California Administrative Code

(a) The nursing service shall, as a minimum: (1) Assess each participant to determine needs for personal care and assistance in activities of daily living such as bathing, grooming, toileting and eating; include these needs in the plan of care and supervise the provision of these…

For each surface application GRRP used for replenishing a groundwater basin, the GRRP's project sponsor shall assess the SAT process through the monitoring of TOC, indicator compounds, and surrogate parameters, as approved by the Department. (a) At least once each week, a project…

(a) Each center shall have an administrator. The administrator shall have the responsibility and authority to carry out the policies of the licenses. The licensee shall notify the Department in writing within 14 working days following a change of administrator. Notification shall…

(a) Each center shall have a full-time program director during hours of operation. The administrator may serve in this capacity if the administrator meets the qualifications. The program director shall be on the premises and available to participants and their relatives and emplo…

(a) The activity coordinator shall have one of the following qualifications: (1) Two years' experience in a social recreational or educational program within the past five years, one year of which was full-time in an activities program in a health care, mental health or handicapp…

(a) Each adult day health care provider shall establish and maintain a procedure for submittal, processing and resolution of grievances of participants regarding care and administration by the provider. Such procedure shall be approved by the Department and shall provide for the …

(a) All subcontracts shall be in writing. (b) Each subcontract shall be submitted to the Department at least 60 days prior to the effective date. If the Department does not formally act on a subcontract within 60 days after receipt, the adult day health care provider may use the …

(a) If, under the option provided in Section 55120(d), the Indian Health Service Facility elects to become a fee-for-service managed care plan, the Indian Health Service Facility shall act as primary care case manager for Medi-Cal beneficiaries who are Indians or non-Indians curr…

(a) The United States Congress has declared that it is the policy of the United States, in fulfillment of the special responsibilities and legal obligations to the American Indian people, to meet the national goal of providing the highest possible health status to Indians. In fur…

The following definitions shall control the construction of this chapter unless the context requires otherwise. (a) County organized health system means a Medi-Cal managed care plan contracting with the department to serve enrolled beneficiaries under the authority of Welfare and…

(a) Indians shall not be required to enroll in any Medi-Cal managed care plans, with the exception of county organized health systems. (b) Indians who are enrolled in a Medi-Cal managed care plan, including county organized health systems, shall not be restricted in their access …

Effective date of enrollment means the first day of the first month in which a Medi-Cal beneficiary's name appears on the approved list of members furnished to the PCCM plan by the Department as a result of the completion of a designation form for enrollment in the PCCM plan.

Enrollment means the process by which a Medi-Cal beneficiary becomes a member of a PCCM plan.

Facility means any location which is: (a) Owned, leased, used or operated directly or indirectly by or for the benefit of a PCCM plan or its affiliates for purposes related to a PCCM contract, or (b) Maintained by a provider for the provision of services on behalf of a PCCM plan.

(a) The provisions of section 56251 notwithstanding, the PCCM plan may obtain reinsurance for the cost of providing capitated services, subject to the following conditions: (1) Reinsurance shall not reduce the PCCM plan's liability below the minimum liability per member for any o…

(a) A provider of medical services may submit a grievance or complaint concerning the authorization or denial of a service or the processing, payment or nonpayment of a claim by a PCCM plan as follows: (1) The provider shall initiate a first level appeal, by submitting a grievanc…

(a) Each PCCM plan shall maintain or cause to be maintained all records necessary to verify information and reports required by statute, regulation or contractual obligation for three years from the date of submission of information or reports, except as specified in subdivision …

Whenever the term “State Board” is used in this division, it means the State Water Resources Control Board, unless otherwise specified.

The Department may impose one or more of the following penalties for violations of the provisions of this Article: (a) Revoke one or more permitted method of marketing. (b) Refuse to accept new enrollments for a period specified by the Department. (c) Refuse to accept enrollments…

Except as provided in section 56440, membership shall continue indefinitely after enrollment. Membership shall be contingent upon the member's retention of Medi-Cal eligibility as well as eligibility for enrollment in the PCCM plan under the terms of the PCCM contract.

(a) A request for disenrollment by a PCCM plan member shall be submitted to the Department by the PCCM plan within five working days after either the date the member submits a signed disenrollment request directly to the PCCM plan or the postmark date for disenrollment requests s…

“Fixed equipment” means equipment that is permanently affixed to the structure and which has a useful life determined in accordance with guidelines published by the American Hospital Association, entitled “Estimated Useful Lives of Depreciable Hospital Assets,” 1983 and does not …

“Revenue bond” as defined in the California Government Code, division 3, Part 7.2, section 15459(c) means any bonds, warrants, notes, leases or installment sale obligations evidenced by certificates of participation, or other evidence of indebtedness issued by a local agency paya…

“Three most recent years” means the three most recent calendar years.

