, as applicable, prior to implementation.
(b) (1) Visits exceeding seven per beneficiary per fiscal year
shall be required to be certified by the physician, or other medical
professional under the supervision of a physician, attesting that one
or more of the following circumstances is applicable:
(A) The services will prevent deterioration in a beneficiary's
condition that would otherwise foreseeably result in admission to the
emergency department.
(B) The services will prevent deterioration in the beneficiary's
condition that would otherwise result in inpatient admission.
(C) The services will prevent disruption in ongoing medical
therapy or surgical therapy, or both, including, but not limited to,
medications, radiation, or wound management.
(D) The services constitute diagnostic workup in progress that
would otherwise foreseeably result in inpatient or emergency
department admission.
(E) The services are for the purpose of assessment and form
completion for Medi-Cal recipients seeking or receiving in-home
supportive services.
(2) The certification shall consist of a written declaration by
the physician, or other medical professional under the supervision of
the physician, that the visit meets the requirements of any one or
more of the circumstances set forth in paragraph (1), and shall
include a description of the services provided.
(3) The certification shall be maintained onsite at the physician'
s office or clinic location at which the medical records for the
beneficiary are maintained and shall be subject to audit and
inspection by the department.
(4) This subdivision does not authorize or direct a beneficiary to
obtain services at a physician office or clinic visit for an
emergency medical condition or that should properly be provided in
the emergency department or as hospital inpatient services.
(c) Specialty mental health services furnished or arranged for the
provision of mental health services to Medi-Cal beneficiaries
pursuant to Chapter 8.9 (commencing with Section 14700), shall not be
subject to the limit provided in subdivision (a).
(d) Any pregnancy-related visit, or any visit for the treatment of
any other condition that might complicate a pregnancy, shall not be
subject to the limit provided in subdivision (a).
(e) The limit on physician office and clinic visits provided in
subdivision (a) shall not apply to any of the following:
(1) A beneficiary under the Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT) Program.
(2) A beneficiary receiving long-term care in a nursing facility
that is both of the following:
(A) A skilled nursing facility or intermediate care facility as
defined in subdivisions (c), (d), (e), (g), and (h), respectively, of
Section 1250 of the Health and Safety Code, and facilities providing
continuous skilled nursing care to persons with developmental
disabilities under the pilot project established pursuant to Section
14132.20.
(B) Licensed pursuant to subdivision (k) of Section 1250 of the
Health and Safety Code.
(f) For managed health care plans that contract with the
department pursuant to this chapter or Chapter 8 (commencing with
Section 14200), except for the Senior Care Action Network or AIDS
Healthcare Foundation, payments shall be reduced by the actuarial
equivalent amount of the benefit reductions resulting from the
implementation of the benefit cap amounts specified in this section
pursuant to contract amendments or change orders effective on July 1,
2011, or thereafter.
(g) This section shall be implemented only to the extent permitted
by federal law.
(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 this section by means of all-county letters,
provider bulletins, or similar instructions, without taking
regulatory action.
(i) This section shall be implemented on the first day of the
first calendar month following 180 days after the effective date of
the act that added this section, or on the first day of the calendar
month following 60 days after the date the department secures all
necessary federal approvals to implement this section, whichever is
later. If the implementation date occurs after July 1, 2011, then the
benefit caps described in subdivision (a) for the first year of
implementation shall be applied from the implementation date to June
30 of the state fiscal year in which implementation begins.
Thereafter, the benefit caps shall apply on a state fiscal year
basis.
SEC. 62. Section 14131.10 of the
Welfare and Institutions Code is amended to read:
14131.10. (a) Notwithstanding any other provision of this
chapter, Chapter 8 (commencing with Section 14200), or Chapter 8.75
(commencing with Section 14591), in order to implement changes in the
level of funding for health care services, specific optional
benefits are excluded from coverage under the Medi-Cal program.
(b) (1) The following optional benefits are excluded from coverage
under the Medi-Cal program:
(A) Adult dental services, except as specified in paragraph (2).
(B) Acupuncture services.
(C) Audiology services and speech therapy services.
(D) Chiropractic services.
(E) Optometric and optician services, including services provided
by a fabricating optical laboratory.
(F) Podiatric services.
(G) Psychology services.
(H) Incontinence creams and washes.
(2) (A) Medical and surgical services
provided by a doctor of dental medicine or dental surgery, which, if
provided by a physician, would be considered physician services, and
which services may be provided by either a physician or a dentist in
this state, are covered.
(B) Emergency procedures are also covered in the categories of
service specified in subparagraph (A). The director may adopt
regulations for any of the services specified in subparagraph (A).
(C) Effective May 1, 2014, or the effective date of any necessary
federal approvals as required by subdivision (f), whichever is later,
for persons 21 years of age or older, adult dental benefits, subject
to utilization controls, are limited to all the following medically
necessary services:
(i) Amalgam and composite restorations.
(ii) Stainless steel, resin, and resin window crowns.
(iii) Complete dentures, including immediate dentures.
(iv) Complete denture adjustments, repairs, and relines.
(D) Services specified in this paragraph shall be included as a
covered medical benefit under the Medi-Cal program pursuant to
Section 14132.89.
(3) Pregnancy-related services and services for the treatment of
other conditions that might complicate the pregnancy are not excluded
from coverage under this section.
(c) The optional benefit exclusions do not apply to either of the
following:
(1) Beneficiaries under the Early and Periodic Screening Diagnosis
and Treatment Program.
