Section 1810.430 - Contracting for Psychiatric Inpatient Hospital Service Availability(a) An MHP shall contract with DSH and Traditional Hospitals when: (1) The DSH or Traditional Hospital meets the hospital selection criteria described in the MHP's Implementation Plan as required by Section 1810.310(a)(4).(2) The DSH is located: (A) In the same county as the MHP, or(B) In a different county than the MHP and according to the latest historical Medi-Cal paid claims data, the DSH provides services to beneficiaries of the MHP that account for five percent or twenty thousand dollars, whichever is more, of the total fiscal year Fee-For-Service/Medi-Cal psychiatric inpatient hospital service payments for beneficiaries of the MHP.(b) Prior to the beginning of each State fiscal year, the Department shall notify all MHPs of the DSH and Traditional Hospitals for that fiscal year.(c)(1) If an MHP determines not to contract with a DSH or Traditional Hospital, it shall submit a Request for Exemption from Contracting to the Department with its Implementation Plan. The MHP shall submit Requests for Exemption initiated after the submission of the Implementation Plan to the Department as a separate submission. The Request for Exemption from Contracting shall address the projected effect on beneficiaries. At a minimum, the Request for Exemption from Contracting shall include: (A) The name of the hospital for which the Request for Exemption from Contracting is requested.(B) An analysis of the most recently available data from the Office of Statewide Health Planning and Development (OSHPD) on the availability, within an accessible geographic area, of hospital beds for psychiatric inpatient hospital services with and without a contract. Other data may be substituted if OSHPD data are not available or if equally reliable data are more comprehensive.(C) The estimated impact on maximum and average travel time and distances for beneficiaries to obtain psychiatric inpatient hospital services, from hospitals either with or without a contract.(2) An MHP shall notify the DSH or Traditional Hospital of the Request for Exemption from Contracting at the same time that the Request for Exemption is sent to the Department.(3) The Department shall approve or deny in writing the MHP's Request for Exemption from Contracting within 30 calendar days of its receipt and shall notify both the MHP and the DSH or Traditional Hospital of its decision. The Department shall deny any Request for Exemption from Contracting when failure to contract is likely to result in hardship to beneficiaries as measured by local community standards.(d) At a minimum, a contract between an MHP and a provider of psychiatric inpatient hospital services shall meet federal contracting requirements as provided in Title 42, Code of Federal Regulations, Section 438.6 (l), and shall include the following provisions:(1) Treatment requirements, as a condition for reimbursement for psychiatric inpatient hospital services, that ensure beneficiaries will receive the same level of services as provided to all other patients served.(2) Assurances that beneficiaries will not be discriminated against in any manner, including admission practices, placement in special wings or rooms, or provision of special or separate meals.(3) Specifics of how the hospital shall make records available for authorized review for fiscal audits, program compliance and beneficiary complaints.(4) Language specifying that the per diem rate included in the contract is considered to be payment in full, subject to third party liability and patient share of costs, for psychiatric inpatient hospital services to a beneficiary.(5) Language specifying that the rate structure in the contract includes all services defined as psychiatric inpatient hospital services in this Chapter and that the rate structure does not include psychiatric inpatient hospital professional services rendered to a beneficiary covered under the contract unless the hospital is a Short-Doyle/Medi-Cal Hospital.(6) Requirements that a hospital adheres to Title XIX of the Social Security Act and conforms to federal and State statutes and regulations.(7) If the contract is in excess of $10,000 and utilizes State funds, a provision that: "The contracting parties shall be subject to the examination and audit of the Auditor General for a period of three years after the final payment under contract (Government Code section 8546.7)." The MHP shall also be subject to the examination and audit of the State Auditor General for a period of three years after final payment under contract (Government Code section 8546.7).(e) For providers of Psychiatric Inpatient Hospital services that conduct utilization management activities, the MHP must ensure that the compensation arrangements in the contract are not structured so as to provide incentives for the provider of Psychiatric Inpatient Hospital services to deny, limit, or discontinue medically necessary services to any beneficiary.(f) Written policies that address a beneficiary's rights as required by title 42 CFR section 438.100 shall be included in the contracts.(g) No provision of a contract shall be construed to replace or conflict with the duties of county patients' rights advocates described in Section 5520 of the Welfare and Institutions Code.(h) A formal contract between an MHP and a hospital is not required when the MHP owns or operates the hospital.Cal. Code Regs. Tit. 9, § 1810.430
1. New section filed 10-31-97 as an emergency; operative 11-1-97 (Register 97, No. 44). A Certificate of Compliance must be transmitted to OAL by 3-2-98 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 3-2-98 as an emergency; operative 3-2-98 (Register 98, No. 10). A Certificate of Compliance must be transmitted to OAL by 6-30-98 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 6-17-98 as an emergency; operative 6-30-98 (Register 98, No. 25). Pursuant to Chapter 324 (Statutes of 1998) Item 4440-103-0001(4), a Certificate of Compliance must be transmitted to OAL by 7-1-99 or emergency language will be repealed by operation of law on the following day.
4. Editorial correction of HISTORY 3 (Register 98, No. 39).
5. Editorial correction extending Certificate of Compliance date to 7-1-2001 pursuant to Chapter 50 (Statutes of 1999) Item 4440-103-0001(4) (Register 99, No. 33). Notwithstanding any other provision of law, emergency regulations adopted pursuant to Welfare and Institutions Code section 14680 to implement the second phase of mental health managed care as provided in this part shall remain in effect until permanent regulations are adopted, or June 30, 2006, whichever occurs first.
6. Editorial correction of HISTORY 5 (Register 2000, No. 42).
7. Editorial correction of HISTORY 5 and repealer and new section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).
8. New subsections (d)(7)-(f), subsection relettering and amendment of NOTE filed 10-18-2010; operative 11-17-2010 (Register 2010, No. 43). Note: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Section 8546.7, Government Code; Sections 5777, 5778 and 14684, Welfare and Institutions Code; and Title 42, Code of Federal Regulations, Sections 438.6 and 438.100.
1. New section filed 10-31-97 as an emergency; operative 11-1-97 (Register 97, No. 44). A Certificate of Compliance must be transmitted to OAL by 3-2-98 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 3-2-98 as an emergency; operative 3-2-98 (Register 98, No. 10). A Certificate of Compliance must be transmitted to OAL by 6-30-98 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 6-17-98 as an emergency; operative 6-30-98 (Register 98, No. 25). Pursuant to Chapter 324 (Statutes of 1998) Item 4440-103-0001(4), a Certificate of Compliance must be transmitted to OAL by 7-1-99 or emergency language will be repealed by operation of law on the following day.
4. Editorial correction of History 3 (Register 98, No. 39).
5. Editorial correction extending Certificate of Compliance date to 7-1-2001 pursuant to Chapter 50 (Statutes of 1999) Item 4440-103-0001(4) (Register 99, No. 33). Notwithstanding any other provision of law, emergency regulations adopted pursuant to Welfare and Institutions Code section 14680 to implement the second phase of mental health managed care as provided in this part shall remain in effect until permanent regulations are adopted, or June 30, 2006, whichever occurs first.
6. Editorial correction of History 5 (Register 2000, No. 42).
7. Editorial correction of History 5 and repealer and new section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).
8. New subsections (d)(7)-(f), subsection relettering and amendment of Note filed 10-18-2010; operative 11-17-2010 (Register 2010, No. 43).