WELFARE AND INSTITUTIONS CODE
SECTION 16800.5-16818
16800.5. The State Department of Health Services shall establish
data collection and reporting requirements for counties to annually
report health expenditures.
16800.7. Agencies responsible for conducting fiscal or program
audits or inspections of grants or subventions pursuant to any of the
following provisions shall, to the extent practicable and consistent
with federal law, endeavor to cooperate and consolidate efforts so
as to conduct a single fiscal or compliance audit for any program
affected by these provisions, thereby maximizing audit efficiency and
minimizing the inconvenience to the program being audited:
(a) The Child Health Disability Prevention Program (Article 6
(commencing with Section 124025) of Chapter 3 of Part 2 of Division
106 of the Health and Safety Code).
(b) The Maternal and Child Health program as set forth in
subdivision (c) of Section 27 of the Health and Safety Code.
(c) The Tobacco Use Prevention program (Article 1 (commencing with
Section 104350) of Chapter 1 of Part 3 of Division 103 of the Health
and Safety Code).
(d) AIDS programs (former Part 1 (commencing with Section 100) of
Division 1 of the Health and Safety Code).
(e) The County Health Care for Indigents program (Part 4.7
(commencing with Section 16900)), including, but not limited to,
county health care reporting requirements pursuant to Chapter 2
(commencing with Section 16910) and Chapter 2.5 (commencing with
Section 16915) of that part.
16801. The following definitions shall govern the construction of
this part, unless the context requires otherwise:
(a) "County health services" means public health services,
outpatient health services, and inpatient health services provided
directly by a local jurisdiction or financed or purchased by a local
jurisdiction through grants, contracts, or agreements but shall not
include mental health services, alcohol and drug abuse services, and
services which were provided in fiscal year 1977-78 but were not part
of the reported net county costs for fiscal year 1977-78.
(b) "Net county costs for health services" means expenditures for
county health services, less revenues received for county health
services.
(c) "City health services" means public health services,
outpatient health services, and inpatient health services provided
directly by the city or financed or purchased by the city through
grants, contracts, or agreements, but shall not include mental health
services, alcohol and drug abuse services, and services which were
not provided in the 1977-78 fiscal year but were not part of the
reported net county costs for the 1977-78 fiscal year.
(d) "Department" means the State Department of Health Services.
(e) "Net city costs for health services" means expenditures for
city health services, less revenues received for city health
services.
(f) "Program account" means the County Medical Services Program
Account in the County Health Services Fund.
(g) "Reserve account" means the County Medical Services Program
Reserve Account in the County Health Services Fund.
16803. (a) The County Health Services Fund is hereby created, and
notwithstanding Section 13340 of the Government Code, is continuously
appropriated to the department, without regard to fiscal years, for
the purposes of this part.
(b) The expenditure of funds from the County Health Services Fund
shall be made by the State Department of Health Services without
regard to fiscal year.
16804.1. (a) No fee or charge shall be required of any person
before a county renders medically necessary services to persons
entitled to services pursuant to Section 17000.
(b) This section is declaratory of existing law and shall not be
interpreted to effect a county's authority to implement a reasonable
sliding fee schedule based on ability to pay.
16809. (a) (1) The board of supervisors of a county that contracted
with the department pursuant to former Section 16709 during the
1990-91 fiscal year and any county with a population under 300,000,
as determined in accordance with the 1990 decennial census, by
adopting a resolution to that effect, may elect to participate in the
County Medical Services Program. The governing board shall have
responsibilities for specified health services to county residents
certified eligible for those services by the county.
(2) The board of supervisors of a county that has contracted with
the governing board pursuant to paragraph (1) may also contract with
the governing board for the delivery of health care and
health-related services to county residents other than under the
County Medical Services Program by adopting a resolution to that
effect. The governing board shall have responsibilities for the
delivery of specified health services to county residents as agreed
upon by the governing board and the county. Participation by a county
pursuant to this paragraph shall be voluntary, and funds shall be
provided solely by the county.
(b) The governing board may contract with the department or any
other person or entity to administer the County Medical Services
Program.
(1) If the governing board contracts with the department to
administer the County Medical Services Program, that contract shall
include, but need not be limited to, all of the following:
(A) Provisions for the payment to participating counties for
making eligibility determinations as determined by the governing
board.
(B) Provisions for payment of expenses of the governing board.
(C) Provisions relating to the flow of funds from counties'
vehicle license fees, sales taxes, and participation fees and the
procedures to be followed if a county does not pay those funds to the
program.
(D) Those provisions, as applicable, contained in the 1993-94
fiscal year contract with counties under the County Medical Services
Program.
(E) Provisions for the department to administer the County Medical
Services Program pursuant to regulations adopted by the governing
board or as otherwise determined by the governing board.
(F) Provisions requiring that the governing board reimburse the
state costs of providing administrative support to the County Medical
Services Program in accordance with amounts determined between the
governing board and the department.
(2) If the governing board does not contract with the department
for administration of the County Medical Services Program, the
governing board may contract with the department for specified
services to assist in the administration of that program. Any
contract with the department under this paragraph shall require that
the governing board reimburse the state costs of providing
administrative support.
(3) The department shall not be liable for any costs related to
decisions of the governing board that are in excess of those set
forth in the contract between the department and the governing board.
(c) Each county intending to participate in the County Medical
Services Program pursuant to this section shall submit to the
governing board a notice of intent to contract adopted by the board
of supervisors no later than April 1 of the fiscal year preceding the
fiscal year in which the county will participate in the County
Medical Services Program.
(d) A county participating in the County Medical Services Program
pursuant to this section, or a county contracting with the governing
board pursuant to paragraph (2) or (3) of subdivision (a), or
participating in a pilot project or contracting with the governing
board for an alternative product pursuant to Section 16809.4, shall
not be relieved of its indigent health care obligation under Section
17000.
(e) (1) The County Medical Services Program Account is established
in the County Health Services Fund. The County Medical Services
Program Account is continuously appropriated, notwithstanding Section
13340 of the Government Code, without regard to fiscal years. The
following amounts may be deposited in the account:
(A) Any interest earned upon moneys deposited in the account.
(B) Moneys provided by participating counties or appropriated by
the Legislature to the account.
(C) Moneys loaned pursuant to subdivision (n).
(2) The methods and procedures used to deposit funds into the
account shall be consistent with the methods used by the program
during the 1993-94 fiscal year, unless otherwise determined by the
governing board.
(f) Moneys in the program account shall be used by the governing
board, or by the department if the department contracts with the
governing board for this purpose, to pay for health care services
provided to the persons meeting the eligibility criteria established
pursuant to subdivision (j) and to pay the governing board expenses
and program administrative costs. In addition, moneys in this account
may be used to reimburse the department for state costs pursuant to
subparagraph (F) of paragraph (1) of subdivision (b).
(g) (1) Moneys in this account shall be administered on an accrual
basis and notwithstanding any other law, except as provided in this
section and Section 17605.051, shall not be transferred to any other
fund or account in the State Treasury except for purposes of
investment as provided in Article 4 (commencing with Section 16470)
of Chapter 3 of Part 2 of Division 4 of Title 2 of the Government
Code.
(2) (A) All interest or other increment resulting from the
investment shall be deposited in the program account, notwithstanding
Section 16305.7 of the Government Code.
(B) All interest deposited pursuant to subparagraph (A) shall be
available to reimburse program-covered services, governing board
expenses, and program administrative costs.
(h) The governing board shall establish a reserve account for the
purpose of depositing funds for the payment of claims and unexpected
contingencies. Funds in the reserve account in excess of the amounts
the governing board determines necessary for these purposes shall be
available for expenditures in years when program expenditures exceed
program funds, and to augment the rates, benefits, or eligibility
criteria under the program.
(i) (1) Counties shall pay participation fees as established by
the governing board and their jurisdictional risk amount in a method
that is consistent with that established in the 1993-94 fiscal year.
(2) A county may request, due to financial hardship, the payments
under paragraph (1) be delayed. The request shall be subject to
approval by the governing board.
(3) Payments made pursuant to this subdivision shall be deposited
in the program account, unless otherwise directed by the governing
board.
(4) Payments may be made as part of the deposits authorized by the
county pursuant to Sections 17603.05 and 17604.05.
(j) (1) (A) Beginning in the 1992-93 fiscal year and for each
fiscal year thereafter, counties and the state shall share the risk
for cost increases of the County Medical Services Program not funded
through other sources. The state shall be at risk for any cost that
exceeds the cumulative annual growth in dedicated sales tax and
vehicle license fee revenue, up to the amount of twenty million two
hundred thirty-seven thousand four hundred sixty dollars
($20,237,460) per fiscal year, except for the 1999-2000, 2000-01,
2001-02, 2002-03, 2003-04, 2004-05, 2005-06, 2006-07, and 2007-08
fiscal years, and all fiscal years thereafter. Counties shall be at
risk up to the cumulative annual growth in the Local Revenue Fund
created by Section 17600, according to the table specified in
paragraph (2), to the County Medical Services Program, plus the
additional cost increases in excess of twenty million two hundred
thirty-seven thousand four hundred sixty dollars ($20,237,460) per
fiscal year, except for the 1999-2000, 2000-01, 2001-02, 2002-03,
2003-04, 2004-05, 2005-06, 2006-07, and 2007-08 fiscal years, and all
fiscal years thereafter.
(B) For the 1999-2000, 2000-01, 2001-02, 2002-03, 2003-04,
2004-05, 2005-06, 2006-07, and 2007-08 fiscal years, and all fiscal
years thereafter, the state shall not be at risk for any cost that
exceeds the cumulative annual growth in dedicated sales tax and
vehicle license fee revenue. Counties shall be at risk up to the
cumulative annual growth in the Local Revenue Fund created by Section
17600, according to the table specified in paragraph (2), to the
County Medical Services Program, plus any additional cost increases
for the 1999-2000, 2000-01, 2001-02, 2002-03, 2003-04, 2004-05,
2005-06, 2006-07, and 2007-08 fiscal years, and all fiscal years
thereafter.
(C) (i) The governing board shall establish uniform eligibility
criteria and benefits among all counties participating in the County
Medical Services Program listed in paragraph (2). For counties that
are not listed in paragraph (2) and that elect to participate
pursuant to paragraph (1) of subdivision (a), the eligibility
criteria and benefit structure may vary from those of counties
participating pursuant to paragraph (2) of subdivision (a).
(ii) Notwithstanding clause (i), the governing board may establish
and maintain pilot projects to identify or test alternative
approaches for determining eligibility or for providing or paying for
benefits under the County Medical Services Program, and may develop
and implement alternative products with varying levels of eligibility
criteria and benefits outside of the County Medical Services
Program.