(2) Beneficiaries receiving long-term care in a nursing facility
that is both:
(A) A skilled nursing facility or intermediate care facility as
defined in subdivisions (c) and (d) of Section 1250 of the Health and
Safety Code.
(B) Licensed pursuant to subdivision (k) of Section 1250 of the
Health and Safety Code.
(d) This section shall only be implemented to the extent permitted
by federal law.
(e) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement the provisions of this section by means of
all-county letters, provider bulletins, or similar instructions,
without taking further regulatory action.
(f) The department shall seek approval for federal financial
participation and coverage of services specified in paragraph (2) of
subdivision (b) under the Medi-Cal program.
(f)
(g) This section , except as specified
in subparagraph (C) of paragraph (2) of subdivision (b), shall
be implemented on the first day of the month following 90 days after
the operative date of this section.
SEC. 63. Section 14132.86 is added to the
Welfare and Institutions Code , to read:
14132.86. (a) Notwithstanding subdivision (ab) of Section 14132,
effective May 1, 2014, purchase of prescribed enteral nutrition
products is covered, subject to the Medi-Cal list of enteral
nutrition products pursuant to Section 14105.8 and utilization
controls pursuant to Section 14105.395.
(b) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall implement this section by means of a provider
bulletin or similar instruction, without taking regulatory action.
(c) This section shall only be implemented to the extent permitted
by federal law.
(d) The department shall seek approval for federal financial
participation and coverage of the service specified in subdivision
(a) under the Medi-Cal program.
SEC. 64. Section 14132.89 is added to the
Welfare and Institutions Code , to read:
14132.89. (a) Notwithstanding subdivision (h) of Section 14132,
effective May 1, 2014, or the effective date of any necessary federal
approvals as required by subdivision (d), all of the following are
covered benefits for persons 21 years of age or older, subject to
utilization controls and medically necessary services:
(1) Amalgam and composite restorations.
(2) Stainless steel, resin, and resin window crowns.
(3) Complete dentures, including immediate dentures.
(4) Complete denture adjustments, repairs, and relines.
(5) Emergency procedures are also covered in the above categories
of service.
(b) This section shall only be implemented to the extent permitted
by federal law.
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department shall implement this section by means of a provider
bulletin or similar instruction, without taking regulatory action.
(d) The department shall seek approval for federal financial
participation and coverage of services specified in subdivision (a)
under the Medi-Cal program.
SEC. 65. Section 14134 of the
Welfare and Institutions Code , as amended by Section
84 of Chapter 23 of the Statutes of 2012, 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, such 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 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:
(A) Any child in AFDC-Foster Care, as defined in Section 11400.
(B) Any person who is an inpatient in a health facility, as
defined in Section 1250 of the Health and Safety Code.
(C) Any person 18 years of age or under.
(D) Any woman receiving perinatal care.
(7) Paragraph (2) does not apply to any 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. An individual shall, however, remain liable to the
provider for any copayment amount owed.
(9) This section shall not apply to any 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.
(9)
(10) 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.
(10)
(1 1) The director shall adopt any
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.
(b) This section, or subdivisions thereof, if applicable, shall
become inoperative on the implementation date for copayments stated
in the declaration executed by the director pursuant to Section 14134
as added by Section 101.5 of the act that added this
subdivision of Chapter 3 of the Statutes of 2011
.
SEC. 66. Section 14134 of the
Welfare and Institutions Code , as amended by Section
85 of Chapter 23 of the Statutes of 2012, is amended to read:
14134. (a) The Legislature finds and declares all of 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 or imposing further reductions on
Medi-Cal providers during times of economic crisis, it is crucial to
find areas within the program where beneficiaries can share
responsibility for utilization of health care, whether they are
participating in the fee-for-service or the managed care model of
service delivery.
(3) The establishment of cost-sharing obligations within the
Medi-Cal program is complex and is subject to close supervision by
the United States Department of Health and Human Services.
(4) As the single state agency for Medicaid in California, the
State Department of Health Care Services has unique expertise that
can inform decisions that set or adjust cost-sharing responsibilities
for Medi-Cal beneficiaries receiving health care services.
(b) Therefore, it is the intent of the Legislature for the
department to obtain federal approval to implement cost-sharing for
Medi-Cal beneficiaries and permit providers to require that
individuals meet their cost-sharing obligation prior to receiving
care or services.
(c) A Medi-Cal beneficiary shall be required to make copayments as
described in this section. These copayments represent a contribution
toward the rate of payment made to providers of Medi-Cal services
and shall be as follows:
(1) Copayment of up to fifty dollars ($50) 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 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, such 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 up to fifty dollars ($50) shall be made for
emergency services received in an emergency department or emergency
room when the services result in the treatment of an emergency
medical condition or inpatient admittance. For purposes of this
section, "emergency services" means services 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, such 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.
(3) Copayment of up to one hundred dollars ($100) shall be made
for each hospital inpatient day, up to a maximum of two hundred
dollars ($200) per admission.
(4) Copayment of up to three dollars ($3) shall be made for each
preferred drug prescription or refill. A copayment of up to five
dollars ($5) shall be made for each nonpreferred drug prescription or
refill. Except as provided in subdivision (g), "preferred drug"
shall have the same meaning as in Section 1916A of the Social
Security Act (42 U.S.C. Sec. 1396o-1).
(5) Copayment of up to five dollars ($5) shall be made for each
visit for services under subdivision (a) of Section 14132 and for
dental services received on an outpatient basis provided as a
Medi-Cal benefit pursuant to this chapter or Chapter 8 (commencing
with Section 14200), as applicable.
