100150. The State Department of Health Services succeeds to and is
vested with all the duties, powers, purposes, responsibilities, and
jurisdiction of the State Department of Health as they relate to
public health, licensing and certification of health facilities,
except community care facility licensing to which the State
Department of Social Services succeeds, and any other functions
performed by the Division of Public Health of the State Department of
Health on July 1, 1978, unless the function is transferred to a
different state agency or department as a result of another provision
of the statutes of the 1977-78 Regular Session of the Legislature
amending this section.
"State department," "department," or "State Department of Health"
as used in this code, except in Article 7.5 (commencing with Section
416) of Chapter 2 of Part 1 of Division 1 or as otherwise specified
in this code, means the State Department of Health Services.
The Office of Statewide Health Planning and Development shall
assume the functions and responsibilities of the Facilities
Construction Unit of the former State Department of Health,
including, but not limited to, those functions and responsibilities
performed pursuant to the following provisions of law: Sections 13113
and 127050; Article 1 (commencing with Section 129000) of Chapter 1
of, and Chapter 2 (commencing with Section 129375) of, Part 6 of, and
Part 7 (commencing with Section 129675) of, Division 107.
100155. The department may use the unexpended balance of funds
available for use in connection with the performance of the functions
of the State Department of Health to which the department has
succeeded pursuant to Section 100150.
100160. All officers and employees of the State Department of
Health heretofore performing any duty, power, purpose,
responsibility, or jurisdiction to which the department has
succeeded, who, on July 1, 1978, are serving in the state civil
service, other than as temporary employees, and engaged in the
performance of a function vested in the department by Section 100150
shall be transferred to the department. The status, positions, and
rights of these persons shall not be affected by the transfer and
shall be retained by them as officers and employees of the
department, pursuant to the State Civil Service Act except as to
positions exempted from civil service.
100165. The department shall have possession and control of all
records, papers, officers, equipment, supplies, moneys, funds,
appropriations, land or other property, real or personal, held for
the benefit or use of any state agency whose functions are vested in
the department by Section 100150.
100170. (a) The department may commence and maintain all proper and
necessary actions and proceedings for any or all of the following
purposes:
(1) To enforce its regulations.
(2) To compel the performance of any act specifically enjoined
upon any person, officer, or board, by any law of this state relating
to its powers and duties.
(b) It may defend all actions and proceedings involving its powers
and duties.
(c) In all actions and proceedings it shall sue and be sued under
the name of the department.
100171. Notwithstanding any other provision of law, whenever the
department is authorized or required by statute, regulation, due
process (Fourteenth Amendment to the United States Constitution;
subdivision (a) of Section 7 of Article I of the California
Constitution), or a contract, to conduct an adjudicative hearing
leading to a final decision of the director or the department, the
following shall apply:
(a) The proceeding shall be conducted pursuant to the
administrative adjudication provisions of Chapter 4.5 (commencing
with Section 11400) and Chapter 5 (commencing with Section 11500) of
Part 1 of Division 3 of Title 2 of the Government Code, except as
specified in this section.
(b) Notwithstanding Section 11502 of the Government Code, whenever
the department conducts a hearing under Chapter 4.5 (commencing with
Section 11400) or Chapter 5 (commencing with Section 11500) of Part
1 of Division 3 of Title 2 of the Government Code, the hearing shall
be conducted before an administrative law judge selected by the
department and assigned to a hearing office that complies with the
procedural requirements of Chapter 4.5 (commencing with Section
11400) of Part 1 of Division 3 of Title 2 of the Government Code.
(c) (1) Notwithstanding Section 11508 of the Government Code,
whenever the department conducts a hearing under Chapter 4.5
(commencing with Section 11400) or Chapter 5 (commencing with Section
11500) of Part 1 of Division 3 of Title 2 of the Government Code,
the time and place of the hearing shall be determined by the staff
assigned to the hearing office of the department, except as provided
in paragraph (2) or unless the department, by regulation, specifies
otherwise.
(2) Formal hearings requested by institutional Medi-Cal providers
and health facilities shall be held in Sacramento.
(d) (1) Unless otherwise specified in this section, the following
sections of the Government Code shall apply to any adjudicative
hearing conducted by the department only if the department has not,
by regulation, specified an alternative procedure for the particular
type of hearing at issue: Section 11503 (relating to accusations),
Section 11504 (relating to statements of issues), Section 11505
(relating to the contents of the statement to respondent), Section
11506 (relating to the notice of defense), Section 11507.6 (relating
to discovery rights and procedures), Section 11508 (relating to the
time and place of hearings), and Section 11516 (relating to amendment
of accusations).