(2) For the 1991-92 fiscal year, and each fiscal year thereafter,
jurisdictional risk limitations shall be as follows:
Jurisdiction Amount
Alpine.......................... $ 13,150
Amador.......................... 620,264
Butte........................... 5,950,593
Calaveras....................... 913,959
Colusa.......................... 799,988
Del Norte....................... 781,358
El Dorado....................... 3,535,288
Glenn........................... 787,933
Humboldt........................ 6,883,182
Imperial........................ 6,394,422
Inyo............................ 1,100,257
Kings........................... 2,832,833
Lake............................ 1,022,963
Lassen.......................... 687,113
Madera.......................... 2,882,147
Marin........................... 7,725,909
Mariposa........................ 435,062
Mendocino....................... 1,654,999
Modoc........................... 469,034
Mono............................ 369,309
Napa............................ 3,062,967
Nevada.......................... 1,860,793
Plumas.......................... 905,192
San Benito...................... 1,086,011
Shasta.......................... 5,361,013
Sierra.......................... 135,888
Siskiyou........................ 1,372,034
Solano.......................... 6,871,127
Sonoma.......................... 13,183,359
Sutter.......................... 2,996,118
Tehama.......................... 1,912,299
Trinity......................... 611,497
Tuolumne........................ 1,455,320
Yuba............................ 2,395,580
(3) Beginning in the 1991-92 fiscal year and in subsequent fiscal
years, the jurisdictional risk limitation for the counties that did
not contract with the department pursuant to former Section 16709
during the 1990-91 fiscal year shall be the amount specified in
subparagraph (A) plus the amount determined pursuant to subparagraph
(B), minus the amount specified by the governing board as
participation fees.
(A)
Jurisdiction Amount
Merced........................... 2,033,729
Placer........................... 1,338,330
San Luis Obispo.................. 2,000,491
Santa Cruz....................... 3,037,783
Yolo............................. 1,475,620
(B) The amount of funds necessary to fully fund the anticipated
costs for the county shall be determined by the governing board
before a county is permitted to participate in the County Medical
Services Program.
(4) The specific amounts and method of apportioning risk to each
participating county may be adjusted by the governing board.
(k) The Legislature hereby determines that an expedited contract
process for contracts under this section is necessary. Contracts
under this section shall be exempt from Part 2 (commencing with
Section 10100) of Division 2 of the Public Contract Code. Contracts
of the department pursuant to this section shall have no force or
effect unless they are approved by the Department of Finance.
(l) The state shall not incur any liability except as specified in
this section.
(m) Third-party recoveries for services provided under this
section may be pursued.
(n) The Department of Finance may authorize a loan of up to thirty
million dollars ($30,000,000) for deposit into the program account
to ensure that there are sufficient funds available to reimburse
providers and counties pursuant to this section.
(o) Moneys appropriated from the General Fund to meet the state
risk, as set forth in subparagraph (A) of paragraph (1) of
subdivision (j), shall not be available for those counties electing
to disenroll from the County Medical Services Program.
(p) Notwithstanding any other law, the Controller may use the
moneys in the County Medical Services Program Account for loans to
the General Fund as provided in Sections 16310 and 16381 of the
Government Code. However, interest shall be paid on all moneys loaned
to the General Fund from the County Medical Services Program
Account. Interest payable shall be computed at a rate determined by
the Pooled Money Investment Board to be the current earning rate of
the fund from which loaned. This subdivision does not authorize any
transfer that will interfere with the carrying out of the object for
which the County Medical Services Program Account was created.
16809.3. (a) Beginning in the 1991-92 fiscal year, and in
subsequent fiscal years, a county shall pay the amount listed below
or as established by the governing board pursuant to subparagraph (B)
of paragraph (1) of subdivision (e) of Section 16809.4, to the
governing board as a condition of participation in the County Medical
Services Program administered pursuant to Section 16809:
Jurisdiction Amount
Alpine............................. $ 661
Amador............................. 17,107
Butte.............................. 459,610
Calaveras.......................... 30,401
Colusa............................. 28,997
Del Norte.......................... 39,424
El Dorado.......................... 233,492
Glenn.............................. 33,989
Humboldt........................... 430,851
Imperial........................... 249,786
Inyo............................... 18,950
Kings.............................. 195,053
Lake............................... 150,278
Lassen............................. 17,206
Madera............................. 151,434
Marin.............................. 576,233
Mariposa........................... 5,649
Mendocino.......................... 247,578
Modoc.............................. 9,688
Mono............................... 25,469
Napa............................... 142,767
Nevada............................. 42,051
Plumas............................. 23,796
San Benito......................... 37,018
Shasta............................. 294,369
Sierra............................. 6,183
Siskiyou........................... 48,956
Solano............................. 809,548
Sonoma............................. 718,947
Sutter............................. 188,781
Tehama............................. 79,950
Trinity............................ 8,319
Tuolumne........................... 34,947
Yuba............................... 101,907
(b) Beginning in the 1991-92 fiscal year and in subsequent fiscal
years, counties that did not contract with the department pursuant to
Section 16709 during the 1990-91 fiscal year shall pay the following
amount listed below or as established by the governing board
pursuant to subparagraph (B) of paragraph (1) of subdivision (e) of
Section 16809.4, to the governing board as a condition of
participation in the County Medical Services Program, administered
pursuant to Section 16809:
Jurisdiction Amount
Merced............................ $488,954
Placer............................ 247,193
San Luis Obispo................... 358,571
Santa Cruz........................ 678,868
Yolo.............................. 532,510
(c) (1) County amounts specified in subdivisions (a) and (b) shall
be paid to the governing board in 12 equal monthly payments or as
otherwise specified by the governing board. Subject to paragraphs (2)
and (3), a county that does not pay the amounts specified in
subdivision (a) or (b) may be terminated from participation in the
program.
(2) A county may request, due to financial hardship, that payments
specified under subdivisions (a) and (b) be delayed. The request
shall be subject to the approval of the governing board.
(3) For the 1991-92 fiscal year and subsequent fiscal years,
counties that enter the County Medical Services Program shall pay the
amount specified in subdivision (a) or (b), as applicable, on a
prorated basis, for the number of contracted months of participation
in the County Medical Services Program.
(d) The payments required by subdivision (c) shall not be paid for
with funds from the health account of the local health and welfare
trust fund established pursuant to Section 17600.10.
16809.4. (a) Counties voluntarily participating in the County
Medical Services Program pursuant to Section 16809 may establish the
County Medical Services Program Governing Board pursuant to
procedures contained in this section. The governing board shall
govern the County Medical Services Program.
(b) The membership of the governing board shall be comprised of
all of the following:
(1) Three members who shall each be a member of a county board of
supervisors.
(2) Three members who shall be county administrative officers.
(3) Two members who shall be county welfare directors.
(4) Two members who shall be county health officials.
(5) One member who shall be the Secretary of the Health and
Welfare Agency, or his or her designee, and who shall serve as an ex
officio, nonvoting member.
(c) The governing board may establish its own bylaws and operating
procedures.
(d) The voting membership of the governing board shall meet all of
the following requirements:
(1) All of the members shall hold office or employment in counties
that participate in the County Medical Services Program.
(A) The three county supervisor members shall be elected by the
boards of supervisors of the CMSP counties, with each county having
one vote and convened at the call of the chair of the governing
board.
(B) The three county administrative officers shall be elected by
the administrative officers of the CMSP counties convened at the call
of the chair of the governing board.
(C) The two county health officials shall be selected by the
health officials of the CMSP counties convened at the call of the
chair of the governing board.
(D) The two county welfare directors shall be elected by the
welfare directors of the CMSP counties convened at the call of the
chair of the governing board.
(2) Governing board members shall serve three-year terms.
(3) No two persons from the same county may serve as members of
the governing board at the same time.
(4) The governing board may elect a permanent chair.
(e) (1) The governing board is hereby established with the
following powers:
(A) Determine program eligibility and benefit levels.
(B) Establish reserves and participation fees.
(C) Establish procedures for the entry into, and disenrollment of
counties from the County Medical Services Program. Disenrollment
procedures shall be fair and equitable.
(D) Establish cost containment and case management procedures,
including, but not limited to, alternative methods for delivery of
care and alternative methods and rates from those used by the
department.
(E) Sue and be sued in the name of the governing board.
(F) Apportion jurisdictional risk to each county.
(G) Utilize procurement policies and procedures of any of the
participating counties as selected by the governing board.
(H) Make rules and regulations.
(I) Make and enter into contracts or stipulations of any nature
with a public agency or person for the purposes of governing or
administering the County Medical Services Program.
(J) Purchase supplies, equipment, materials, property, or
services.
(K) Appoint and employ staff to assist the governing board.
(L) Establish rules for its proceedings.
(M) Accept gifts, contributions, grants, or loans from any public
agency or person for the purposes of this program.
(N) Negotiate and set rates, charges, or fees with service
providers, including alternative methods of payment to those used by
the department.
(O) Establish methods of payment that are compatible with the
administrative requirements of the department's fiscal intermediary
during the term of any contract with the department for the
administration of the County Medical Services Program.
(P) Use generally accepted accounting procedures.
(Q) Develop and implement procedures and processes to monitor and
enforce the appropriate billing and payment of rates, charges, and
fees.
(R) Investigate and pursue repayment of fees billed and paid
through improper means, including, but not limited to, fraudulent
billing and collection practices by providers.
(S) Pursue third-party recoveries and estate recoveries for
services provided under the County Medical Services Program,
including the filing and perfecting of liens to secure reimbursement
for the reasonable value of benefits provided.
(T) Establish and maintain pilot projects to identify or test
alternative approaches for determining eligibility or for providing
or paying for services.
(U) Establish provisions for payment to participating counties for
making eligibility determinations, as determined by the governing
board.
(V) Develop and implement alternative products with varying levels
of eligibility criteria and benefits outside of the County Medical
Services Program for counties contracting with the governing board
for those products, provided that any such products shall be funded
separately from the County Medical Services Program and shall not
impair the financial stability of that program.
(2) The Legislature finds and declares that the amendment of
subparagraph (N) of paragraph (1) in 1995, and the addition of
subparagraphs (Q), (R), (S), (T), and (U) in 2006, are declaratory of
existing law.