(6) This section does not apply to services provided pursuant to
subdivision (aa) of Section 14132.
(d) The copayments established pursuant to subdivision (c) shall
be set by the department, at the maximum amount provided for in the
applicable paragraph, except that each copayment amount shall not
exceed the maximum amount allowable pursuant to the state plan
amendments or other federal approvals.
(e) The copayment amounts set forth in subdivision (c) may be
collected and retained or waived by the provider. The department
shall deduct the amount of the copayment from the payment the
department makes to the provider whether retained, waived, or not
collected by the provider.
(f) Notwithstanding any other provision of law, and only to the
extent allowed pursuant to federal law, a provider of service has no
obligation to provide services to a Medi-Cal beneficiary who does
not, at the point of service, pay the copayment assessed pursuant to
this section. If the provider provides services without collecting
the copayment, and has not waived the copayment, the provider may
hold the beneficiary liable for the copayment amount owed.
(g) (1) Notwithstanding any other provision of law, except as
described in paragraph (2), this section shall apply to Medi-Cal
beneficiaries enrolled in a health plan contracting with the
department pursuant to this chapter or Chapter 8 (commencing with
Section 14200), except for the Senior Care Action Network or AIDS
Healthcare Foundation. To the extent permitted by federal law and
pursuant to any federal waivers or state plan adjustments obtained, a
managed care health plan may establish a lower copayment or no
copayment.
(2) For the purpose of paragraph (4) of subdivision (c),
copayments assessed against a beneficiary who receives Medi-Cal
services through a health plan described in paragraph (1) shall be
based on the plan's designation of a drug as preferred or
nonpreferred.
(3) To the extent provided by federal law, capitation payments
shall be calculated on an actuarial basis as if copayments described
in this section were collected.
(h) This section shall not apply to any 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.
(h)
(i) This section shall be implemented only to the
extent that federal financial participation is available. The
department shall seek and obtain any federal waivers or state plan
amendments necessary to implement this section. The provisions for
which appropriate federal waivers or state plan amendments cannot be
obtained shall not be implemented, but provisions for which waivers
or state plan amendments are either obtained or found to be
unnecessary shall be unaffected by the inability to obtain federal
waivers or state plan amendments for the other provisions.
(i)
(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, all-plan letters, provider
bulletins, or similar instructions, without taking further regulatory
actions.
(j)
(k) (1) This section shall become operative on the date
that the act adding this section is effective, but shall not be
implemented until the date in the declaration executed by the
director pursuant to paragraph (2). In no event shall the director
set an implementation date prior to the date federal approval is
received.
(2) The director shall execute a declaration that states the date
that implementation of the copayments described in this section or
subdivisions thereof, if applicable, will commence and shall post the
declaration on the department's Internet Web site and provide a copy
of the declaration to the Chair of the Joint Legislative Budget
Committee, the Chief Clerk of the Assembly, the Secretary of the
Senate, the Office of the Legislative Counsel, and the Secretary of
State.
SEC. 67. Section 14707.5 of the Welfare
and Institutions Code is amended to read:
14707.5. (a) It is the intent of the Legislature to develop a
performance outcome system for Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT) mental health services that will
improve outcomes at the individual and system levels and will inform
fiscal decision making related to the purchase of services.
(b) The State Department of Health Care Services, in collaboration
with the California Health and Human Services Agency, and in
consultation with the Mental Health Services Oversight and
Accountability Commission, shall create a plan for a performance
outcome system for EPSDT mental health services provided to eligible
Medi-Cal beneficiaries under the age of 21 pursuant to 42 U.S.C.
Section 1396d(a)(4)(B).
(1) Commencing no later than September 1, 2012, the department
shall convene a stakeholder advisory committee comprised of
representatives of child and youth clients, family members,
providers, counties, and the Legislature. This consultation shall
inform the creation of a plan for a performance outcome system for
EPSDT mental health services.
(2) In developing a plan for a performance outcomes system for
EPSDT mental health services, the department shall consider the
following objectives, among others:
(A) High quality and accessible EPSDT mental health services for
eligible children and youth, consistent with federal law.
(B) Information that improves practice at the individual, program,
and system levels.
(C) Minimization of costs by building upon existing resources to
the fullest extent possible.
(D) Reliable data that are collected and analyzed in a timely
fashion.
(3) At a minimum, the plan for a performance outcome system for
EPSDT mental health services shall consider evidence-based models for
performance outcome systems, such as the Child and Adolescent Needs
and Strengths (CANS), federal requirements, including the review by
the External Quality Review Organization (EQRO), and, timelines for
implementation at the provider, county, and state levels.
(c) The State Department of Health Care Services shall provide the
performance outcomes system plan, including milestones and
timelines, for EPSDT mental health services described in subdivision
(a) to all fiscal committees and appropriate policy committees of the
Legislature no later than October 1, 2013.
(d) The State Department of Health Care Services shall propose how
to implement the performance outcomes system plan for EPSDT mental
health services described in subdivision (a) no later than January
10, 2014.
(e) Commencing no later than February 1, 2014, the department
shall convene a stakeholder advisory committee comprised of advocates
for and representatives of, child and youth clients, family members,
managed care health plans, providers, counties, and the Legislature.
The committee shall develop methods to routinely measure, assess,
and communicate program information regarding informing, identifying,
screening, assessing, referring, and linking Medi-Cal eligible
beneficiaries to mental health services and supports. The committee
shall also review health plan screenings for mental health illness,
health plan referrals to Medi-Cal fee-for-service providers, and
health plan referrals to county mental health plans, among others.