(2) Any alternative procedure specified by the department in
accordance with this subdivision shall conform to the purpose of the
Government Code provision it replaces insofar as it is possible to do
so consistent with the specific procedural requirements applicable
to the type of hearing at issue.
(3) Any alternative procedures adopted by the department under
this subdivision shall not diminish the amount of notice given of the
issues to be heard by the department or deprive appellants of the
right to discovery suitable to the particular proceedings. Except as
specified in paragraph (2) of subdivision (c), modifications of
timeframes or of the place of hearing made by regulation shall not
lengthen timeframes within which the department is required to act
nor require hearings to be held at a greater distance from the
appellant's place of residence or business than is the case under the
otherwise applicable Government Code provision.
(e) The specific timelines specified in Section 11517 of the
Government Code shall not apply to any adjudicative hearing conducted
by the department to the extent that the department has, by
regulation, specified different timelines for the particular type of
hearing at issue.
(f) In the case of any adjudicative hearing conducted by the
department, "transcript," as used in subdivision (c) of Section 11517
of the Government Code, shall be deemed to include any alternative
form of recordation of the oral proceedings, including, but not
limited to, an audio recording.
(g) Pursuant to Section 11415.50 of the Government Code, the
department may, by regulation, provide for any appropriate informal
procedure to be used for an informal level of review that does not
itself lead to a final decision of the department or the director.
The procedures specified in Article 10 (commencing with Section
11445.10) of Chapter 4.5 of Part 1 of Division 3 of Title 2 of the
Government Code shall not apply to an informal level of review
authorized by this subdivision. Informal conferences concerning
appeals by institutional Medi-Cal providers and health facilities may
be held in Sacramento or Los Angeles.
(h) Notwithstanding any other provision of law, any adjudicative
hearing conducted by the department that is conducted pursuant to a
federal statutory or regulatory requirement that contains specific
procedures may be conducted pursuant to those procedures to the
extent they are inconsistent with the procedures specified in this
section.
(i) Nothing in this section shall apply to a fair hearing
involving a Medi-Cal beneficiary insofar as the hearing is, by
agreement or otherwise, heard before an administrative law judge
employed by the State Department of Social Services, or insofar as
the hearing is being held pursuant to Division 4.5 (commencing with
Section 4500) of the Welfare and Institutions Code in connection with
services provided by the State Department of Developmental Services
under applicable federal Medicaid waivers. Nothing in this
subdivision shall be interpreted as abrogating the authority of the
State Department of Health Care Services as the single state agency
under the state Medicaid plan.
(j) Nothing in this provision shall supersede express provisions
of law that apply to any hearing that is not adjudicative in nature
or that does not involve due process rights specific to an individual
or specific individuals, as opposed to the general public or a
segment of the general public.
100185.5. (a) When a letter or order of denial of continued
enrollment or suspension of any type or duration, based upon fraud or
abuse, or a withholding of payments, based upon reliable evidence of
fraud or willful misrepresentation, is issued by the department to a
provider, the director shall review the evidence supporting the
denial of continued enrollment, suspension, or withholding of
payments. If, in the opinion of the director, the evidence shows a
pattern or practice of fraud, abuse, or willful misrepresentation
that, if replicated in any other health care program administered by
the department, could cause either fiscal loss to the state or harm
to any participant, the director may deny continued enrollment,
suspend, or withhold payments to, the provider with respect to those
other health care programs. Any denial of continued enrollment,
suspension, or withholding of payments may be for an indefinite or
definite period of time, may be stayed for a period of time, and may
be with or without conditions or probation.
(b) The director may deny the application of an applicant or
provider to participate in any health care program administered by
the department, when, based upon fraud or abuse, the applicant or
provider has been denied continued enrollment in, or suspended from,
any health care program administered by the department, or has had
payments withheld based upon reliable evidence of fraud or willful
misrepresentation in connection with any health care program
administered by the department, and remains ineligible to participate
in the health care program from which the applicant or provider was
denied continued enrollment, suspended, or had payments withheld.
(c) The director may deny any new or additional application of a
provider to participate in any health care program administered by
the department if utilization controls including, but not limited to,
prior authorization or special claims review pursuant to Sections
51159, 51455, and 51460 of Title 22 of the California Code of
Regulations have been imposed upon that provider by any health care
program administered by the department. Applications shall not be
denied based solely upon utilization controls imposed upon an entire
class or category of providers to which that provider belongs.
