Title WIC, California Welf. & Inst. Code

(a) A participating FQHC shall be compensated for the APM scope of services provided to its APM enrollees pursuant to this section. (b) A participating FQHC shall receive from the principal health plan or applicable subcontracting payer reimbursement for each APM enrollee in the …

(a) A principal health plan shall be compensated by the department for the APM scope of services provided to its APM enrollees pursuant to this section. (b) For each principal health plan that contains at least one participating FQHC in its provider network, the department shall …

(a) For the duration of the APM project, the department shall establish a risk corridor structure for the principal health plans relating only to the APM supplemental capitation payments pursuant to Section 14138.15, to the extent consistent with principles of actuarial soundness…

(a) In order to ensure participating FQHCs have an incentive to manage visits and costs, while at the same time exercising a reasonable amount of flexibility to deliver care in the most efficient and quality driven manner, for the duration of the APM project the department shall,…

(a) This article shall be implemented only to the extent that any necessary federal approvals have been obtained and federal financial participation is available and not otherwise jeopardized. (b) (1) The department may modify any methodology or other provision specified in this …

This article shall not be deemed to affect the amounts paid or the reimbursement methodology applicable to FQHCs for dental services and for services that are provided outside the scope of a contract between the department and an applicable principal health plan that is in effect…

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 article by means of all-county letters, plan letters, plan or provider bulletins, or similar instr…

For purposes of implementing this article, the department may enter into exclusive or nonexclusive contracts on a bid or negotiated basis, including, but not limited to, contracts for the purpose of obtaining subject matter expertise or other technical assistance. Any contract en…

The State Department of Health Services shall report to the Legislature on a biennial basis on all of the following data with respect to the child health and disability prevention program provided for pursuant to Article 6 (commencing with Section 124025) of Chapter 3 of Part 2 o…

(a) The department shall expend, upon appropriation, any savings accrued from the establishment and implementation of a bulk purchase vaccine program to increase the participation of physicians and surgeons, public and community-based health clinics, and health care facilities as…

The Legislature finds and declares that: (a) Long-term care services in California include an uncoordinated array of categorical programs offering medical, social, and other support services that are funded and administered by a variety of federal, state, and local agencies and a…

(a) It is the intent of the Legislature to establish the Long-Term Care Integration Pilot Program that will integrate the financing and administration of long-term care services in up to five pilot project sites in the state. Contingent upon a state approved administrative action…

The goals of this pilot program shall be to: (a) Provide a continuum of social and health services that foster independence and self-reliance, maintain individual dignity, and allow consumers of long-term care services to remain an integral part of their family and community life…

It is the intent of the Legislature that the costs of this pilot program to the General Fund will not exceed the direct and indirect costs that existing programs would expect to incur had the integrated services not been provided through this pilot program. If the Department of F…

(a) Any contract entered into pursuant to this article may be renewed if the long-term care services agency continues to meet the requirements of this article and the contract. Failure to meet these requirements shall be cause for nonrenewal of the contract. The department may co…

The department shall serve as the lead agency for the administration of this chapter. The department’s responsibilities shall include, but are not limited to: (a) Development of criteria for the selection of pilot project sites. (b) Selection of the pilot project sites to partici…

The department may accept funding from federal agencies, foundations or other nongovernmental sources and may contract with qualified consultants to assist with the provision of technical assistance, the development of data collection, reporting, and analysis systems, or any othe…

(a) The department shall convene a working group that shall include the Director of Health Care Services, the Director of Social Services, and the Director of the California Department of Aging, or the program staff from each of those departments who have direct responsibility fo…

Upon the implementation of the pilot program, responsibility for administering the programs integrated within the pilot program shall be transferred to the department, and shall be specified in an interagency agreement between participating departments. Prior requirements for any…

The department shall seek all federal waivers necessary to allow for federal financial participation in the pilot program implemented pursuant to this article. This article shall not be implemented unless and until the director has executed a declaration that the approval of all …

Notwithstanding any other provision of this article, costs to the General Fund shall not exceed the amount that would have been expended in the absence of the pilot program. (Added by Stats. 1995, Ch. 875, Sec. 1. Effective January 1, 1996.)