The committee shall make recommendations to the department regarding
performance and outcome measures that will contribute to improving
timely access to appropriate care for Medi-Cal eligible
beneficiaries.
(1) The department shall incorporate into the performance outcomes
system established pursuant to this section the screenings and
referrals described in this subdivision, including milestones and
timelines, and shall provide an updated performance outcomes system
plan to all fiscal committees and the appropriate policy committees
of the Legislature no later than October 1, 2014.
(2) The department shall propose how to implement the updated
performance systems outcome plan described in paragraph (1) no later
than January 10, 2015.
SEC. 68. Part 3.3 (commencing with Section 15800)
is added to Division 9 of the Welfare and Institutions
Code , to read:
PART 3.3. Health Care Coverage Assistance
CHAPTER 1. GENERAL PROVISIONS
15800. (a) (1) Commencing October 1, 2013, the State Department
of Health Care Services shall administer the AIM-Linked Infants
Program to address the health care needs of children formerly covered
pursuant to clause (ii) of subparagraph (A) of paragraph (6) of
subdivision (a) of Section 12693.70 of the Insurance Code. The
department is vested with the same powers, purposes,
responsibilities, and jurisdiction exercised by the Managed Risk
Medical Insurance Board as they relate to those children. Nothing in
this paragraph shall be construed to alter, diminish, or supersede
the authority of the Managed Risk Medical Insurance Board to exercise
the same powers, purposes, responsibilities, and jurisdiction within
the Healthy Families Program established under Part 6.2 (commencing
with Section 12693) of Division 2 of the Insurance Code.
(2) The department may, before October 1, 2013, conduct transition
activities necessary to ensure the efficient transfer of the program
identified in subdivision (a) and populations served by that
program.
(b) The department shall seek any federal waivers, approvals, and
state plan amendments necessary to implement this part. This part
shall only be implemented to the extent that necessary federal
approvals are obtained and federal financial participation is
available for eligible programs and services.
15801. The terms of all regulations and orders adopted by the
Managed Risk Medical Insurance Board in effect immediately preceding
October 1, 2013, that relate to the operation of the program and to
the children transferred by the act that added this section and are
not rendered legally unenforceable by the act that added this section
shall be fully enforceable by the State Department of Health Care
Services within the AIM-Linked Infants Program unless and until the
department adopts regulations for the AIM-Linked Infants Program.
Nothing in this section shall be construed to alter, diminish, or
supersede the authority of the Managed Risk Medical Insurance Board
to interpret, enforce, maintain, or amend the same regulations for
purposes of the Healthy Families Program established under Part 6.2
(commencing with Section 12693) of Division 2 of the Insurance Code.
15802. (a) The State Department of Health Care Services may issue
rules and regulations to carry out the purposes of this part.
(b) Notwithstanding subdivision (a) or 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 actions, may implement, interpret, or make specific this
part and amend or repeal regulations and orders adopted by the
Managed Risk Medical Insurance Board as provided in Section 15801 by
means of all-county letters, plan letters, plan or provider
bulletins, or similar instructions, without taking regulatory action
during the transition of the programs to the department. Thereafter,
the adoption and readoption of regulations to implement, interpret,
or make specific this part shall be deemed to be an emergency that
calls for immediate action to avoid serious harm to the public peace,
health, safety, or general welfare for purposes of Sections 11346.1
and 11349.6 of the Government Code, and the department is exempted
from the requirement that it describe facts showing the need for
immediate action. The regulations shall become effective immediately
upon filing with the Secretary of State.
15803. (a) To implement this part and clause (ii) of subparagraph
(A) of paragraph (6) of subdivision (a) of Section 12693.70 of the
Insurance Code, the State Department of Health Care Services may
contract with public or private entities, including the Managed Risk
Medical Insurance Board, which administers the Access for Infants and
Mothers Program pursuant to Part 6.3 (commencing with Section12695)
of Division 2 of the Insurance Code. Contracts entered into under
this part 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.
(b) During the transition of the programs to the department, the
department shall also be exempt from the review or approval of
feasibility study reports and the requirements of Sections 4819.35 to
4819.37, inclusive, and 4920 to 4928, inclusive, of the State
Administrative Manual.
15804. On October 1, 2013, or when the State Department of Health
Care Services has implemented Chapter 2 (commencing with Section
15850), whichever occurs later, the Managed Risk Medical Insurance
Board shall cease to provide coverage to the children transferred to
the AIM-Linked Infants Program, pursuant to Section 15800.
15805. (a) The Managed Risk Medical Insurance Board shall provide
the State Department of Health Care Services any data, information,
or record concerning the Healthy Families Program or the Access for
Infants and Mothers Program as are necessary to implement this part
and clause (ii) of subparagraph (A) of paragraph (6) of subdivision
(a) of Section 12693.70 of the Insurance Code.
(b) Notwithstanding any other law, all of the following shall
apply:
(1) The term "data, information, or record" shall include, but is
not limited to, personal information as defined in Section 1798.3 of
the Civil Code.
(2) Any data, information, or record shall be exempt from
disclosure under the California Public Records Act (Chapter 3.5
(commencing with Section 6250) of Division 7 of the Government Code)
and any other law, to the same extent that it was exempt from
disclosure or privileged prior to the provision of the data,
information, or record to the department.