(d) Notwithstanding any other provision of law, any provider or
applicant who has been denied continued enrollment in, or suspended
from, or who has had payments withheld in connection with, any health
care program administered by the department, or whose application to
participate in a health care program administered by the department
is denied, pursuant to this section, may appeal that action in
accordance with Section 14043.65 of the Welfare and Institutions
Code.
(e) For purposes of this section, the following definitions apply:
(1) "Abuse" has the same meaning as that term is defined in
Section 14043.1 of the Welfare and Institutions Code.
(2) "Administered by the department" means administered by the
State Department of Health Services or by its agents or contractors
on behalf of the State Department of Health Services.
(3) "Applicant" means any person, individual, partnership, group,
association, corporation, institution, or entity, and the officers,
directors, owners, managing employees, or agents thereof, that
applies to the department for enrollment as a provider or
participation as a provider in a health care program administered by
the department.
(4) "Fraud" has the same meaning as that term is defined in
Section 14043.1 of the Welfare and Institutions Code.
(5) "Provider" means any person, individual, partnership, group,
association, corporation, institution, or entity, and the officers,
directors, owners, managing employees, or agents thereof, that
provides services, goods, supplies, or merchandise, directly or
indirectly, to a person enrolled in a health care program
administered by the department.
(6) "Withholding of payments" means the withholding of payments in
accordance with Section 14107.11 of the Welfare and Institutions
Code.
(f) For purposes of this section, "suspension" includes, but is
not limited to, suspensions authorized under Article 1.3 (commencing
with Section 14043) or Article 3 (commencing with Section 14123) of
Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code.
(g) For purposes of this section, "health care program
administered by the department" includes, but is not limited to, the
Medi-Cal program.
100220. With the approval of the Department of Finance, and for use
in the furtherance of the work of the department, the director may
accept (a) grants of interest in real property, and (b) gifts of
money from public agencies or from organizations or associations
organized for scientific, educational, or charitable purposes.
100236. (a) Within 60 days of enactment of the Budget Act, the
department shall advance to a local health department 25 percent of
the annual General Fund allocation, subvention, or reimbursement
required by a local health department for the delivery of services
specified in subdivision (b). In determining the dollar amount of the
25 percent allocation, subvention, or reimbursement, the department
shall use the local health department's prior year's or the most
recently completed fiscal year's allocation.
(b) Subdivision (a) shall apply to the following health programs
and General Fund funding sources:
(1) Funding for administration for the California Children's
Services Program (Article 5 (commencing with Section 123800) of
Chapter 3 of Part 2 of Division 106).
(2) Funding for medical therapy for the California Children's
Services Program (Article 5 (commencing with Section 123800) of
Chapter 3 of Part 2 of Division 106).
(3) Funding for administration for the Child Health and Disability
Prevention Program (Article 6 (commencing with Section 124025) of
Chapter 3 of Part 2 of Division 106).
(4) Funding for HIV education and prevention services under
Section 100119.
(c) This section shall not apply to a local health department that
is three or more quarters in arrears in billing the state for the
programs specified in subdivision (b).
(d) For purposes of this section, "local health department" has
the same meaning as that set forth in Section 101185.
100150. The State Department of Health Services succeeds to and is
vested with all the duties, powers, purposes, responsibilities, and
jurisdiction of the State Department of Health as they relate to
public health, licensing and certification of health facilities,
except community care facility licensing to which the State
Department of Social Services succeeds, and any other functions
performed by the Division of Public Health of the State Department of
Health on July 1, 1978, unless the function is transferred to a
different state agency or department as a result of another provision
of the statutes of the 1977-78 Regular Session of the Legislature
amending this section.
"State department," "department," or "State Department of Health"
as used in this code, except in Article 7.5 (commencing with Section
416) of Chapter 2 of Part 1 of Division 1 or as otherwise specified
in this code, means the State Department of Health Services.
The Office of Statewide Health Planning and Development shall
assume the functions and responsibilities of the Facilities
Construction Unit of the former State Department of Health,
including, but not limited to, those functions and responsibilities
performed pursuant to the following provisions of law: Sections 13113
and 127050; Article 1 (commencing with Section 129000) of Chapter 1
of, and Chapter 2 (commencing with Section 129375) of, Part 6 of, and
Part 7 (commencing with Section 129675) of, Division 107.
100155. The department may use the unexpended balance of funds
available for use in connection with the performance of the functions
of the State Department of Health to which the department has
succeeded pursuant to Section 100150.