(f) (1) The governing board shall be considered a "public entity"
for purposes of Division 3.6 (commencing with Section 810) of Title 1
of the Government Code, and a "local public entity" for purposes of
Part 3 (commencing with Section 900) of Division 3.6 of Title 1 of
the Government Code, but shall not be considered a "state agency" for
purposes of Chapter 3.5 (commencing with Section 11340) of Part 1 of
Division 3 of Title 2 of the Government Code and shall be exempt
from that chapter. No participating county shall have any liability
for civil judgments awarded against the County Medical Services
Program or the governing board. Nothing in this paragraph shall be
construed to expand the liability of the state with respect to the
County Medical Services Program beyond that set forth in Section
16809. Nothing in this paragraph shall be construed to relieve any
county of the obligation to provide health care to indigent persons
pursuant to Section 17000, or the obligation of any county to pay its
participation fees and share of apportioned and allocated risk.
(2) Before initiating any proceeding to challenge rates of
payment, charges, or fees set by the governing board, to seek
reimbursement or release of any funds from the County Medical
Services Program, or to challenge any other action by the governing
board, any prospective claimant shall first notify the governing
board, in writing, of the nature and basis of the challenge and the
amount claimed. The governing board shall consider the matter within
60 days after receiving the notice and shall promptly thereafter
provide written notice of the governing board's decision. If the
governing board contracts with the department for administration of
the program in accordance with Section 16809, this paragraph shall
have no application to provider audit appeals conducted pursuant to
Article 1.5 (commencing with Section 51016) of Chapter 3 of Division
3 of Title 22 of the California Code of Regulations and shall apply
to all claims not reviewed pursuant to Section 51003 or 51015 of
Title 22 of the California Code of Regulations.
(3) All regulations adopted by the governing board shall clearly
specify by reference the statute, court decision, or other provision
of law that the governing board is seeking to implement, interpret,
or make specific by adopting, amending, or repealing the regulation.
(4) No regulation adopted by the governing board is valid and
effective unless the regulation meets the standards of necessity,
authority, clarity, consistency, and nonduplication, as defined in
paragraph (5).
(5) The following definitions govern the interpretation of this
subdivision:
(A) "Necessity" means the record of the regulatory proceeding that
demonstrates by substantial evidence the need for the regulation.
For purposes of this standard, evidence includes, but is not limited
to, facts, studies, and expert opinion.
(B) "Authority" means the provision of law that permits or
obligates the CMSP Governing Board to adopt, amend, or repeal a
regulation.
(C) "Clarity" means that the regulation is written or displayed so
that the meaning of the regulation can be easily understood by those
persons directly affected by it.
(D) "Consistency" means being in harmony with, and not in conflict
with, or contradictory to, existing statutes, court decisions, or
other provisions of law.
(E) "Nonduplication" means that a regulation does not serve the
same purpose as a state or federal statute or another regulation.
This standard requires that the governing board identify any state or
federal statute or regulation that is overlapped or duplicated by
the proposed regulation and justify any overlap or duplication. This
standard is not intended to prohibit the governing board from
printing relevant portions of enabling legislation in regulations
when the duplication is necessary to satisfy the clarity standard in
subparagraph (C). This standard is intended to prevent the
indiscriminate incorporation of statutory language in a regulation.
(g) The requirements of the Ralph M. Brown Act (Chapter 9
(commencing with Section 54950) of Part 1 of Division 2 of Title 5 of
the Government Code) shall apply to the meetings of the governing
board, including meetings held pursuant to subdivision (i), except
the board may meet in closed session to consider and take action on
matters pertaining to contracts and contract negotiations with
providers of health care services.
(h) (1) The governing board shall comply with the following
procedures for public meetings held to eliminate or reduce the level
of services, restrict eligibility for services, or adopt regulations:
(A) Provide prior public notice of those meetings.
(B) Provide that notice not less than 30 days prior to those
meetings.
(C) Publish that notice in a newspaper of general circulation in
each participating CMSP county.
(D) Include in the notice, at a minimum, the amount and type of
each proposed change, the expected savings, and the number of persons
affected.
(E) Either hold those meetings in the county seats of at least
four regionally distributed CMSP participating counties, or,
alternatively, hold two meetings in Sacramento County.
(2) For meetings held outside Sacramento County, the requirements
for public meetings pursuant to this subdivision to eliminate or
reduce the level of services, or to restrict the eligibility for
services or hear testimony regarding regulations to implement any of
these service charges, are satisfied if at least three voting members
of the governing board hold the meetings as required and report the
testimony from those meetings to the full governing board at its next
regular meeting. No action shall be taken at any meeting held
outside Sacramento County pursuant to this paragraph.
(i) Records of the County Medical Services Program and of the
governing board that relate to rates of payment or to the board's
negotiations with providers of health care services or to the
governing board's deliberative processes regarding either shall not
be subject to disclosure pursuant to the Public Records Act (Chapter
5 (commencing with Section 6250) of Division 7 of Title 1 of the
Government Code).
(j) The following definitions shall govern the construction of
this part, unless the context requires otherwise:
(1) "CMSP" or "program" means the County Medical Services Program,
which is the program by which health care services are provided to
eligible persons in those counties electing to participate in the
CMSP pursuant to Section 16809.
(2) "CMSP county" means a county that has elected to participate
pursuant to Section 16809 in the CMSP.
(3) "Governing Board" means the County Medical Services Program
Governing Board established pursuant to this section.
16809.5. (a) Funds appropriated for the purposes of this section
shall be allocated on a monthly basis.
(b) Money allocated for the purposes of this section may be used
to expand the scope of benefits, to fund special projects which
alleviate problems of access to health and dental care under the
County Medical Services Program and to compensate hospitals and other
emergency health service providers for emergency treatment of
out-of-county indigent patients and shall not be used to fund
existing levels of service.
(c) Funds available from appropriations for the purposes of this
chapter may be utilized to fund increased program costs due to
caseload increases and provider rate increases.
16812. The State Department of Health Services, in consultation
with the local jurisdictions, shall adopt any regulations necessary
to implement this part. The department may adopt these regulations on
an emergency basis pursuant to Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code. The
adoption of those regulations shall be deemed to be an emergency and
necessary for the immediate preservation of the public peace,
health, or safety. Notwithstanding Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code, emergency regulations adopted by the department in order to
implement this part shall not be subject to the review and approval
of the Office of Administrative Law. These regulations shall become
effective immediately upon filing with the Secretary of State.
16817. Notwithstanding any other provision of law, a county may
enter into contracts with selected providers to provide health care
services in expending funds provided pursuant to this part and Part 5
(commencing with Section 17000). The county may negotiate such
reimbursement or payment arrangements it desires in such contracts. A
county shall not be obligated to pay for health care services unless
pursuant to a contract or the county has specifically authorized
such services and agreed to payment. All such contracts shall be
available for review by the department. A county may require county
residents specified in this part and Part 5 to use county facilities
or county selected providers. This section may not be construed to
limit a county's existing obligations to furnish health care. Any
county may also elect to act jointly on a regional basis with other
counties in assuming the program responsibilities.
16818. (a) Each facility treating persons pursuant to Section 17000
shall provide, at the time treatment is sought, individual notice of
the availability of reduced cost health care. In addition,
conspicuous posted notices of the procedures for applying for reduced
cost health care shall be displayed in all emergency rooms and
patient waiting rooms of each facility treating persons pursuant to
Section 17000.
(b) This section is declaratory of existing law and shall not be
interpreted to constitute a new mandate.
WELFARE AND INSTITUTIONS CODE
SECTION 16800.5-16818
16800.5. The State Department of Health Services shall establish
data collection and reporting requirements for counties to annually
report health expenditures.
16800.7. Agencies responsible for conducting fiscal or program
audits or inspections of grants or subventions pursuant to any of the
following provisions shall, to the extent practicable and consistent
with federal law, endeavor to cooperate and consolidate efforts so
as to conduct a single fiscal or compliance audit for any program
affected by these provisions, thereby maximizing audit efficiency and
minimizing the inconvenience to the program being audited:
(a) The Child Health Disability Prevention Program (Article 6
(commencing with Section 124025) of Chapter 3 of Part 2 of Division
106 of the Health and Safety Code).
(b) The Maternal and Child Health program as set forth in
subdivision (c) of Section 27 of the Health and Safety Code.
(c) The Tobacco Use Prevention program (Article 1 (commencing with
Section 104350) of Chapter 1 of Part 3 of Division 103 of the Health
and Safety Code).
(d) AIDS programs (former Part 1 (commencing with Section 100) of
Division 1 of the Health and Safety Code).
(e) The County Health Care for Indigents program (Part 4.7
(commencing with Section 16900)), including, but not limited to,
county health care reporting requirements pursuant to Chapter 2
(commencing with Section 16910) and Chapter 2.5 (commencing with
Section 16915) of that part.
16801. The following definitions shall govern the construction of
this part, unless the context requires otherwise:
(a) "County health services" means public health services,
outpatient health services, and inpatient health services provided
directly by a local jurisdiction or financed or purchased by a local
jurisdiction through grants, contracts, or agreements but shall not
include mental health services, alcohol and drug abuse services, and
services which were provided in fiscal year 1977-78 but were not part
of the reported net county costs for fiscal year 1977-78.
(b) "Net county costs for health services" means expenditures for
county health services, less revenues received for county health
services.
(c) "City health services" means public health services,
outpatient health services, and inpatient health services provided
directly by the city or financed or purchased by the city through
grants, contracts, or agreements, but shall not include mental health
services, alcohol and drug abuse services, and services which were
not provided in the 1977-78 fiscal year but were not part of the
reported net county costs for the 1977-78 fiscal year.
(d) "Department" means the State Department of Health Services.
(e) "Net city costs for health services" means expenditures for
city health services, less revenues received for city health
services.
(f) "Program account" means the County Medical Services Program
Account in the County Health Services Fund.
(g) "Reserve account" means the County Medical Services Program
Reserve Account in the County Health Services Fund.
16803. (a) The County Health Services Fund is hereby created, and
notwithstanding Section 13340 of the Government Code, is continuously
appropriated to the department, without regard to fiscal years, for
the purposes of this part.
(b) The expenditure of funds from the County Health Services Fund
shall be made by the State Department of Health Services without
regard to fiscal year.
16804.1. (a) No fee or charge shall be required of any person
before a county renders medically necessary services to persons
entitled to services pursuant to Section 17000.
(b) This section is declaratory of existing law and shall not be
interpreted to effect a county's authority to implement a reasonable
sliding fee schedule based on ability to pay.
16809. (a) (1) The board of supervisors of a county that contracted
with the department pursuant to former Section 16709 during the
1990-91 fiscal year and any county with a population under 300,000,
as determined in accordance with the 1990 decennial census, by
adopting a resolution to that effect, may elect to participate in the
County Medical Services Program. The governing board shall have
responsibilities for specified health services to county residents
certified eligible for those services by the county.