“Adult Day Health/Social Care” means a structured, comprehensive program which provides a variety of community-based services including health, social, and related supportive services in a protective setting on a less than 24-hour basis. These community-based services are designe…

“Average Daily Private Pay Rate for Nursing Facilities” means the estimated average net revenue per patient day for intermediate and skilled nursing facility services for the current calendar year for patients not qualifying for Federal and State reimbursement. The net revenue pe…

“Benefit Eligibility” in each Policy or Certificate is defined as follows: (a) “How to qualify for Benefits: We will pay for the Qualified Long-Term Care Services covered by this policy if: (1) The insured becomes a Chronically Ill Individual, and (2) The Services are prescribed …

“Elimination Period” is defined as either (a) or (b). (a) “Elimination Period” means the total number of days that covered, Formal Long-Term Care Services must be received after the insured is determined to be a Chronically Ill Individual and before the benefits covered by the Po…

“Policy” means any contract, rider, or endorsement delivered or issued for delivery in the State of California by an Issuer.

“Qualified Long-Term Care Services” means necessary diagnostic, preventive, therapeutic, curing, treating, mitigating, and rehabilitative services, and maintenance or personal services which are needed to assist the insured with the disabling conditions that cause the insured to …

“Quarterly/Annually”, unless otherwise stated, refers to periods aligned with the State Fiscal Year of July 1 to June 30.

(a) The Care Management Provider Agency must be capable of providing a professional assessment of a person's physical, cognitive, social and emotional functional levels in order to identify individual strengths and needs. The individual's current functional capacities, family and…

(a) A Care Management Supervisor shall have demonstrated expert ability in the Care Management role. This individual shall also: (1) support and clarify the role of the Care Manager; (2) be accessible to Care Managers on a scheduled and as needed basis; (3) provide guidance on de…

(a) Care Managers shall meet or exceed both of the following qualifications: (1) be a registered nurse and/or graduate of an accredited four year college or university with a degree in nursing, health, social work, gerontology or other related area; and (2) have a minimum of two …

(a) A Care Management Provider Agency shall have a written list of rights and legal responsibilities which shall be presented to each client or his or her representative at the time of assessment or as soon as possible thereafter. The list shall include: (1) a description of avai…

The Department of Health Services incorporates by reference the objectives, criteria, and procedures as delineated in Chapters 1, 2, 2.5, 2.6, 3, 4, 5, and 6, Division 13, Public Resources Code, Sections 21000 et seq., and the Guidelines for the Implementation of the California E…

The following specific activities are determined by the Department to fall within the classes of categorical exemptions set forth in Sections 15300 et seq. of Title 14 of the California Administrative Code: (a) Class 1: Existing Facilities. (1) Any interior or exterior alteration…

“24-hour Composite Sample” means an aggregate sample derived from no fewer than eight discrete samples collected at equal time intervals or collected proportional to the flow rate over the compositing period. The aggregate sample shall reflect the average source water quality cov…

“Augmented Reservoir” means a surface water reservoir used as a source of domestic drinking water supply that receives recycled municipal wastewater from a Surface Water Source Augmentation Project (SWSAP).

“Coagulated wastewater” means oxidized wastewater in which colloidal and finely divided suspended matter have been destabilized and agglomerated upstream from a filter by the addition of suitable floc-forming chemicals.

“Facility” means any type of building or structure, or a defined area of specific use that receives water for domestic use from a public water system as defined in section 116275 of the Health and Safety Code.

“Food crops” means any crops intended for human consumption.

“Groundwater Replenishment Reuse Project” or “GRRP” means a project involving the planned use of recycled municipal wastewater that is operated for the purpose of replenishing a groundwater basin designated in the Water Quality Control Plan [as defined in Water Code section 13050…

“Standby unit process” means an alternate unit process or an equivalent alternative process which is maintained in operable condition and which is capable of providing comparable treatment of the actual flow through the unit for which it is a substitute.

“Surface Application” means the application of recharge water to a spreading area.

As used in this Article and Article 5.3 of this Chapter, “Surface Water” has the same meaning as defined in section 64651.83 of Chapter 17.

“Surrogate Parameter” means a measurable physical or chemical property that has been demonstrated to provide a direct correlation with the concentration of an indicator compound, can be used to monitor the efficiency of trace organic compounds removal by a treatment process, and/…

“Total Organic Carbon” or “TOC” means the concentration of organic carbon present in water.

“Undisinfected secondary recycled water” means oxidized wastewater.

The public water supply shall not be used as a backup or supplemental source of water for a dual-plumbed recycled water system unless the connection between the two systems is protected in a manner that complies with the requirements of the Cross-Connection Control Policy Handboo…