100160. All officers and employees of the State Department of
Health heretofore performing any duty, power, purpose,
responsibility, or jurisdiction to which the department has
succeeded, who, on July 1, 1978, are serving in the state civil
service, other than as temporary employees, and engaged in the
performance of a function vested in the department by Section 100150
shall be transferred to the department. The status, positions, and
rights of these persons shall not be affected by the transfer and
shall be retained by them as officers and employees of the
department, pursuant to the State Civil Service Act except as to
positions exempted from civil service.
100165. The department shall have possession and control of all
records, papers, officers, equipment, supplies, moneys, funds,
appropriations, land or other property, real or personal, held for
the benefit or use of any state agency whose functions are vested in
the department by Section 100150.
100170. (a) The department may commence and maintain all proper and
necessary actions and proceedings for any or all of the following
purposes:
(1) To enforce its regulations.
(2) To compel the performance of any act specifically enjoined
upon any person, officer, or board, by any law of this state relating
to its powers and duties.
(b) It may defend all actions and proceedings involving its powers
and duties.
(c) In all actions and proceedings it shall sue and be sued under
the name of the department.
100171. Notwithstanding any other provision of law, whenever the
department is authorized or required by statute, regulation, due
process (Fourteenth Amendment to the United States Constitution;
subdivision (a) of Section 7 of Article I of the California
Constitution), or a contract, to conduct an adjudicative hearing
leading to a final decision of the director or the department, the
following shall apply:
(a) The proceeding shall be conducted pursuant to the
administrative adjudication provisions of Chapter 4.5 (commencing
with Section 11400) and Chapter 5 (commencing with Section 11500) of
Part 1 of Division 3 of Title 2 of the Government Code, except as
specified in this section.
(b) Notwithstanding Section 11502 of the Government Code, whenever
the department conducts a hearing under Chapter 4.5 (commencing with
Section 11400) or Chapter 5 (commencing with Section 11500) of Part
1 of Division 3 of Title 2 of the Government Code, the hearing shall
be conducted before an administrative law judge selected by the
department and assigned to a hearing office that complies with the
procedural requirements of Chapter 4.5 (commencing with Section
11400) of Part 1 of Division 3 of Title 2 of the Government Code.
(c) (1) Notwithstanding Section 11508 of the Government Code,
whenever the department conducts a hearing under Chapter 4.5
(commencing with Section 11400) or Chapter 5 (commencing with Section
11500) of Part 1 of Division 3 of Title 2 of the Government Code,
the time and place of the hearing shall be determined by the staff
assigned to the hearing office of the department, except as provided
in paragraph (2) or unless the department, by regulation, specifies
otherwise.
(2) Formal hearings requested by institutional Medi-Cal providers
and health facilities shall be held in Sacramento.
(d) (1) Unless otherwise specified in this section, the following
sections of the Government Code shall apply to any adjudicative
hearing conducted by the department only if the department has not,
by regulation, specified an alternative procedure for the particular
type of hearing at issue: Section 11503 (relating to accusations),
Section 11504 (relating to statements of issues), Section 11505
(relating to the contents of the statement to respondent), Section
11506 (relating to the notice of defense), Section 11507.6 (relating
to discovery rights and procedures), Section 11508 (relating to the
time and place of hearings), and Section 11516 (relating to amendment
of accusations).
(2) Any alternative procedure specified by the department in
accordance with this subdivision shall conform to the purpose of the
Government Code provision it replaces insofar as it is possible to do
so consistent with the specific procedural requirements applicable
to the type of hearing at issue.
(3) Any alternative procedures adopted by the department under
this subdivision shall not diminish the amount of notice given of the
issues to be heard by the department or deprive appellants of the
right to discovery suitable to the particular proceedings. Except as
specified in paragraph (2) of subdivision (c), modifications of
timeframes or of the place of hearing made by regulation shall not
lengthen timeframes within which the department is required to act
nor require hearings to be held at a greater distance from the
appellant's place of residence or business than is the case under the
otherwise applicable Government Code provision.
(e) The specific timelines specified in Section 11517 of the
Government Code shall not apply to any adjudicative hearing conducted
by the department to the extent that the department has, by
regulation, specified different timelines for the particular type of
hearing at issue.
(f) In the case of any adjudicative hearing conducted by the
department, "transcript," as used in subdivision (c) of Section 11517
of the Government Code, shall be deemed to include any alternative
form of recordation of the oral proceedings, including, but not
limited to, an audio recording.
(g) Pursuant to Section 11415.50 of the Government Code, the
department may, by regulation, provide for any appropriate informal
procedure to be used for an informal level of review that does not
itself lead to a final decision of the department or the director.