(3) The provision of any data, information, or record to the
department shall not constitute a waiver of any evidentiary privilege
or exemption from disclosure.
(4) The department shall keep all data, information, or records
provided by the Managed Risk Medical Insurance Board confidential to
the full extent permitted by law, including, but not limited to, the
California Public Records Act (Chapter 3.5 (commencing with Section
6250) of Division 7 of the Government Code), and consistent with the
Managed Risk Medical Insurance Board's contractual obligations to
keep data, information, or records confidential.
CHAPTER 2. AIM-LINKED INFANTS PROGRAM
15810. This chapter shall be known, and may be cited, as the
AIM-Linked Infants Program.
15811. The definitions contained in this section govern the
construction of this chapter, unless the context requires otherwise.
(a) "AIM-linked infant" means any infant born to a woman whose
enrollment in the Access for Infants and Mothers Program under Part
6.3 (commencing with Section 12695) of Division 2 of the Insurance
Code begins after June 30, 2004.
(b) "Department" means the State Department of Health Care
Services.
(c) "Program" means the AIM-Linked Infants Program.
(d) "Subscriber" means an individual who is eligible for and
enrolled in the program.
(e) "Subscriber contribution" means the cost to the subscriber to
participate in the program.
15822. Health care services under the program shall include, but
are not limited to, all of the following:
(a) Preventive, screening, diagnostic, and treatment services
furnished directly by a licensed clinic, either onsite or by formal
written contract, on a case-managed basis, to patients who remain
less than 24 hours at the clinic for an illness or injury, advice,
counseling, outreach, and translation as needed.
(b) Physician services.
(c) Emergency first aid, perinatal, obstetric, radiology,
laboratory, and nutrition services.
(d) Services of advanced practice nurses or mid-level
practitioners who are authorized to perform any of the services
listed in this section within the scope of their licensure.
(e) All services and benefits set forth in Chapter 7 (commencing
with Section 14000) of Part 3.
15824. To the extent permitted by federal law, services for
individuals eligible under this chapter shall be provided, at the
department's discretion and to the extent the department determines
the selected delivery system is cost effective, through the Medi-Cal
fee-for-service or managed care delivery system, or both.
15826. The department shall administer the program and may do all
of the following:
(a) Determine eligibility criteria for the program. These criteria
shall include the requirements set forth in Section 15832.
(b) Determine the eligibility of AIM-linked infants.
(c) Determine when subscribers are covered and the extent and
scope of coverage.
(d) Determine subscriber contribution amounts schedules.
Subscriber contributions shall not be greater than those applicable
on March 23, 2010, for infants enrolled pursuant to clause (ii) of
subparagraph (A) of paragraph (6) of subdivision (a) of Section
12693.70 of the Insurance Code.
(e) Provide coverage through Medi-Cal delivery systems and
contract for the administration of the program and the enrollment of
subscribers. Any contract entered into pursuant to this chapter shall
be exempt from any provision of law relating to competitive bidding,
and shall be exempt from the review or approval of any division of
the Department of General Services. The department shall not be
required to specify the amounts encumbered for each contract, but may
allocate funds to each contract based on projected and actual
subscriber enrollments in a total amount not to exceed the amount
appropriated for the program.
(f) Authorize expenditures to pay program expenses that exceed
subscriber contributions, and to administer the program as necessary.
(g) Develop a promotional component of the program to make
Californians aware of the program and the opportunity that it
presents.
(h) (1) Issue rules and regulations as necessary to administer the
program.
(2) During the 2011-12 to 2014-15 fiscal years, inclusive, the
adoption and readoption of regulations pursuant to this chapter shall
be deemed to be an emergency that calls for immediate action to
avoid serious harm to the public peace, health, safety, or general
welfare for purposes of Sections 11346.1 and 11349.6 of the
Government Code, and the department is hereby exempted from the
requirement that the department describe facts showing the need for
immediate action.
(i) Exercise all powers reasonably necessary to carry out the
powers and responsibilities expressly granted or imposed by this
chapter.
15828. The department shall coordinate with other state agencies,
as appropriate, to help ensure continuity of health care services.
15830. (a) The department may contract with a variety of health
plans and types of health care service delivery systems in order to
offer subscribers a choice of plans, providers, and types of service
delivery.
(b) Participating health plans contracting with the department
pursuant to this chapter shall provide benefits or coverage to
subscribers only as determined by the department pursuant to
subdivision (b) of Section 15826.
15832. To be eligible to participate in the program, a person
shall meet all of the following requirements:
(a) (1) Be a child under two years of age who is delivered by a
mother enrolled in the program under Part 6.3 (commencing with
Section 12695) of Division 2 of the Insurance Code. Except as stated
in this section, these infants shall be automatically enrolled in the
program.
(2) For the applicable month, not be enrolled in
employer-sponsored health care coverage, or have been enrolled in
that health care coverage in the prior three months or enrolled in
full-scope Medi-Cal without a share of cost. Exceptions may be
identified in regulations or other guidance and shall, at minimum,
include all exceptions applicable to the Healthy Families Program on
and after March 23, 2010.
(3) Be subject to subscriber contributions as determined by the
department. The subscriber contributions shall not be greater than
those applicable on March 23, 2010, for infants enrolled in the
Healthy Families Program pursuant to clause (ii) of subparagraph (A)
of paragraph (6) of subdivision (a) of Section 12693.70 of the
Insurance Code.