(2) The board of supervisors of a county that has contracted with
the governing board pursuant to paragraph (1) may also contract with
the governing board for the delivery of health care and
health-related services to county residents other than under the
County Medical Services Program by adopting a resolution to that
effect. The governing board shall have responsibilities for the
delivery of specified health services to county residents as agreed
upon by the governing board and the county. Participation by a county
pursuant to this paragraph shall be voluntary, and funds shall be
provided solely by the county.
(b) The governing board may contract with the department or any
other person or entity to administer the County Medical Services
Program.
(1) If the governing board contracts with the department to
administer the County Medical Services Program, that contract shall
include, but need not be limited to, all of the following:
(A) Provisions for the payment to participating counties for
making eligibility determinations as determined by the governing
board.
(B) Provisions for payment of expenses of the governing board.
(C) Provisions relating to the flow of funds from counties'
vehicle license fees, sales taxes, and participation fees and the
procedures to be followed if a county does not pay those funds to the
program.
(D) Those provisions, as applicable, contained in the 1993-94
fiscal year contract with counties under the County Medical Services
Program.
(E) Provisions for the department to administer the County Medical
Services Program pursuant to regulations adopted by the governing
board or as otherwise determined by the governing board.
(F) Provisions requiring that the governing board reimburse the
state costs of providing administrative support to the County Medical
Services Program in accordance with amounts determined between the
governing board and the department.
(2) If the governing board does not contract with the department
for administration of the County Medical Services Program, the
governing board may contract with the department for specified
services to assist in the administration of that program. Any
contract with the department under this paragraph shall require that
the governing board reimburse the state costs of providing
administrative support.
(3) The department shall not be liable for any costs related to
decisions of the governing board that are in excess of those set
forth in the contract between the department and the governing board.
(c) Each county intending to participate in the County Medical
Services Program pursuant to this section shall submit to the
governing board a notice of intent to contract adopted by the board
of supervisors no later than April 1 of the fiscal year preceding the
fiscal year in which the county will participate in the County
Medical Services Program.
(d) A county participating in the County Medical Services Program
pursuant to this section, or a county contracting with the governing
board pursuant to paragraph (2) or (3) of subdivision (a), or
participating in a pilot project or contracting with the governing
board for an alternative product pursuant to Section 16809.4, shall
not be relieved of its indigent health care obligation under Section
17000.
(e) (1) The County Medical Services Program Account is established
in the County Health Services Fund. The County Medical Services
Program Account is continuously appropriated, notwithstanding Section
13340 of the Government Code, without regard to fiscal years. The
following amounts may be deposited in the account:
(A) Any interest earned upon moneys deposited in the account.
(B) Moneys provided by participating counties or appropriated by
the Legislature to the account.
(C) Moneys loaned pursuant to subdivision (n).
(2) The methods and procedures used to deposit funds into the
account shall be consistent with the methods used by the program
during the 1993-94 fiscal year, unless otherwise determined by the
governing board.
(f) Moneys in the program account shall be used by the governing
board, or by the department if the department contracts with the
governing board for this purpose, to pay for health care services
provided to the persons meeting the eligibility criteria established
pursuant to subdivision (j) and to pay the governing board expenses
and program administrative costs. In addition, moneys in this account
may be used to reimburse the department for state costs pursuant to
subparagraph (F) of paragraph (1) of subdivision (b).
(g) (1) Moneys in this account shall be administered on an accrual
basis and notwithstanding any other law, except as provided in this
section and Section 17605.051, shall not be transferred to any other
fund or account in the State Treasury except for purposes of
investment as provided in Article 4 (commencing with Section 16470)
of Chapter 3 of Part 2 of Division 4 of Title 2 of the Government
Code.
(2) (A) All interest or other increment resulting from the
investment shall be deposited in the program account, notwithstanding
Section 16305.7 of the Government Code.
(B) All interest deposited pursuant to subparagraph (A) shall be
available to reimburse program-covered services, governing board
expenses, and program administrative costs.
(h) The governing board shall establish a reserve account for the
purpose of depositing funds for the payment of claims and unexpected
contingencies. Funds in the reserve account in excess of the amounts
the governing board determines necessary for these purposes shall be
available for expenditures in years when program expenditures exceed
program funds, and to augment the rates, benefits, or eligibility
criteria under the program.
(i) (1) Counties shall pay participation fees as established by
the governing board and their jurisdictional risk amount in a method
that is consistent with that established in the 1993-94 fiscal year.
(2) A county may request, due to financial hardship, the payments
under paragraph (1) be delayed. The request shall be subject to
approval by the governing board.
(3) Payments made pursuant to this subdivision shall be deposited
in the program account, unless otherwise directed by the governing
board.
(4) Payments may be made as part of the deposits authorized by the
county pursuant to Sections 17603.05 and 17604.05.
(j) (1) (A) Beginning in the 1992-93 fiscal year and for each
fiscal year thereafter, counties and the state shall share the risk
for cost increases of the County Medical Services Program not funded
through other sources. The state shall be at risk for any cost that
exceeds the cumulative annual growth in dedicated sales tax and
vehicle license fee revenue, up to the amount of twenty million two
hundred thirty-seven thousand four hundred sixty dollars
($20,237,460) per fiscal year, except for the 1999-2000, 2000-01,
2001-02, 2002-03, 2003-04, 2004-05, 2005-06, 2006-07, and 2007-08
fiscal years, and all fiscal years thereafter. Counties shall be at
risk up to the cumulative annual growth in the Local Revenue Fund
created by Section 17600, according to the table specified in
paragraph (2), to the County Medical Services Program, plus the
additional cost increases in excess of twenty million two hundred
thirty-seven thousand four hundred sixty dollars ($20,237,460) per
fiscal year, except for the 1999-2000, 2000-01, 2001-02, 2002-03,
2003-04, 2004-05, 2005-06, 2006-07, and 2007-08 fiscal years, and all
fiscal years thereafter.
(B) For the 1999-2000, 2000-01, 2001-02, 2002-03, 2003-04,
2004-05, 2005-06, 2006-07, and 2007-08 fiscal years, and all fiscal
years thereafter, the state shall not be at risk for any cost that
exceeds the cumulative annual growth in dedicated sales tax and
vehicle license fee revenue. Counties shall be at risk up to the
cumulative annual growth in the Local Revenue Fund created by Section
17600, according to the table specified in paragraph (2), to the
County Medical Services Program, plus any additional cost increases
for the 1999-2000, 2000-01, 2001-02, 2002-03, 2003-04, 2004-05,
2005-06, 2006-07, and 2007-08 fiscal years, and all fiscal years
thereafter.
(C) (i) The governing board shall establish uniform eligibility
criteria and benefits among all counties participating in the County
Medical Services Program listed in paragraph (2). For counties that
are not listed in paragraph (2) and that elect to participate
pursuant to paragraph (1) of subdivision (a), the eligibility
criteria and benefit structure may vary from those of counties
participating pursuant to paragraph (2) of subdivision (a).
(ii) Notwithstanding clause (i), the governing board may establish
and maintain pilot projects to identify or test alternative
approaches for determining eligibility or for providing or paying for
benefits under the County Medical Services Program, and may develop
and implement alternative products with varying levels of eligibility
criteria and benefits outside of the County Medical Services
Program.
(2) For the 1991-92 fiscal year, and each fiscal year thereafter,
jurisdictional risk limitations shall be as follows:
Jurisdiction Amount
Alpine.......................... $ 13,150
Amador.......................... 620,264
Butte........................... 5,950,593
Calaveras....................... 913,959
Colusa.......................... 799,988
Del Norte....................... 781,358
El Dorado....................... 3,535,288
Glenn........................... 787,933
Humboldt........................ 6,883,182
Imperial........................ 6,394,422
Inyo............................ 1,100,257
Kings........................... 2,832,833
Lake............................ 1,022,963
Lassen.......................... 687,113
Madera.......................... 2,882,147
Marin........................... 7,725,909
Mariposa........................ 435,062
Mendocino....................... 1,654,999
Modoc........................... 469,034
Mono............................ 369,309
Napa............................ 3,062,967
Nevada.......................... 1,860,793
Plumas.......................... 905,192
San Benito...................... 1,086,011
Shasta.......................... 5,361,013
Sierra.......................... 135,888
Siskiyou........................ 1,372,034
Solano.......................... 6,871,127
Sonoma.......................... 13,183,359
Sutter.......................... 2,996,118
Tehama.......................... 1,912,299
Trinity......................... 611,497
Tuolumne........................ 1,455,320
Yuba............................ 2,395,580
(3) Beginning in the 1991-92 fiscal year and in subsequent fiscal
years, the jurisdictional risk limitation for the counties that did
not contract with the department pursuant to former Section 16709
during the 1990-91 fiscal year shall be the amount specified in
subparagraph (A) plus the amount determined pursuant to subparagraph
(B), minus the amount specified by the governing board as
participation fees.
(A)
Jurisdiction Amount
Merced........................... 2,033,729
Placer........................... 1,338,330
San Luis Obispo.................. 2,000,491
Santa Cruz....................... 3,037,783
Yolo............................. 1,475,620
(B) The amount of funds necessary to fully fund the anticipated
costs for the county shall be determined by the governing board
before a county is permitted to participate in the County Medical
Services Program.
(4) The specific amounts and method of apportioning risk to each
participating county may be adjusted by the governing board.
(k) The Legislature hereby determines that an expedited contract
process for contracts under this section is necessary. Contracts
under this section shall be exempt from Part 2 (commencing with
Section 10100) of Division 2 of the Public Contract Code. Contracts
of the department pursuant to this section shall have no force or
effect unless they are approved by the Department of Finance.
(l) The state shall not incur any liability except as specified in
this section.
(m) Third-party recoveries for services provided under this
section may be pursued.
(n) The Department of Finance may authorize a loan of up to thirty
million dollars ($30,000,000) for deposit into the program account
to ensure that there are sufficient funds available to reimburse
providers and counties pursuant to this section.
(o) Moneys appropriated from the General Fund to meet the state
risk, as set forth in subparagraph (A) of paragraph (1) of
subdivision (j), shall not be available for those counties electing
to disenroll from the County Medical Services Program.
(p) Notwithstanding any other law, the Controller may use the
moneys in the County Medical Services Program Account for loans to
the General Fund as provided in Sections 16310 and 16381 of the
Government Code. However, interest shall be paid on all moneys loaned
to the General Fund from the County Medical Services Program
Account. Interest payable shall be computed at a rate determined by
the Pooled Money Investment Board to be the current earning rate of
the fund from which loaned. This subdivision does not authorize any
transfer that will interfere with the carrying out of the object for
which the County Medical Services Program Account was created.