The procedures specified in Article 10 (commencing with Section
11445.10) of Chapter 4.5 of Part 1 of Division 3 of Title 2 of the
Government Code shall not apply to an informal level of review
authorized by this subdivision. Informal conferences concerning
appeals by institutional Medi-Cal providers and health facilities may
be held in Sacramento or Los Angeles.
(h) Notwithstanding any other provision of law, any adjudicative
hearing conducted by the department that is conducted pursuant to a
federal statutory or regulatory requirement that contains specific
procedures may be conducted pursuant to those procedures to the
extent they are inconsistent with the procedures specified in this
section.
(i) Nothing in this section shall apply to a fair hearing
involving a Medi-Cal beneficiary insofar as the hearing is, by
agreement or otherwise, heard before an administrative law judge
employed by the State Department of Social Services, or insofar as
the hearing is being held pursuant to Division 4.5 (commencing with
Section 4500) of the Welfare and Institutions Code in connection with
services provided by the State Department of Developmental Services
under applicable federal Medicaid waivers. Nothing in this
subdivision shall be interpreted as abrogating the authority of the
State Department of Health Care Services as the single state agency
under the state Medicaid plan.
(j) Nothing in this provision shall supersede express provisions
of law that apply to any hearing that is not adjudicative in nature
or that does not involve due process rights specific to an individual
or specific individuals, as opposed to the general public or a
segment of the general public.
100185.5. (a) When a letter or order of denial of continued
enrollment or suspension of any type or duration, based upon fraud or
abuse, or a withholding of payments, based upon reliable evidence of
fraud or willful misrepresentation, is issued by the department to a
provider, the director shall review the evidence supporting the
denial of continued enrollment, suspension, or withholding of
payments. If, in the opinion of the director, the evidence shows a
pattern or practice of fraud, abuse, or willful misrepresentation
that, if replicated in any other health care program administered by
the department, could cause either fiscal loss to the state or harm
to any participant, the director may deny continued enrollment,
suspend, or withhold payments to, the provider with respect to those
other health care programs. Any denial of continued enrollment,
suspension, or withholding of payments may be for an indefinite or
definite period of time, may be stayed for a period of time, and may
be with or without conditions or probation.
(b) The director may deny the application of an applicant or
provider to participate in any health care program administered by
the department, when, based upon fraud or abuse, the applicant or
provider has been denied continued enrollment in, or suspended from,
any health care program administered by the department, or has had
payments withheld based upon reliable evidence of fraud or willful
misrepresentation in connection with any health care program
administered by the department, and remains ineligible to participate
in the health care program from which the applicant or provider was
denied continued enrollment, suspended, or had payments withheld.
(c) The director may deny any new or additional application of a
provider to participate in any health care program administered by
the department if utilization controls including, but not limited to,
prior authorization or special claims review pursuant to Sections
51159, 51455, and 51460 of Title 22 of the California Code of
Regulations have been imposed upon that provider by any health care
program administered by the department. Applications shall not be
denied based solely upon utilization controls imposed upon an entire
class or category of providers to which that provider belongs.
(d) Notwithstanding any other provision of law, any provider or
applicant who has been denied continued enrollment in, or suspended
from, or who has had payments withheld in connection with, any health
care program administered by the department, or whose application to
participate in a health care program administered by the department
is denied, pursuant to this section, may appeal that action in
accordance with Section 14043.65 of the Welfare and Institutions
Code.
(e) For purposes of this section, the following definitions apply:
(1) "Abuse" has the same meaning as that term is defined in
Section 14043.1 of the Welfare and Institutions Code.
(2) "Administered by the department" means administered by the
State Department of Health Services or by its agents or contractors
on behalf of the State Department of Health Services.
(3) "Applicant" means any person, individual, partnership, group,
association, corporation, institution, or entity, and the officers,
directors, owners, managing employees, or agents thereof, that
applies to the department for enrollment as a provider or
participation as a provider in a health care program administered by
the department.
(4) "Fraud" has the same meaning as that term is defined in
Section 14043.1 of the Welfare and Institutions Code.
(5) "Provider" means any person, individual, partnership, group,
association, corporation, institution, or entity, and the officers,
directors, owners, managing employees, or agents thereof, that
provides services, goods, supplies, or merchandise, directly or
indirectly, to a person enrolled in a health care program
administered by the department.
(6) "Withholding of payments" means the withholding of payments in
accordance with Section 14107.11 of the Welfare and Institutions
Code.
(f) For purposes of this section, "suspension" includes, but is
not limited to, suspensions authorized under Article 1.3 (commencing
with Section 14043) or Article 3 (commencing with Section 14123) of
Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code.