(b) For AIM-linked infants identified in subdivision (a), all of
the following shall apply:
(1) Enrollment shall cover the first 12 months of the infant's
life unless he or she is eligible for Medi-Cal benefits under Section
14005.26. If the infant is eligible under Section 14005.26, he or
she shall be automatically enrolled in the Medi-Cal program on that
basis.
(2) (A) At the end of the 12 months, as a condition of continued
eligibility, the subscriber shall provide income information. The
infant shall be disenrolled from the program if the annual household
income exceeds 300 percent of the federal poverty level, or if the
infant is eligible for full-scope Medi-Cal with no share of cost.
(B) Effective January 1, 2014, when determining eligibility for
benefits under the program, income shall be determined, counted, and
valued in accordance with the requirements of Section 1397bb(b)(1)(B)
of Title 42 of the United States Code as added by the federal
Patient Protection and Affordable Care Act (Public Law 111-148) and
as amended by the federal Health Care and Education Reconciliation
Act of 2010 (Public Law
111-152) and any subsequent amendments.
(3) At the end of their first and second year in the program,
infants shall be screened for eligibility for the Medi-Cal program.
(c) If at any time the director determines that the eligibility
criteria established under this chapter for the program may
jeopardize the state's ability to receive federal financial
participation under the federal Patient Protection and Affordable
Care Act (Public Law 111-148), or any amendment or extension of that
act, the director may alter the eligibility criteria to the extent
necessary for the state to receive that federal financial
participation.
15834. A person shall not be eligible for covered services under
the program if those services are covered through private health care
coverage arrangements at the time of eligibility.
15836. (a) If a subscriber is dissatisfied with any action, or
failure to act, that has occurred in connection with eligibility or
covered services under this chapter, the subscriber may appeal to the
department and shall be accorded an opportunity for a fair hearing.
Hearings may be conducted pursuant to the provisions of Chapter 5
(commencing with Section 11500) of Part 1 of Division 3 of Title 2 of
the Government Code.
(b) The department may place a lien on compensation or benefits
that are recovered or recoverable by a subscriber for whom benefits
have been provided under a policy or plan issued under this chapter
from any party or parties responsible for the compensation or
benefits.
15838. (a) A provider who is furnished documentation of a
subscriber's enrollment in the program shall not seek reimbursement
or attempt to obtain payment for any covered services provided to
that subscriber other than from the participating health plan or
insurer covering the subscriber or from the department.
(b) Subdivision (a) shall not apply to any copayment required by
the department under this chapter for the covered services provided
to the subscriber.
(c) For purposes of this chapter, "provider" means any
professional person, organization, health facility, or other person
or institution licensed by the state to deliver or furnish health
care services and includes as that term is defined in subdivision (o)
of Section 14043.1.
15840. (a) At a minimum, coverage provided pursuant to this
chapter shall be provided to eligible AIM-linked infants less than
two years of age.
(b) Coverage provided pursuant to this chapter shall include, at a
minimum, those services required to be provided by health care
service plans approved by the Secretary of Health and Human Services
as a federally qualified health care service plan pursuant to Section
417.101 of Title 42 of the Code of Federal Regulations.
(c) Medically necessary prescription drugs shall be a required
benefit in the coverage provided pursuant to this chapter.
15842. Notwithstanding any other law, for a subscriber who is
determined by the California Children's Services Program to be
eligible for benefits under the program pursuant to Article 5
(commencing with Section 123800) of Chapter 3 of Part 2 of Division
106 of the Health and Safety Code, a provider shall not be
responsible for the provision of, or payment for, the particular
services authorized by the California Children's Services Program for
the particular subscriber for the treatment of a California Children'
s Services Program eligible medical condition. Providers shall refer
a child whom they reasonably suspect of having a medical condition
that is eligible for services under the California Children's
Services Program to the California Children's Services Program. The
California Children's Services Program shall provide case management
and authorization of services if the child is found to be medically
eligible for the California Children's Services Program. Diagnosis
and treatment services that are authorized by the California Children'
s Services Program shall be performed by paneled providers for that
program and approved special care centers of that program in
accordance with treatment plans approved by the California Children's
Services Program. All other services provided under this chapter
shall be available to the subscriber.
15844. A child enrolled in the program under this chapter who has
a medical condition that is eligible for services pursuant to the
California Children's Services Program, and whose family is not
financially eligible for the California Children's Services Program,
shall have the medically necessary treatment services for his or her
California Children's Services Program eligible medical condition
authorized and paid for by the California Children's Services
Program. County expenditures for the payment of services for the
child shall be waived and these expenditures shall be paid for by the
state from Title XXI of the federal Social Security Act (42 U.S.C.
Sec. 1397aa et seq.) funds and state general funds.
15846. The department shall encourage all providers who provide
services under the program to have viable protocols for screening and
referring children needing supplemental services outside of the
scope of the screening, preventive, and medically necessary and
therapeutic services covered by the contract to public programs
providing such supplemental services for which they may be eligible,
as well as for coordination of care between the provider and the
public programs. The public programs for which providers may be
required to develop screening, referral, and care coordination
protocols may include the California Children's Services Program, the
regional centers, county mental health programs, programs
administered by the Department of Alcohol and Drug Programs or its
successor agency or agencies, and programs administered by local
education agencies.
SEC. 69. Section 15911 of the Welfare
and Institutions Code is amended to read:
15911. (a) Funding for each LIHP shall be based on all of the
following:
(1) The amount of funding that the participating entity
voluntarily provides for the nonfederal share of LIHP expenditures.