16809.3. (a) Beginning in the 1991-92 fiscal year, and in
subsequent fiscal years, a county shall pay the amount listed below
or as established by the governing board pursuant to subparagraph (B)
of paragraph (1) of subdivision (e) of Section 16809.4, to the
governing board as a condition of participation in the County Medical
Services Program administered pursuant to Section 16809:
Jurisdiction Amount
Alpine............................. $ 661
Amador............................. 17,107
Butte.............................. 459,610
Calaveras.......................... 30,401
Colusa............................. 28,997
Del Norte.......................... 39,424
El Dorado.......................... 233,492
Glenn.............................. 33,989
Humboldt........................... 430,851
Imperial........................... 249,786
Inyo............................... 18,950
Kings.............................. 195,053
Lake............................... 150,278
Lassen............................. 17,206
Madera............................. 151,434
Marin.............................. 576,233
Mariposa........................... 5,649
Mendocino.......................... 247,578
Modoc.............................. 9,688
Mono............................... 25,469
Napa............................... 142,767
Nevada............................. 42,051
Plumas............................. 23,796
San Benito......................... 37,018
Shasta............................. 294,369
Sierra............................. 6,183
Siskiyou........................... 48,956
Solano............................. 809,548
Sonoma............................. 718,947
Sutter............................. 188,781
Tehama............................. 79,950
Trinity............................ 8,319
Tuolumne........................... 34,947
Yuba............................... 101,907
(b) Beginning in the 1991-92 fiscal year and in subsequent fiscal
years, counties that did not contract with the department pursuant to
Section 16709 during the 1990-91 fiscal year shall pay the following
amount listed below or as established by the governing board
pursuant to subparagraph (B) of paragraph (1) of subdivision (e) of
Section 16809.4, to the governing board as a condition of
participation in the County Medical Services Program, administered
pursuant to Section 16809:
Jurisdiction Amount
Merced............................ $488,954
Placer............................ 247,193
San Luis Obispo................... 358,571
Santa Cruz........................ 678,868
Yolo.............................. 532,510
(c) (1) County amounts specified in subdivisions (a) and (b) shall
be paid to the governing board in 12 equal monthly payments or as
otherwise specified by the governing board. Subject to paragraphs (2)
and (3), a county that does not pay the amounts specified in
subdivision (a) or (b) may be terminated from participation in the
program.
(2) A county may request, due to financial hardship, that payments
specified under subdivisions (a) and (b) be delayed. The request
shall be subject to the approval of the governing board.
(3) For the 1991-92 fiscal year and subsequent fiscal years,
counties that enter the County Medical Services Program shall pay the
amount specified in subdivision (a) or (b), as applicable, on a
prorated basis, for the number of contracted months of participation
in the County Medical Services Program.
(d) The payments required by subdivision (c) shall not be paid for
with funds from the health account of the local health and welfare
trust fund established pursuant to Section 17600.10.
16809.4. (a) Counties voluntarily participating in the County
Medical Services Program pursuant to Section 16809 may establish the
County Medical Services Program Governing Board pursuant to
procedures contained in this section. The governing board shall
govern the County Medical Services Program.
(b) The membership of the governing board shall be comprised of
all of the following:
(1) Three members who shall each be a member of a county board of
supervisors.
(2) Three members who shall be county administrative officers.
(3) Two members who shall be county welfare directors.
(4) Two members who shall be county health officials.
(5) One member who shall be the Secretary of the Health and
Welfare Agency, or his or her designee, and who shall serve as an ex
officio, nonvoting member.
(c) The governing board may establish its own bylaws and operating
procedures.
(d) The voting membership of the governing board shall meet all of
the following requirements:
(1) All of the members shall hold office or employment in counties
that participate in the County Medical Services Program.
(A) The three county supervisor members shall be elected by the
boards of supervisors of the CMSP counties, with each county having
one vote and convened at the call of the chair of the governing
board.
(B) The three county administrative officers shall be elected by
the administrative officers of the CMSP counties convened at the call
of the chair of the governing board.
(C) The two county health officials shall be selected by the
health officials of the CMSP counties convened at the call of the
chair of the governing board.
(D) The two county welfare directors shall be elected by the
welfare directors of the CMSP counties convened at the call of the
chair of the governing board.
(2) Governing board members shall serve three-year terms.
(3) No two persons from the same county may serve as members of
the governing board at the same time.
(4) The governing board may elect a permanent chair.
(e) (1) The governing board is hereby established with the
following powers:
(A) Determine program eligibility and benefit levels.
(B) Establish reserves and participation fees.
(C) Establish procedures for the entry into, and disenrollment of
counties from the County Medical Services Program. Disenrollment
procedures shall be fair and equitable.
(D) Establish cost containment and case management procedures,
including, but not limited to, alternative methods for delivery of
care and alternative methods and rates from those used by the
department.
(E) Sue and be sued in the name of the governing board.
(F) Apportion jurisdictional risk to each county.
(G) Utilize procurement policies and procedures of any of the
participating counties as selected by the governing board.
(H) Make rules and regulations.
(I) Make and enter into contracts or stipulations of any nature
with a public agency or person for the purposes of governing or
administering the County Medical Services Program.
(J) Purchase supplies, equipment, materials, property, or
services.
(K) Appoint and employ staff to assist the governing board.
(L) Establish rules for its proceedings.
(M) Accept gifts, contributions, grants, or loans from any public
agency or person for the purposes of this program.
(N) Negotiate and set rates, charges, or fees with service
providers, including alternative methods of payment to those used by
the department.
(O) Establish methods of payment that are compatible with the
administrative requirements of the department's fiscal intermediary
during the term of any contract with the department for the
administration of the County Medical Services Program.
(P) Use generally accepted accounting procedures.
(Q) Develop and implement procedures and processes to monitor and
enforce the appropriate billing and payment of rates, charges, and
fees.
(R) Investigate and pursue repayment of fees billed and paid
through improper means, including, but not limited to, fraudulent
billing and collection practices by providers.
(S) Pursue third-party recoveries and estate recoveries for
services provided under the County Medical Services Program,
including the filing and perfecting of liens to secure reimbursement
for the reasonable value of benefits provided.
(T) Establish and maintain pilot projects to identify or test
alternative approaches for determining eligibility or for providing
or paying for services.
(U) Establish provisions for payment to participating counties for
making eligibility determinations, as determined by the governing
board.
(V) Develop and implement alternative products with varying levels
of eligibility criteria and benefits outside of the County Medical
Services Program for counties contracting with the governing board
for those products, provided that any such products shall be funded
separately from the County Medical Services Program and shall not
impair the financial stability of that program.
(2) The Legislature finds and declares that the amendment of
subparagraph (N) of paragraph (1) in 1995, and the addition of
subparagraphs (Q), (R), (S), (T), and (U) in 2006, are declaratory of
existing law.
(f) (1) The governing board shall be considered a "public entity"
for purposes of Division 3.6 (commencing with Section 810) of Title 1
of the Government Code, and a "local public entity" for purposes of
Part 3 (commencing with Section 900) of Division 3.6 of Title 1 of
the Government Code, but shall not be considered a "state agency" for
purposes of Chapter 3.5 (commencing with Section 11340) of Part 1 of
Division 3 of Title 2 of the Government Code and shall be exempt
from that chapter. No participating county shall have any liability
for civil judgments awarded against the County Medical Services
Program or the governing board. Nothing in this paragraph shall be
construed to expand the liability of the state with respect to the
County Medical Services Program beyond that set forth in Section
16809. Nothing in this paragraph shall be construed to relieve any
county of the obligation to provide health care to indigent persons
pursuant to Section 17000, or the obligation of any county to pay its
participation fees and share of apportioned and allocated risk.
(2) Before initiating any proceeding to challenge rates of
payment, charges, or fees set by the governing board, to seek
reimbursement or release of any funds from the County Medical
Services Program, or to challenge any other action by the governing
board, any prospective claimant shall first notify the governing
board, in writing, of the nature and basis of the challenge and the
amount claimed. The governing board shall consider the matter within
60 days after receiving the notice and shall promptly thereafter
provide written notice of the governing board's decision. If the
governing board contracts with the department for administration of
the program in accordance with Section 16809, this paragraph shall
have no application to provider audit appeals conducted pursuant to
Article 1.5 (commencing with Section 51016) of Chapter 3 of Division
3 of Title 22 of the California Code of Regulations and shall apply
to all claims not reviewed pursuant to Section 51003 or 51015 of
Title 22 of the California Code of Regulations.
(3) All regulations adopted by the governing board shall clearly
specify by reference the statute, court decision, or other provision
of law that the governing board is seeking to implement, interpret,
or make specific by adopting, amending, or repealing the regulation.
(4) No regulation adopted by the governing board is valid and
effective unless the regulation meets the standards of necessity,
authority, clarity, consistency, and nonduplication, as defined in
paragraph (5).
(5) The following definitions govern the interpretation of this
subdivision:
(A) "Necessity" means the record of the regulatory proceeding that
demonstrates by substantial evidence the need for the regulation.
For purposes of this standard, evidence includes, but is not limited
to, facts, studies, and expert opinion.
(B) "Authority" means the provision of law that permits or
obligates the CMSP Governing Board to adopt, amend, or repeal a
regulation.
(C) "Clarity" means that the regulation is written or displayed so
that the meaning of the regulation can be easily understood by those
persons directly affected by it.
(D) "Consistency" means being in harmony with, and not in conflict
with, or contradictory to, existing statutes, court decisions, or
other provisions of law.
(E) "Nonduplication" means that a regulation does not serve the
same purpose as a state or federal statute or another regulation.
This standard requires that the governing board identify any state or
federal statute or regulation that is overlapped or duplicated by
the proposed regulation and justify any overlap or duplication. This
standard is not intended to prohibit the governing board from
printing relevant portions of enabling legislation in regulations
when the duplication is necessary to satisfy the clarity standard in
subparagraph (C). This standard is intended to prevent the
indiscriminate incorporation of statutory language in a regulation.
(g) The requirements of the Ralph M. Brown Act (Chapter 9
(commencing with Section 54950) of Part 1 of Division 2 of Title 5 of
the Government Code) shall apply to the meetings of the governing
board, including meetings held pursuant to subdivision (i), except
the board may meet in closed session to consider and take action on
matters pertaining to contracts and contract negotiations with
providers of health care services.
(h) (1) The governing board shall comply with the following
procedures for public meetings held to eliminate or reduce the level
of services, restrict eligibility for services, or adopt regulations:
(A) Provide prior public notice of those meetings.
(B) Provide that notice not less than 30 days prior to those
meetings.
(C) Publish that notice in a newspaper of general circulation in
each participating CMSP county.