(a) Pilot project sites may be comprised of a single county, a multicounty unit, or a subcounty unit. (b) Each selected site shall do all of the following: (1) Establish a consolidated long-term care services fund that shall accommodate state and federal fiscal and auditing requi…

In order to be selected, a pilot project site shall demonstrate that it has an active advisory committee that includes consumers of long-term care services, representatives of local organizations of persons with disabilities, seniors, representatives of local senior organizations…

(a) The administrative action plan shall identify the funds to be transferred into the consolidated long-term care services fund. (b) The funds shall include Medi-Cal long-term institutional care, the Medi-Cal Personal Care Services Program, and the In-Home Supportive Services Pr…

The administrative action plan shall delineate the services to be provided to all eligible beneficiaries. At a minimum, services to be provided shall include all of the following: (a) Care or case management, including assessment, development of a service plan in conjunction with…

The administrative action plan may also include any of the following services: (a) Transportation. (b) Home modification. (c) Medical services, including, but not limited to, primary, ancillary, and acute care. (d) Housing and residential services. (e) Other services determined b…

The department may exempt a pilot project site from the requirements of subdivisions (d) and (f) of Section 14139.33 if both the following conditions are met: (a) State funds were not being used in the geographic area covered by the pilot projects to provide those services at the…

(a) If primary, ancillary, and acute care are not included among the services offered by a pilot project site, the administrative action plan shall include all of the following: (1) A mechanism for tracking the usage of these services by beneficiaries of the plan. (2) Provisions …

The administrative action plan shall delineate specifically how the pooled funds will be used to deliver services to all eligible recipients in the geographic area covered by the pilot project site. (Added by Stats. 1995, Ch. 875, Sec. 1. Effective January 1, 1996.)

Participating counties shall continue their financial maintenance of effort for each of the programs integrated within the pilot program under this article. The amount of a county’s maintenance of effort shall be the same as if the program were not integrated within the pilot pro…

(a) The long-term care services agency shall be responsible and at risk for implementing the administrative action plan. The long-term care services agency shall do all of the following: (1) Respond, or provide for response to, consumer needs on a 24-hour, seven-day-a-week basis.…

(a) For purposes of this chapter, “eligible beneficiaries” shall be defined as persons meeting all the following criteria: (1) Are Medi-Cal eligible. (2) Are functionally or cognitively impaired. For purposes of this paragraph “cognitively impaired” means having an impairment cau…

(a) Each pilot project site shall serve all eligible beneficiaries who live in the geographic area served by the long-term care services agency. In order to eliminate duplicative administrative costs and to achieve a more efficient delivery system, pilot project sites shall also …

This article shall not preclude a long-term care services agency from entering into additional agreements, separate from the pilot project, to serve additional individuals or populations. (Added by Stats. 1995, Ch. 875, Sec. 1. Effective January 1, 1996.)

Pilot project sites shall ensure provider reimbursement rates that are adequate to maintain compliance with applicable federal and state requirements. (Added by Stats. 1995, Ch. 875, Sec. 1. Effective January 1, 1996.)

The department shall set a capitated rate of payment that is actuarially sound and that is based on the number of beneficiaries who are eligible for Medi-Cal benefits to be enrolled in the pilot project, the mix of provided services and programs being integrated, and past Medi-Ca…

If the department determines that a program or programs cannot reasonably be capitated, funds may be transferred separately from the capitation payment. The amount of those noncapitated funds shall be based on amounts that would have been expended by the state for those programs …

(a) The department shall develop criteria to ensure that pilot project sites maintain fiscal solvency, including, but not limited to, the following: (1) The capability to achieve and maintain sufficient fiscal tangible net equity within a timeframe to be specified by the departme…

(a) It is the intent of the Legislature that local entities that are potential participants in this pilot program shall be assured of sufficient time to plan their pilot projects, and that the selected pilot project sites shall be assured of sufficient time to phase in the implem…

The department may adopt emergency regulations as necessary to implement this article in accordance with the Administrative Procedure Act, Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. The initial adoption of emergency regu…

Contingent on the availability of funding, the department shall evaluate the effectiveness of each pilot project on a schedule that coincides with federal waiver reporting requirements, and shall make this information available upon request. The department’s evaluation shall incl…

The following definitions shall apply to the provisions of this article: (a) “Net worth” means: (1) Personal property, which consists of cash, savings accounts, securities, and similar items; notes, mortgages, and deeds of trust; the cash surrender value of life insurance on the …

Net worth liability shall be determined as of the time of the initial dialysis or parenteral hyperalimentation treatment and shall be reevaluated each year by the department. (Amended by Stats. 1980, Ch. 1240, Sec. 2.)

Notwithstanding Section 14005.4 or 14005.7, a person who is otherwise eligible for dialysis and related services under Section 14005.4 or 14005.7, except for his or her income and resource eligibility, is eligible for dialysis and related services under Medi-Cal pursuant to this …

Notwithstanding Section 14005.4 or 14005.7, a person requiring parenteral hyperalimentation and related services is eligible for these services under Medi-Cal pursuant to this section, as follows: (a) A person in a family unit with a net worth of less than five thousand dollars (…

The health care benefits and services specified in this article, to the extent that such benefits and services are neither provided under any other federal or state law nor provided nor available under other contractual or legal entitlements of the person, shall be provided to an…