(2) For a LIHP that had in operation a Health Care Coverage
Initiative program under Part 3.5 (commencing with Section 15900) as
of November 1, 2010, and elects to continue funding the program, the
amount of funds requested to ensure that eligible enrollees continue
to receive health care services for persons enrolled in the Health
Care Coverage Initiative program as of November 1, 2010.
(3) Any limitations imposed by the Special Terms and Conditions of
the demonstration project.
(4) The total allocations requested by participating entities for
Health Care Coverage Initiative eligible individuals.
(5) Whether funding under this part would result in the reduction
of other payments under the demonstration project.
(b) Nothing in this part shall be construed to require a political
subdivision of the state to participate in a LIHP as set forth in
this part, and those local funds expended or transferred for the
nonfederal share of LIHP expenditures under this part shall be
considered voluntary contributions for purposes of 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 the federal American Recovery and
Reinvestment Act of 2009 (Public Law 111-5), as amended by the
federal Patient Protection and Affordable Care Act.
(c) No state General Fund moneys shall be used to fund LIHP
services, nor to fund any related administrative costs incurred by
counties or any other political subdivision of the state.
(d) Subject to the Special Terms and Conditions of the
demonstration project, if a participating entity elects to fund the
nonfederal share of a LIHP, the nonfederal funding and payments to
the LIHP shall be provided through one of the following mechanisms,
at the options of the participating entity:
(1) On a quarterly basis, the participating entity shall transfer
to the department for deposit in the LIHP Fund established for the
participating counties and pursuant to subparagraph (A), the amount
necessary to meet the nonfederal share of estimated payments to the
LIHP for the next quarter under subdivision (g) Section 15910.3.
(A) The LIHP Fund is hereby created in the State Treasury.
Notwithstanding Section 13340 of the Government Code, all moneys in
the fund shall be continuously appropriated to the department for the
purposes specified in this part. The fund shall contain all moneys
deposited into the fund in accordance with this paragraph.
(B) The department shall obtain the related federal financial
participation and pay the rates established under Section 15910.3,
provided that the intergovernmental transfer is transferred in
accordance with the deadlines imposed under the Medi-Cal Checkwrite
Schedule, no later than the next available warrant release date. This
payment shall be a nondiscretionary obligation of the department,
enforceable under a writ of mandate pursuant to Section 1085 of the
Code of Civil Procedure. Participating entities may request expedited
processing within seven business days of the transfer as made
available by the Controller's office, provided that the participating
entity prepay the department for the additional administrative costs
associated with the expedited processing.
(C) Total quarterly payment amounts shall be determined in
accordance with estimates of the number of enrollees in each rate
category, subject to annual reconciliation to final enrollment data.
(2) If a participating entity operates its LIHP through a contract
with another entity, the participating entity may pay the operating
entity based on the per enrollee rates established under Section
15910.3 on a quarterly basis in accordance with estimates of the
number of enrollees in each rate category, subject to annual
reconciliation to final enrollment data.
(A) (i) On a quarterly basis, the participating entity shall
certify the expenditures made under this paragraph and submit the
report of certified public expenditures to the department.
(ii) The department shall report the certified public expenditures
of a participating entity under this paragraph on the next available
quarterly report as necessary to obtain federal financial
participation for the expenditures. The total amount of federal
financial participation associated with the participating entity's
expenditures under this paragraph shall be reimbursed to the
participating entity.
(B) At the option of the participating entity, the LIHP may be
reimbursed on a cost basis in accordance with the methodology applied
to Health Care Coverage Initiative programs established under Part
3.5 (commencing with Section 15900) including interim quarterly
payments.
(e) (1) Notwithstanding
Section 15910.3 and subdivision (d) of this section, if the
participating entity cannot reach an agreement with the department as
to the appropriate rate to be paid under Section 15910.3, at the
option of the participating entity, the LIHP shall be reimbursed on a
cost basis in accordance with the methodology applied to Health Care
Coverage Initiative programs established under Part 3.5 (commencing
with Section 15900), including interim quarterly payments. If the
participating entity and the department reach an agreement as to the
appropriate rate, the rate shall be applied no earlier than the first
day of the LIHP year in which the parties agree to the
rate, except that for the LIHP year ending June 30, 2012, the rate
may apply as early as July 1, 2011, without regard to the date of the
agreement between the participating entity and the department
rate .
(2) (A) The department finds and declares all of the following:
(i) The department, in consultation with a number of the LIHPs,
has proposed LIHP capitation rates for federal approval.
(ii) There is some concern that federal approval of the proposed
rates will not be received, and implementing contracts may not be
signed, before June 30, 2012.
(iii) The amendments made to this subdivision by the act that
added this clause would allow the federally approved capitation rates
to apply to the LIHP year, which is July 1, 2011, to June 30, 2012,
inclusive, even if federal approval and the necessary contract
amendments are not finalized until after June 30, 2012.
(B) Therefore, it is the intent of the Legislature in amending
this subdivision to allow the LIHP capitation rates to apply for the
2011-12 fiscal year even if final agreements on the capitation rates
are delayed while awaiting federal approval and are not finalized
until after June 30, 2012.
(f) If authorized under the Special Terms and Conditions of the
demonstration project, pending the department's development of rates
in accordance with Section 15910.3, the department shall make interim
quarterly payments to approved LIHPs for expenditures based on
estimated costs submitted for rate setting.