(D) Include in the notice, at a minimum, the amount and type of
each proposed change, the expected savings, and the number of persons
affected.
(E) Either hold those meetings in the county seats of at least
four regionally distributed CMSP participating counties, or,
alternatively, hold two meetings in Sacramento County.
(2) For meetings held outside Sacramento County, the requirements
for public meetings pursuant to this subdivision to eliminate or
reduce the level of services, or to restrict the eligibility for
services or hear testimony regarding regulations to implement any of
these service charges, are satisfied if at least three voting members
of the governing board hold the meetings as required and report the
testimony from those meetings to the full governing board at its next
regular meeting. No action shall be taken at any meeting held
outside Sacramento County pursuant to this paragraph.
(i) Records of the County Medical Services Program and of the
governing board that relate to rates of payment or to the board's
negotiations with providers of health care services or to the
governing board's deliberative processes regarding either shall not
be subject to disclosure pursuant to the Public Records Act (Chapter
5 (commencing with Section 6250) of Division 7 of Title 1 of the
Government Code).
(j) The following definitions shall govern the construction of
this part, unless the context requires otherwise:
(1) "CMSP" or "program" means the County Medical Services Program,
which is the program by which health care services are provided to
eligible persons in those counties electing to participate in the
CMSP pursuant to Section 16809.
(2) "CMSP county" means a county that has elected to participate
pursuant to Section 16809 in the CMSP.
(3) "Governing Board" means the County Medical Services Program
Governing Board established pursuant to this section.
16809.5. (a) Funds appropriated for the purposes of this section
shall be allocated on a monthly basis.
(b) Money allocated for the purposes of this section may be used
to expand the scope of benefits, to fund special projects which
alleviate problems of access to health and dental care under the
County Medical Services Program and to compensate hospitals and other
emergency health service providers for emergency treatment of
out-of-county indigent patients and shall not be used to fund
existing levels of service.
(c) Funds available from appropriations for the purposes of this
chapter may be utilized to fund increased program costs due to
caseload increases and provider rate increases.
16812. The State Department of Health Services, in consultation
with the local jurisdictions, shall adopt any regulations necessary
to implement this part. The department may adopt these regulations on
an emergency basis pursuant to Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code. The
adoption of those regulations shall be deemed to be an emergency and
necessary for the immediate preservation of the public peace,
health, or safety. Notwithstanding Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code, emergency regulations adopted by the department in order to
implement this part shall not be subject to the review and approval
of the Office of Administrative Law. These regulations shall become
effective immediately upon filing with the Secretary of State.
16817. Notwithstanding any other provision of law, a county may
enter into contracts with selected providers to provide health care
services in expending funds provided pursuant to this part and Part 5
(commencing with Section 17000). The county may negotiate such
reimbursement or payment arrangements it desires in such contracts. A
county shall not be obligated to pay for health care services unless
pursuant to a contract or the county has specifically authorized
such services and agreed to payment. All such contracts shall be
available for review by the department. A county may require county
residents specified in this part and Part 5 to use county facilities
or county selected providers. This section may not be construed to
limit a county's existing obligations to furnish health care. Any
county may also elect to act jointly on a regional basis with other
counties in assuming the program responsibilities.
16818. (a) Each facility treating persons pursuant to Section 17000
shall provide, at the time treatment is sought, individual notice of
the availability of reduced cost health care. In addition,
conspicuous posted notices of the procedures for applying for reduced
cost health care shall be displayed in all emergency rooms and
patient waiting rooms of each facility treating persons pursuant to
Section 17000.
(b) This section is declaratory of existing law and shall not be
interpreted to constitute a new mandate.
WELFARE AND INSTITUTIONS CODE
SECTION 16800.5-16818
16800.5. The State Department of Health Services shall establish
data collection and reporting requirements for counties to annually
report health expenditures.
16800.7. Agencies responsible for conducting fiscal or program
audits or inspections of grants or subventions pursuant to any of the
following provisions shall, to the extent practicable and consistent
with federal law, endeavor to cooperate and consolidate efforts so
as to conduct a single fiscal or compliance audit for any program
affected by these provisions, thereby maximizing audit efficiency and
minimizing the inconvenience to the program being audited:
(a) The Child Health Disability Prevention Program (Article 6
(commencing with Section 124025) of Chapter 3 of Part 2 of Division
106 of the Health and Safety Code).
(b) The Maternal and Child Health program as set forth in
subdivision (c) of Section 27 of the Health and Safety Code.
(c) The Tobacco Use Prevention program (Article 1 (commencing with
Section 104350) of Chapter 1 of Part 3 of Division 103 of the Health
and Safety Code).
(d) AIDS programs (former Part 1 (commencing with Section 100) of
Division 1 of the Health and Safety Code).
(e) The County Health Care for Indigents program (Part 4.7
(commencing with Section 16900)), including, but not limited to,
county health care reporting requirements pursuant to Chapter 2
(commencing with Section 16910) and Chapter 2.5 (commencing with
Section 16915) of that part.
16801. The following definitions shall govern the construction of
this part, unless the context requires otherwise:
(a) "County health services" means public health services,
outpatient health services, and inpatient health services provided
directly by a local jurisdiction or financed or purchased by a local
jurisdiction through grants, contracts, or agreements but shall not
include mental health services, alcohol and drug abuse services, and
services which were provided in fiscal year 1977-78 but were not part
of the reported net county costs for fiscal year 1977-78.
(b) "Net county costs for health services" means expenditures for
county health services, less revenues received for county health
services.
(c) "City health services" means public health services,
outpatient health services, and inpatient health services provided
directly by the city or financed or purchased by the city through
grants, contracts, or agreements, but shall not include mental health
services, alcohol and drug abuse services, and services which were
not provided in the 1977-78 fiscal year but were not part of the
reported net county costs for the 1977-78 fiscal year.
(d) "Department" means the State Department of Health Services.
(e) "Net city costs for health services" means expenditures for
city health services, less revenues received for city health
services.
(f) "Program account" means the County Medical Services Program
Account in the County Health Services Fund.
(g) "Reserve account" means the County Medical Services Program
Reserve Account in the County Health Services Fund.
16803. (a) The County Health Services Fund is hereby created, and
notwithstanding Section 13340 of the Government Code, is continuously
appropriated to the department, without regard to fiscal years, for
the purposes of this part.
(b) The expenditure of funds from the County Health Services Fund
shall be made by the State Department of Health Services without
regard to fiscal year.
16804.1. (a) No fee or charge shall be required of any person
before a county renders medically necessary services to persons
entitled to services pursuant to Section 17000.
(b) This section is declaratory of existing law and shall not be
interpreted to effect a county's authority to implement a reasonable
sliding fee schedule based on ability to pay.
16809. (a) (1) The board of supervisors of a county that contracted
with the department pursuant to former Section 16709 during the
1990-91 fiscal year and any county with a population under 300,000,
as determined in accordance with the 1990 decennial census, by
adopting a resolution to that effect, may elect to participate in the
County Medical Services Program. The governing board shall have
responsibilities for specified health services to county residents
certified eligible for those services by the county.
(2) The board of supervisors of a county that has contracted with
the governing board pursuant to paragraph (1) may also contract with
the governing board for the delivery of health care and
health-related services to county residents other than under the
County Medical Services Program by adopting a resolution to that
effect. The governing board shall have responsibilities for the
delivery of specified health services to county residents as agreed
upon by the governing board and the county. Participation by a county
pursuant to this paragraph shall be voluntary, and funds shall be
provided solely by the county.
(b) The governing board may contract with the department or any
other person or entity to administer the County Medical Services
Program.
(1) If the governing board contracts with the department to
administer the County Medical Services Program, that contract shall
include, but need not be limited to, all of the following:
(A) Provisions for the payment to participating counties for
making eligibility determinations as determined by the governing
board.
(B) Provisions for payment of expenses of the governing board.
(C) Provisions relating to the flow of funds from counties'
vehicle license fees, sales taxes, and participation fees and the
procedures to be followed if a county does not pay those funds to the
program.
(D) Those provisions, as applicable, contained in the 1993-94
fiscal year contract with counties under the County Medical Services
Program.
(E) Provisions for the department to administer the County Medical
Services Program pursuant to regulations adopted by the governing
board or as otherwise determined by the governing board.
(F) Provisions requiring that the governing board reimburse the
state costs of providing administrative support to the County Medical
Services Program in accordance with amounts determined between the
governing board and the department.
(2) If the governing board does not contract with the department
for administration of the County Medical Services Program, the
governing board may contract with the department for specified
services to assist in the administration of that program. Any
contract with the department under this paragraph shall require that
the governing board reimburse the state costs of providing
administrative support.
(3) The department shall not be liable for any costs related to
decisions of the governing board that are in excess of those set
forth in the contract between the department and the governing board.
(c) Each county intending to participate in the County Medical
Services Program pursuant to this section shall submit to the
governing board a notice of intent to contract adopted by the board
of supervisors no later than April 1 of the fiscal year preceding the
fiscal year in which the county will participate in the County
Medical Services Program.
(d) A county participating in the County Medical Services Program
pursuant to this section, or a county contracting with the governing
board pursuant to paragraph (2) or (3) of subdivision (a), or
participating in a pilot project or contracting with the governing
board for an alternative product pursuant to Section 16809.4, shall
not be relieved of its indigent health care obligation under Section
17000.
(e) (1) The County Medical Services Program Account is established
in the County Health Services Fund. The County Medical Services
Program Account is continuously appropriated, notwithstanding Section
13340 of the Government Code, without regard to fiscal years. The
following amounts may be deposited in the account:
(A) Any interest earned upon moneys deposited in the account.
(B) Moneys provided by participating counties or appropriated by
the Legislature to the account.
(C) Moneys loaned pursuant to subdivision (n).
(2) The methods and procedures used to deposit funds into the
account shall be consistent with the methods used by the program
during the 1993-94 fiscal year, unless otherwise determined by the
governing board.
(f) Moneys in the program account shall be used by the governing
board, or by the department if the department contracts with the
governing board for this purpose, to pay for health care services
provided to the persons meeting the eligibility criteria established
pursuant to subdivision (j) and to pay the governing board expenses
and program administrative costs. In addition, moneys in this account
may be used to reimburse the department for state costs pursuant to
subparagraph (F) of paragraph (1) of subdivision (b).
(g) (1) Moneys in this account shall be administered on an accrual
basis and notwithstanding any other law, except as provided in this
section and Section 17605.051, shall not be transferred to any other
fund or account in the State Treasury except for purposes of
investment as provided in Article 4 (commencing with Section 16470)
of Chapter 3 of Part 2 of Division 4 of Title 2 of the Government
Code.