(g) For purposes of this section, "health care program
administered by the department" includes, but is not limited to, the
Medi-Cal program.
100220. With the approval of the Department of Finance, and for use
in the furtherance of the work of the department, the director may
accept (a) grants of interest in real property, and (b) gifts of
money from public agencies or from organizations or associations
organized for scientific, educational, or charitable purposes.
100236. (a) Within 60 days of enactment of the Budget Act, the
department shall advance to a local health department 25 percent of
the annual General Fund allocation, subvention, or reimbursement
required by a local health department for the delivery of services
specified in subdivision (b). In determining the dollar amount of the
25 percent allocation, subvention, or reimbursement, the department
shall use the local health department's prior year's or the most
recently completed fiscal year's allocation.
(b) Subdivision (a) shall apply to the following health programs
and General Fund funding sources:
(1) Funding for administration for the California Children's
Services Program (Article 5 (commencing with Section 123800) of
Chapter 3 of Part 2 of Division 106).
(2) Funding for medical therapy for the California Children's
Services Program (Article 5 (commencing with Section 123800) of
Chapter 3 of Part 2 of Division 106).
(3) Funding for administration for the Child Health and Disability
Prevention Program (Article 6 (commencing with Section 124025) of
Chapter 3 of Part 2 of Division 106).
(4) Funding for HIV education and prevention services under
Section 100119.
(c) This section shall not apply to a local health department that
is three or more quarters in arrears in billing the state for the
programs specified in subdivision (b).
(d) For purposes of this section, "local health department" has
the same meaning as that set forth in Section 101185.
100150. The State Department of Health Services succeeds to and is
vested with all the duties, powers, purposes, responsibilities, and
jurisdiction of the State Department of Health as they relate to
public health, licensing and certification of health facilities,
except community care facility licensing to which the State
Department of Social Services succeeds, and any other functions
performed by the Division of Public Health of the State Department of
Health on July 1, 1978, unless the function is transferred to a
different state agency or department as a result of another provision
of the statutes of the 1977-78 Regular Session of the Legislature
amending this section.
"State department," "department," or "State Department of Health"
as used in this code, except in Article 7.5 (commencing with Section
416) of Chapter 2 of Part 1 of Division 1 or as otherwise specified
in this code, means the State Department of Health Services.
The Office of Statewide Health Planning and Development shall
assume the functions and responsibilities of the Facilities
Construction Unit of the former State Department of Health,
including, but not limited to, those functions and responsibilities
performed pursuant to the following provisions of law: Sections 13113
and 127050; Article 1 (commencing with Section 129000) of Chapter 1
of, and Chapter 2 (commencing with Section 129375) of, Part 6 of, and
Part 7 (commencing with Section 129675) of, Division 107.
100155. The department may use the unexpended balance of funds
available for use in connection with the performance of the functions
of the State Department of Health to which the department has
succeeded pursuant to Section 100150.
100160. All officers and employees of the State Department of
Health heretofore performing any duty, power, purpose,
responsibility, or jurisdiction to which the department has
succeeded, who, on July 1, 1978, are serving in the state civil
service, other than as temporary employees, and engaged in the
performance of a function vested in the department by Section 100150
shall be transferred to the department. The status, positions, and
rights of these persons shall not be affected by the transfer and
shall be retained by them as officers and employees of the
department, pursuant to the State Civil Service Act except as to
positions exempted from civil service.
100165. The department shall have possession and control of all
records, papers, officers, equipment, supplies, moneys, funds,
appropriations, land or other property, real or personal, held for
the benefit or use of any state agency whose functions are vested in
the department by Section 100150.
100170. (a) The department may commence and maintain all proper and
necessary actions and proceedings for any or all of the following
purposes:
(1) To enforce its regulations.
(2) To compel the performance of any act specifically enjoined
upon any person, officer, or board, by any law of this state relating
to its powers and duties.
(b) It may defend all actions and proceedings involving its powers
and duties.
(c) In all actions and proceedings it shall sue and be sued under
the name of the department.
100171. Notwithstanding any other provision of law, whenever the
department is authorized or required by statute, regulation, due
process (Fourteenth Amendment to the United States Constitution;
subdivision (a) of Section 7 of Article I of the California
Constitution), or a contract, to conduct an adjudicative hearing
leading to a final decision of the director or the department, the
following shall apply:
(a) The proceeding shall be conducted pursuant to the
administrative adjudication provisions of Chapter 4.5 (commencing
with Section 11400) and Chapter 5 (commencing with Section 11500) of
Part 1 of Division 3 of Title 2 of the Government Code, except as
specified in this section.