(g) Participating entities that operate a LIHP directly or through
contract with another entity shall be entitled to any federal
financial participation available for administrative expenditures
incurred in the operation of the Medi-Cal program or the
demonstration project, including, but not limited to, outreach,
screening and enrollment, program development, data collection,
reporting and quality monitoring, and contract administration, but
only to the extent that the expenditures are allowable under federal
law and only to the extent the expenditures are not taken into
account in the determination of the per enrollee rates under Section
15910.3.
(h) On and after January 1, 2014, the state shall implement
comprehensive health care reform for the populations targeted by the
LIHP in compliance with federal health care reform law, regulation,
and policy, including 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
subsequent amendments.
(i) Subject to the Special Terms and Conditions of the
demonstration project, a participating entity may elect to include,
in collaboration with the department, as the nonfederal share of LIHP
expenditures, voluntary intergovernmental transfers or certified
public expenditures of another governmental entity, as long as the
intergovernmental transfer or certified public expenditure is
consistent with federal law.
(j) Participation in the LIHP under this part is voluntary on the
part of the eligible entity for purposes of all applicable federal
laws. As part of its voluntary participation under this article, the
participating entity shall agree to reimburse the state for the
nonfederal share of state staffing and administrative costs directly
attributable to the cost of administering that LIHP, including, but
not limited to, the state administrative costs related to certified
public expenditures and intergovernmental transfers. This section
shall be implemented only to the extent federal financial
participation is not jeopardized.
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.
SEC. 71. (a) (1) The State Department of Health
Care Services shall accept funding from private foundations in the
amount of at least $12.5 million 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) The department may use a portion of the private foundation
funding pursuant to paragraph (a) to carry out the activities under
this section.
SEC. 72. Commencing no later than August 1, 2013,
the State Department of Health Care Services shall convene a series
of stakeholder meetings to receive input from clients, family
members, providers, counties, and representatives of the Legislature
concerning the development of the Behavioral Health Services Plan, as
required by paragraph 25.d of the Special Terms and Conditions of
California's Bridge to Reform Section 1115(a) Medicaid Demonstration.
SEC. 73. Given the uncertainty within which
persons diagnosed with HIV/AIDS from federal Ryan White HIV/AIDS
Treatment Extension Act of 2009 funded programs may transition to
Medi-Cal or other health insurance coverage, the State Department of
Public Health shall report to the Joint Legislative Budget Committee
by October 1, 2013, on whether any of the projections or assumptions
used to develop the AIDS Drug Assistance Program (ADAP) estimated
budget for the Budget Act of 2013 may result in an inability of ADAP
to provide services to ADAP eligible clients. If the State Department
of Public Health determines, before October 1, 2013, that ADAP is
unable to provide services to ADAP eligible clients, the State
Department of Public Health shall provide notification to the Joint
Legislative Budget Committee within 15 calendar days of making this
determination.
SEC. 74. By October 1, 2013, the State Department
of Public Health shall submit to the fiscal and appropriate policy
committees of the Legislature a report describing how it plans to
address the findings and recommendations described in its "Zero-Based
Budgeting Review" report dated May 14, 2013, regarding the Infant
Botulism Treatment and Prevention Program (BabyBIG program).
SEC. 75. As part of the Governor's annual budget
release to the Legislature in January and May, the State Department
of Health Care Services shall identify as a separate policy change
within the Medi-Cal Local Assistance Estimate, the projected General
Fund savings attributable to the receipt of enhanced federal funding
for Medi-Cal eligibles, subject to the use of Modified Adjusted Gross
Income as the basis for their income eligibility, who were
previously calculated as being currently eligible and for whom the
state received only a 50 percent federal matching assistant payment.
The identified savings shall be attributed to the receipt of enhanced
federal funding under Title XIX of the federal Social Security Act.
The State Department of Health Care Services shall confer with
applicable fiscal and policy staff of the Legislature by no later
than October 1, 2013, regarding the potential content and attributes
of the information provided in this policy change. This separate
policy change format shall be provided through 2019-20.
SEC. 76. Notwithstanding any other law, the
balance of Item 4150-001-0890 of the Budget Act of 2012 is
reappropriated to the Department of Managed Health Care for the
purposes of continuing operation of consumer assistance programs to
help uninsured individuals obtain health care coverage pursuant to
the terms of the federal Consumer Assistance Program Grant. These
funds shall be available for encumbrance and expenditure until June
30, 2014.
SEC. 77. The adoption and readoption of
regulations implementing portions of this act by the Managed Risk
Medical Insurance Board shall be deemed an emergency and necessary to
avoid serious harm to the public peace, health, safety, or general
welfare for purposes of Sections 11346.1 and 11349.6 of the
Government Code, and the board is hereby exempted from the
requirement that it describe facts showing the need for immediate
action and from review by the Office of Administrative Law.
SEC. 78. The Legislature finds and declares that
Section 2 of this act, which amends Section 6254 to the Government
Code, and Section 68 of this act, which adds Part 3.3 (commencing
with Section 15800) to Division 9 of the Welfare and Institution
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:
(a) In order to ensure that the State Department of Health Care
Services is not constrained in exercising its fiduciary powers and
obligations to negotiate on behalf of the public as it implements the
provisions of Part 3.3 (commencing with Section 15800) of Division 9
of the Welfare and Institutions Code, the limitations on the public'
s right of access imposed by Section 2 of this act are necessary.
(b) To ensure the continued confidentiality of otherwise
privileged or confidential information, the limitations on the public'
s right of access imposed by Section 68 of this act are necessary.
SEC. 79. 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.
SECTION 1. It is the intent of the Legislature
to enact statutory changes relating to the Budget Act of 2013.