(2) (A) All interest or other increment resulting from the
investment shall be deposited in the program account, notwithstanding
Section 16305.7 of the Government Code.
(B) All interest deposited pursuant to subparagraph (A) shall be
available to reimburse program-covered services, governing board
expenses, and program administrative costs.
(h) The governing board shall establish a reserve account for the
purpose of depositing funds for the payment of claims and unexpected
contingencies. Funds in the reserve account in excess of the amounts
the governing board determines necessary for these purposes shall be
available for expenditures in years when program expenditures exceed
program funds, and to augment the rates, benefits, or eligibility
criteria under the program.
(i) (1) Counties shall pay participation fees as established by
the governing board and their jurisdictional risk amount in a method
that is consistent with that established in the 1993-94 fiscal year.
(2) A county may request, due to financial hardship, the payments
under paragraph (1) be delayed. The request shall be subject to
approval by the governing board.
(3) Payments made pursuant to this subdivision shall be deposited
in the program account, unless otherwise directed by the governing
board.
(4) Payments may be made as part of the deposits authorized by the
county pursuant to Sections 17603.05 and 17604.05.
(j) (1) (A) Beginning in the 1992-93 fiscal year and for each
fiscal year thereafter, counties and the state shall share the risk
for cost increases of the County Medical Services Program not funded
through other sources. The state shall be at risk for any cost that
exceeds the cumulative annual growth in dedicated sales tax and
vehicle license fee revenue, up to the amount of twenty million two
hundred thirty-seven thousand four hundred sixty dollars
($20,237,460) per fiscal year, except for the 1999-2000, 2000-01,
2001-02, 2002-03, 2003-04, 2004-05, 2005-06, 2006-07, and 2007-08
fiscal years, and all fiscal years thereafter. Counties shall be at
risk up to the cumulative annual growth in the Local Revenue Fund
created by Section 17600, according to the table specified in
paragraph (2), to the County Medical Services Program, plus the
additional cost increases in excess of twenty million two hundred
thirty-seven thousand four hundred sixty dollars ($20,237,460) per
fiscal year, except for the 1999-2000, 2000-01, 2001-02, 2002-03,
2003-04, 2004-05, 2005-06, 2006-07, and 2007-08 fiscal years, and all
fiscal years thereafter.
(B) For the 1999-2000, 2000-01, 2001-02, 2002-03, 2003-04,
2004-05, 2005-06, 2006-07, and 2007-08 fiscal years, and all fiscal
years thereafter, the state shall not be at risk for any cost that
exceeds the cumulative annual growth in dedicated sales tax and
vehicle license fee revenue. Counties shall be at risk up to the
cumulative annual growth in the Local Revenue Fund created by Section
17600, according to the table specified in paragraph (2), to the
County Medical Services Program, plus any additional cost increases
for the 1999-2000, 2000-01, 2001-02, 2002-03, 2003-04, 2004-05,
2005-06, 2006-07, and 2007-08 fiscal years, and all fiscal years
thereafter.
(C) (i) The governing board shall establish uniform eligibility
criteria and benefits among all counties participating in the County
Medical Services Program listed in paragraph (2). For counties that
are not listed in paragraph (2) and that elect to participate
pursuant to paragraph (1) of subdivision (a), the eligibility
criteria and benefit structure may vary from those of counties
participating pursuant to paragraph (2) of subdivision (a).
(ii) Notwithstanding clause (i), the governing board may establish
and maintain pilot projects to identify or test alternative
approaches for determining eligibility or for providing or paying for
benefits under the County Medical Services Program, and may develop
and implement alternative products with varying levels of eligibility
criteria and benefits outside of the County Medical Services
Program.
(2) For the 1991-92 fiscal year, and each fiscal year thereafter,
jurisdictional risk limitations shall be as follows:
Jurisdiction Amount
Alpine.......................... $ 13,150
Amador.......................... 620,264
Butte........................... 5,950,593
Calaveras....................... 913,959
Colusa.......................... 799,988
Del Norte....................... 781,358
El Dorado....................... 3,535,288
Glenn........................... 787,933
Humboldt........................ 6,883,182
Imperial........................ 6,394,422
Inyo............................ 1,100,257
Kings........................... 2,832,833
Lake............................ 1,022,963
Lassen.......................... 687,113
Madera.......................... 2,882,147
Marin........................... 7,725,909
Mariposa........................ 435,062
Mendocino....................... 1,654,999
Modoc........................... 469,034
Mono............................ 369,309
Napa............................ 3,062,967
Nevada.......................... 1,860,793
Plumas.......................... 905,192
San Benito...................... 1,086,011
Shasta.......................... 5,361,013
Sierra.......................... 135,888
Siskiyou........................ 1,372,034
Solano.......................... 6,871,127
Sonoma.......................... 13,183,359
Sutter.......................... 2,996,118
Tehama.......................... 1,912,299
Trinity......................... 611,497
Tuolumne........................ 1,455,320
Yuba............................ 2,395,580
(3) Beginning in the 1991-92 fiscal year and in subsequent fiscal
years, the jurisdictional risk limitation for the counties that did
not contract with the department pursuant to former Section 16709
during the 1990-91 fiscal year shall be the amount specified in
subparagraph (A) plus the amount determined pursuant to subparagraph
(B), minus the amount specified by the governing board as
participation fees.
(A)
Jurisdiction Amount
Merced........................... 2,033,729
Placer........................... 1,338,330
San Luis Obispo.................. 2,000,491
Santa Cruz....................... 3,037,783
Yolo............................. 1,475,620
(B) The amount of funds necessary to fully fund the anticipated
costs for the county shall be determined by the governing board
before a county is permitted to participate in the County Medical
Services Program.
(4) The specific amounts and method of apportioning risk to each
participating county may be adjusted by the governing board.
(k) The Legislature hereby determines that an expedited contract
process for contracts under this section is necessary. Contracts
under this section shall be exempt from Part 2 (commencing with
Section 10100) of Division 2 of the Public Contract Code. Contracts
of the department pursuant to this section shall have no force or
effect unless they are approved by the Department of Finance.
(l) The state shall not incur any liability except as specified in
this section.
(m) Third-party recoveries for services provided under this
section may be pursued.
(n) The Department of Finance may authorize a loan of up to thirty
million dollars ($30,000,000) for deposit into the program account
to ensure that there are sufficient funds available to reimburse
providers and counties pursuant to this section.
(o) Moneys appropriated from the General Fund to meet the state
risk, as set forth in subparagraph (A) of paragraph (1) of
subdivision (j), shall not be available for those counties electing
to disenroll from the County Medical Services Program.
(p) Notwithstanding any other law, the Controller may use the
moneys in the County Medical Services Program Account for loans to
the General Fund as provided in Sections 16310 and 16381 of the
Government Code. However, interest shall be paid on all moneys loaned
to the General Fund from the County Medical Services Program
Account. Interest payable shall be computed at a rate determined by
the Pooled Money Investment Board to be the current earning rate of
the fund from which loaned. This subdivision does not authorize any
transfer that will interfere with the carrying out of the object for
which the County Medical Services Program Account was created.
16809.3. (a) Beginning in the 1991-92 fiscal year, and in
subsequent fiscal years, a county shall pay the amount listed below
or as established by the governing board pursuant to subparagraph (B)
of paragraph (1) of subdivision (e) of Section 16809.4, to the
governing board as a condition of participation in the County Medical
Services Program administered pursuant to Section 16809:
Jurisdiction Amount
Alpine............................. $ 661
Amador............................. 17,107
Butte.............................. 459,610
Calaveras.......................... 30,401
Colusa............................. 28,997
Del Norte.......................... 39,424
El Dorado.......................... 233,492
Glenn.............................. 33,989
Humboldt........................... 430,851
Imperial........................... 249,786
Inyo............................... 18,950
Kings.............................. 195,053
Lake............................... 150,278
Lassen............................. 17,206
Madera............................. 151,434
Marin.............................. 576,233
Mariposa........................... 5,649
Mendocino.......................... 247,578
Modoc.............................. 9,688
Mono............................... 25,469
Napa............................... 142,767
Nevada............................. 42,051
Plumas............................. 23,796
San Benito......................... 37,018
Shasta............................. 294,369
Sierra............................. 6,183
Siskiyou........................... 48,956
Solano............................. 809,548
Sonoma............................. 718,947
Sutter............................. 188,781
Tehama............................. 79,950
Trinity............................ 8,319
Tuolumne........................... 34,947
Yuba............................... 101,907
(b) Beginning in the 1991-92 fiscal year and in subsequent fiscal
years, counties that did not contract with the department pursuant to
Section 16709 during the 1990-91 fiscal year shall pay the following
amount listed below or as established by the governing board
pursuant to subparagraph (B) of paragraph (1) of subdivision (e) of
Section 16809.4, to the governing board as a condition of
participation in the County Medical Services Program, administered
pursuant to Section 16809:
Jurisdiction Amount
Merced............................ $488,954
Placer............................ 247,193
San Luis Obispo................... 358,571
Santa Cruz........................ 678,868
Yolo.............................. 532,510
(c) (1) County amounts specified in subdivisions (a) and (b) shall
be paid to the governing board in 12 equal monthly payments or as
otherwise specified by the governing board. Subject to paragraphs (2)
and (3), a county that does not pay the amounts specified in
subdivision (a) or (b) may be terminated from participation in the
program.
(2) A county may request, due to financial hardship, that payments
specified under subdivisions (a) and (b) be delayed. The request
shall be subject to the approval of the governing board.
(3) For the 1991-92 fiscal year and subsequent fiscal years,
counties that enter the County Medical Services Program shall pay the
amount specified in subdivision (a) or (b), as applicable, on a
prorated basis, for the number of contracted months of participation
in the County Medical Services Program.
(d) The payments required by subdivision (c) shall not be paid for
with funds from the health account of the local health and welfare
trust fund established pursuant to Section 17600.10.
16809.4. (a) Counties voluntarily participating in the County
Medical Services Program pursuant to Section 16809 may establish the
County Medical Services Program Governing Board pursuant to
procedures contained in this section. The governing board shall
govern the County Medical Services Program.
(b) The membership of the governing board shall be comprised of
all of the following:
(1) Three members who shall each be a member of a county board of
supervisors.
(2) Three members who shall be county administrative officers.
(3) Two members who shall be county welfare directors.
(4) Two members who shall be county health officials.
(5) One member who shall be the Secretary of the Health and
Welfare Agency, or his or her designee, and who shall serve as an ex
officio, nonvoting member.
(c) The governing board may establish its own bylaws and operating
procedures.