(b) Notwithstanding Section 11502 of the Government Code, whenever
the department conducts a hearing under Chapter 4.5 (commencing with
Section 11400) or Chapter 5 (commencing with Section 11500) of Part
1 of Division 3 of Title 2 of the Government Code, the hearing shall
be conducted before an administrative law judge selected by the
department and assigned to a hearing office that complies with the
procedural requirements of Chapter 4.5 (commencing with Section
11400) of Part 1 of Division 3 of Title 2 of the Government Code.
(c) (1) Notwithstanding Section 11508 of the Government Code,
whenever the department conducts a hearing under Chapter 4.5
(commencing with Section 11400) or Chapter 5 (commencing with Section
11500) of Part 1 of Division 3 of Title 2 of the Government Code,
the time and place of the hearing shall be determined by the staff
assigned to the hearing office of the department, except as provided
in paragraph (2) or unless the department, by regulation, specifies
otherwise.
(2) Formal hearings requested by institutional Medi-Cal providers
and health facilities shall be held in Sacramento.
(d) (1) Unless otherwise specified in this section, the following
sections of the Government Code shall apply to any adjudicative
hearing conducted by the department only if the department has not,
by regulation, specified an alternative procedure for the particular
type of hearing at issue: Section 11503 (relating to accusations),
Section 11504 (relating to statements of issues), Section 11505
(relating to the contents of the statement to respondent), Section
11506 (relating to the notice of defense), Section 11507.6 (relating
to discovery rights and procedures), Section 11508 (relating to the
time and place of hearings), and Section 11516 (relating to amendment
of accusations).
(2) Any alternative procedure specified by the department in
accordance with this subdivision shall conform to the purpose of the
Government Code provision it replaces insofar as it is possible to do
so consistent with the specific procedural requirements applicable
to the type of hearing at issue.
(3) Any alternative procedures adopted by the department under
this subdivision shall not diminish the amount of notice given of the
issues to be heard by the department or deprive appellants of the
right to discovery suitable to the particular proceedings. Except as
specified in paragraph (2) of subdivision (c), modifications of
timeframes or of the place of hearing made by regulation shall not
lengthen timeframes within which the department is required to act
nor require hearings to be held at a greater distance from the
appellant's place of residence or business than is the case under the
otherwise applicable Government Code provision.
(e) The specific timelines specified in Section 11517 of the
Government Code shall not apply to any adjudicative hearing conducted
by the department to the extent that the department has, by
regulation, specified different timelines for the particular type of
hearing at issue.
(f) In the case of any adjudicative hearing conducted by the
department, "transcript," as used in subdivision (c) of Section 11517
of the Government Code, shall be deemed to include any alternative
form of recordation of the oral proceedings, including, but not
limited to, an audio recording.
(g) Pursuant to Section 11415.50 of the Government Code, the
department may, by regulation, provide for any appropriate informal
procedure to be used for an informal level of review that does not
itself lead to a final decision of the department or the director.
The procedures specified in Article 10 (commencing with Section
11445.10) of Chapter 4.5 of Part 1 of Division 3 of Title 2 of the
Government Code shall not apply to an informal level of review
authorized by this subdivision. Informal conferences concerning
appeals by institutional Medi-Cal providers and health facilities may
be held in Sacramento or Los Angeles.
(h) Notwithstanding any other provision of law, any adjudicative
hearing conducted by the department that is conducted pursuant to a
federal statutory or regulatory requirement that contains specific
procedures may be conducted pursuant to those procedures to the
extent they are inconsistent with the procedures specified in this
section.
(i) Nothing in this section shall apply to a fair hearing
involving a Medi-Cal beneficiary insofar as the hearing is, by
agreement or otherwise, heard before an administrative law judge
employed by the State Department of Social Services, or insofar as
the hearing is being held pursuant to Division 4.5 (commencing with
Section 4500) of the Welfare and Institutions Code in connection with
services provided by the State Department of Developmental Services
under applicable federal Medicaid waivers. Nothing in this
subdivision shall be interpreted as abrogating the authority of the
State Department of Health Care Services as the single state agency
under the state Medicaid plan.
(j) Nothing in this provision shall supersede express provisions
of law that apply to any hearing that is not adjudicative in nature
or that does not involve due process rights specific to an individual
or specific individuals, as opposed to the general public or a
segment of the general public.