(d) The voting membership of the governing board shall meet all of
the following requirements:
(1) All of the members shall hold office or employment in counties
that participate in the County Medical Services Program.
(A) The three county supervisor members shall be elected by the
boards of supervisors of the CMSP counties, with each county having
one vote and convened at the call of the chair of the governing
board.
(B) The three county administrative officers shall be elected by
the administrative officers of the CMSP counties convened at the call
of the chair of the governing board.
(C) The two county health officials shall be selected by the
health officials of the CMSP counties convened at the call of the
chair of the governing board.
(D) The two county welfare directors shall be elected by the
welfare directors of the CMSP counties convened at the call of the
chair of the governing board.
(2) Governing board members shall serve three-year terms.
(3) No two persons from the same county may serve as members of
the governing board at the same time.
(4) The governing board may elect a permanent chair.
(e) (1) The governing board is hereby established with the
following powers:
(A) Determine program eligibility and benefit levels.
(B) Establish reserves and participation fees.
(C) Establish procedures for the entry into, and disenrollment of
counties from the County Medical Services Program. Disenrollment
procedures shall be fair and equitable.
(D) Establish cost containment and case management procedures,
including, but not limited to, alternative methods for delivery of
care and alternative methods and rates from those used by the
department.
(E) Sue and be sued in the name of the governing board.
(F) Apportion jurisdictional risk to each county.
(G) Utilize procurement policies and procedures of any of the
participating counties as selected by the governing board.
(H) Make rules and regulations.
(I) Make and enter into contracts or stipulations of any nature
with a public agency or person for the purposes of governing or
administering the County Medical Services Program.
(J) Purchase supplies, equipment, materials, property, or
services.
(K) Appoint and employ staff to assist the governing board.
(L) Establish rules for its proceedings.
(M) Accept gifts, contributions, grants, or loans from any public
agency or person for the purposes of this program.
(N) Negotiate and set rates, charges, or fees with service
providers, including alternative methods of payment to those used by
the department.
(O) Establish methods of payment that are compatible with the
administrative requirements of the department's fiscal intermediary
during the term of any contract with the department for the
administration of the County Medical Services Program.
(P) Use generally accepted accounting procedures.
(Q) Develop and implement procedures and processes to monitor and
enforce the appropriate billing and payment of rates, charges, and
fees.
(R) Investigate and pursue repayment of fees billed and paid
through improper means, including, but not limited to, fraudulent
billing and collection practices by providers.
(S) Pursue third-party recoveries and estate recoveries for
services provided under the County Medical Services Program,
including the filing and perfecting of liens to secure reimbursement
for the reasonable value of benefits provided.
(T) Establish and maintain pilot projects to identify or test
alternative approaches for determining eligibility or for providing
or paying for services.
(U) Establish provisions for payment to participating counties for
making eligibility determinations, as determined by the governing
board.
(V) Develop and implement alternative products with varying levels
of eligibility criteria and benefits outside of the County Medical
Services Program for counties contracting with the governing board
for those products, provided that any such products shall be funded
separately from the County Medical Services Program and shall not
impair the financial stability of that program.
(2) The Legislature finds and declares that the amendment of
subparagraph (N) of paragraph (1) in 1995, and the addition of
subparagraphs (Q), (R), (S), (T), and (U) in 2006, are declaratory of
existing law.
(f) (1) The governing board shall be considered a "public entity"
for purposes of Division 3.6 (commencing with Section 810) of Title 1
of the Government Code, and a "local public entity" for purposes of
Part 3 (commencing with Section 900) of Division 3.6 of Title 1 of
the Government Code, but shall not be considered a "state agency" for
purposes of Chapter 3.5 (commencing with Section 11340) of Part 1 of
Division 3 of Title 2 of the Government Code and shall be exempt
from that chapter. No participating county shall have any liability
for civil judgments awarded against the County Medical Services
Program or the governing board. Nothing in this paragraph shall be
construed to expand the liability of the state with respect to the
County Medical Services Program beyond that set forth in Section
16809. Nothing in this paragraph shall be construed to relieve any
county of the obligation to provide health care to indigent persons
pursuant to Section 17000, or the obligation of any county to pay its
participation fees and share of apportioned and allocated risk.
(2) Before initiating any proceeding to challenge rates of
payment, charges, or fees set by the governing board, to seek
reimbursement or release of any funds from the County Medical
Services Program, or to challenge any other action by the governing
board, any prospective claimant shall first notify the governing
board, in writing, of the nature and basis of the challenge and the
amount claimed. The governing board shall consider the matter within
60 days after receiving the notice and shall promptly thereafter
provide written notice of the governing board's decision. If the
governing board contracts with the department for administration of
the program in accordance with Section 16809, this paragraph shall
have no application to provider audit appeals conducted pursuant to
Article 1.5 (commencing with Section 51016) of Chapter 3 of Division
3 of Title 22 of the California Code of Regulations and shall apply
to all claims not reviewed pursuant to Section 51003 or 51015 of
Title 22 of the California Code of Regulations.
(3) All regulations adopted by the governing board shall clearly
specify by reference the statute, court decision, or other provision
of law that the governing board is seeking to implement, interpret,
or make specific by adopting, amending, or repealing the regulation.
(4) No regulation adopted by the governing board is valid and
effective unless the regulation meets the standards of necessity,
authority, clarity, consistency, and nonduplication, as defined in
paragraph (5).
(5) The following definitions govern the interpretation of this
subdivision:
(A) "Necessity" means the record of the regulatory proceeding that
demonstrates by substantial evidence the need for the regulation.
For purposes of this standard, evidence includes, but is not limited
to, facts, studies, and expert opinion.
(B) "Authority" means the provision of law that permits or
obligates the CMSP Governing Board to adopt, amend, or repeal a
regulation.
(C) "Clarity" means that the regulation is written or displayed so
that the meaning of the regulation can be easily understood by those
persons directly affected by it.
(D) "Consistency" means being in harmony with, and not in conflict
with, or contradictory to, existing statutes, court decisions, or
other provisions of law.
(E) "Nonduplication" means that a regulation does not serve the
same purpose as a state or federal statute or another regulation.
This standard requires that the governing board identify any state or
federal statute or regulation that is overlapped or duplicated by
the proposed regulation and justify any overlap or duplication. This
standard is not intended to prohibit the governing board from
printing relevant portions of enabling legislation in regulations
when the duplication is necessary to satisfy the clarity standard in
subparagraph (C). This standard is intended to prevent the
indiscriminate incorporation of statutory language in a regulation.
(g) The requirements of the Ralph M. Brown Act (Chapter 9
(commencing with Section 54950) of Part 1 of Division 2 of Title 5 of
the Government Code) shall apply to the meetings of the governing
board, including meetings held pursuant to subdivision (i), except
the board may meet in closed session to consider and take action on
matters pertaining to contracts and contract negotiations with
providers of health care services.
(h) (1) The governing board shall comply with the following
procedures for public meetings held to eliminate or reduce the level
of services, restrict eligibility for services, or adopt regulations:
(A) Provide prior public notice of those meetings.
(B) Provide that notice not less than 30 days prior to those
meetings.
(C) Publish that notice in a newspaper of general circulation in
each participating CMSP county.
(D) Include in the notice, at a minimum, the amount and type of
each proposed change, the expected savings, and the number of persons
affected.
(E) Either hold those meetings in the county seats of at least
four regionally distributed CMSP participating counties, or,
alternatively, hold two meetings in Sacramento County.
(2) For meetings held outside Sacramento County, the requirements
for public meetings pursuant to this subdivision to eliminate or
reduce the level of services, or to restrict the eligibility for
services or hear testimony regarding regulations to implement any of
these service charges, are satisfied if at least three voting members
of the governing board hold the meetings as required and report the
testimony from those meetings to the full governing board at its next
regular meeting. No action shall be taken at any meeting held
outside Sacramento County pursuant to this paragraph.
(i) Records of the County Medical Services Program and of the
governing board that relate to rates of payment or to the board's
negotiations with providers of health care services or to the
governing board's deliberative processes regarding either shall not
be subject to disclosure pursuant to the Public Records Act (Chapter
5 (commencing with Section 6250) of Division 7 of Title 1 of the
Government Code).
(j) The following definitions shall govern the construction of
this part, unless the context requires otherwise:
(1) "CMSP" or "program" means the County Medical Services Program,
which is the program by which health care services are provided to
eligible persons in those counties electing to participate in the
CMSP pursuant to Section 16809.
(2) "CMSP county" means a county that has elected to participate
pursuant to Section 16809 in the CMSP.
(3) "Governing Board" means the County Medical Services Program
Governing Board established pursuant to this section.
16809.5. (a) Funds appropriated for the purposes of this section
shall be allocated on a monthly basis.
(b) Money allocated for the purposes of this section may be used
to expand the scope of benefits, to fund special projects which
alleviate problems of access to health and dental care under the
County Medical Services Program and to compensate hospitals and other
emergency health service providers for emergency treatment of
out-of-county indigent patients and shall not be used to fund
existing levels of service.
(c) Funds available from appropriations for the purposes of this
chapter may be utilized to fund increased program costs due to
caseload increases and provider rate increases.
16812. The State Department of Health Services, in consultation
with the local jurisdictions, shall adopt any regulations necessary
to implement this part. The department may adopt these regulations on
an emergency basis pursuant to Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code. The
adoption of those regulations shall be deemed to be an emergency and
necessary for the immediate preservation of the public peace,
health, or safety. Notwithstanding Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code, emergency regulations adopted by the department in order to
implement this part shall not be subject to the review and approval
of the Office of Administrative Law. These regulations shall become
effective immediately upon filing with the Secretary of State.
16817. Notwithstanding any other provision of law, a county may
enter into contracts with selected providers to provide health care
services in expending funds provided pursuant to this part and Part 5
(commencing with Section 17000). The county may negotiate such
reimbursement or payment arrangements it desires in such contracts. A
county shall not be obligated to pay for health care services unless
pursuant to a contract or the county has specifically authorized
such services and agreed to payment. All such contracts shall be
available for review by the department. A county may require county
residents specified in this part and Part 5 to use county facilities
or county selected providers. This section may not be construed to
limit a county's existing obligations to furnish health care. Any
county may also elect to act jointly on a regional basis with other
counties in assuming the program responsibilities.
16818. (a) Each facility treating persons pursuant to Section 17000
shall provide, at the time treatment is sought, individual notice of
the availability of reduced cost health care. In addition,
conspicuous posted notices of the procedures for applying for reduced
cost health care shall be displayed in all emergency rooms and
patient waiting rooms of each facility treating persons pursuant to
Section 17000.
(b) This section is declaratory of existing law and shall not be
interpreted to constitute a new mandate.