100185.5. (a) When a letter or order of denial of continued
enrollment or suspension of any type or duration, based upon fraud or
abuse, or a withholding of payments, based upon reliable evidence of
fraud or willful misrepresentation, is issued by the department to a
provider, the director shall review the evidence supporting the
denial of continued enrollment, suspension, or withholding of
payments. If, in the opinion of the director, the evidence shows a
pattern or practice of fraud, abuse, or willful misrepresentation
that, if replicated in any other health care program administered by
the department, could cause either fiscal loss to the state or harm
to any participant, the director may deny continued enrollment,
suspend, or withhold payments to, the provider with respect to those
other health care programs. Any denial of continued enrollment,
suspension, or withholding of payments may be for an indefinite or
definite period of time, may be stayed for a period of time, and may
be with or without conditions or probation.
(b) The director may deny the application of an applicant or
provider to participate in any health care program administered by
the department, when, based upon fraud or abuse, the applicant or
provider has been denied continued enrollment in, or suspended from,
any health care program administered by the department, or has had
payments withheld based upon reliable evidence of fraud or willful
misrepresentation in connection with any health care program
administered by the department, and remains ineligible to participate
in the health care program from which the applicant or provider was
denied continued enrollment, suspended, or had payments withheld.
(c) The director may deny any new or additional application of a
provider to participate in any health care program administered by
the department if utilization controls including, but not limited to,
prior authorization or special claims review pursuant to Sections
51159, 51455, and 51460 of Title 22 of the California Code of
Regulations have been imposed upon that provider by any health care
program administered by the department. Applications shall not be
denied based solely upon utilization controls imposed upon an entire
class or category of providers to which that provider belongs.
(d) Notwithstanding any other provision of law, any provider or
applicant who has been denied continued enrollment in, or suspended
from, or who has had payments withheld in connection with, any health
care program administered by the department, or whose application to
participate in a health care program administered by the department
is denied, pursuant to this section, may appeal that action in
accordance with Section 14043.65 of the Welfare and Institutions
Code.
(e) For purposes of this section, the following definitions apply:
(1) "Abuse" has the same meaning as that term is defined in
Section 14043.1 of the Welfare and Institutions Code.
(2) "Administered by the department" means administered by the
State Department of Health Services or by its agents or contractors
on behalf of the State Department of Health Services.
(3) "Applicant" means any person, individual, partnership, group,
association, corporation, institution, or entity, and the officers,
directors, owners, managing employees, or agents thereof, that
applies to the department for enrollment as a provider or
participation as a provider in a health care program administered by
the department.
(4) "Fraud" has the same meaning as that term is defined in
Section 14043.1 of the Welfare and Institutions Code.
(5) "Provider" means any person, individual, partnership, group,
association, corporation, institution, or entity, and the officers,
directors, owners, managing employees, or agents thereof, that
provides services, goods, supplies, or merchandise, directly or
indirectly, to a person enrolled in a health care program
administered by the department.
(6) "Withholding of payments" means the withholding of payments in
accordance with Section 14107.11 of the Welfare and Institutions
Code.
(f) For purposes of this section, "suspension" includes, but is
not limited to, suspensions authorized under Article 1.3 (commencing
with Section 14043) or Article 3 (commencing with Section 14123) of
Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code.
(g) For purposes of this section, "health care program
administered by the department" includes, but is not limited to, the
Medi-Cal program.
100220. With the approval of the Department of Finance, and for use
in the furtherance of the work of the department, the director may
accept (a) grants of interest in real property, and (b) gifts of
money from public agencies or from organizations or associations
organized for scientific, educational, or charitable purposes.
100236. (a) Within 60 days of enactment of the Budget Act, the
department shall advance to a local health department 25 percent of
the annual General Fund allocation, subvention, or reimbursement
required by a local health department for the delivery of services
specified in subdivision (b). In determining the dollar amount of the
25 percent allocation, subvention, or reimbursement, the department
shall use the local health department's prior year's or the most
recently completed fiscal year's allocation.
(b) Subdivision (a) shall apply to the following health programs
and General Fund funding sources:
(1) Funding for administration for the California Children's
Services Program (Article 5 (commencing with Section 123800) of
Chapter 3 of Part 2 of Division 106).
(2) Funding for medical therapy for the California Children's
Services Program (Article 5 (commencing with Section 123800) of
Chapter 3 of Part 2 of Division 106).
(3) Funding for administration for the Child Health and Disability
Prevention Program (Article 6 (commencing with Section 124025) of
Chapter 3 of Part 2 of Division 106).
(4) Funding for HIV education and prevention services under
Section 100119.
(c) This section shall not apply to a local health department that
is three or more quarters in arrears in billing the state for the
programs specified in subdivision (b).
(d) For purposes of this section, "local health department" has
the same meaning as that set forth in Section 101185.
