Current through the 2021 Legislative Session
(a) The department shall approve any CEED project that meets both of the following requirements and any additional requirements imposed by the terms and conditions of the demonstration project: (1) Is proposed by an eligible entity that voluntarily agrees to commit, on an annual basis, to provide the nonfederal share of CEED project expenditures for services to individuals who meet the income eligibility standards specified for the CEED project.(2) Includes the CEED project elements set forth in subdivision (b).(b) An approved CEED project shall include all of the following elements, subject to the terms and conditions of the demonstration project:(1) Development of standardized eligibility and enrollment procedures that interface with Medi-Cal processes according to the milestones developed in consultation with the counties, county health departments, public hospitals, and county human service departments. CEED projects shall migrate to the standardized procedures in accordance with the terms and conditions of the demonstration project. If authorized under the terms and conditions of the demonstration project, eligibility for CEED benefits may be provided retroactively for any of the three months prior to the enrollment date in which the individual would have been found eligible had he or she applied during that month. If an individual is determined to be retroactively eligible, CEED project coverage for the retroactive period shall be limited to those services provided within the approved CEED project network.(2)(A) Assignment of eligible individuals to a medical home. For purposes of this paragraph and subject to the terms and conditions of the demonstration project, "medical home" means a single provider, facility, or health care team that maintains an individual's medical information, and coordinates health care services for enrolled individuals. The medical home shall provide, at a minimum, all of the following elements, which shall be considered in the provider contracting process: (i) A primary health care contact who facilitates the enrollee's access to preventive, primary, specialty, mental health, or chronic illness treatment, as appropriate.(ii) An intake assessment of each new enrollee's general health status.(iii) Referrals to qualified professionals, community resources, or other agencies as needed.(iv) Care coordination for the beneficiary across the service delivery system, as agreed to between the medical home and the CEED project. This may include facilitating communication among enrollee's health care providers, including appropriate outreach to mental health providers.(v) Care management, case management, and transitions among levels of care, if needed and as agreed to between the medical home and the CEED project.(vi) Use of clinical guidelines and other evidence-based medicine when applicable for treatment of the enrollee's health care issues and timing of clinical preventive services.(vii) Focus on continuous improvement in quality of care.(viii) Timely access to qualified health care interpretation as needed and as appropriate for enrollees with limited English proficiency, as determined by applicable federal guidelines.(ix) Health information, education, and support to beneficiaries and, where appropriate, their families, if and when needed, in a culturally competent manner.(B) In implementing this section, and the terms and conditions of the demonstration project, the department may alter the medical home elements described in this paragraph as necessary to secure the increased federal financial participation associated with the provision of medical assistance in conjunction with a health home, as made available under the federal Patient Protection and Affordable Care Act ( P.L. 111-148 ), as amended by the federal Health Care and Education Reconciliation Act of 2010 ( P.L. 111-152 ), and codified in Section 1945 of Title XIX of the federal Social Security Act.(3) A scheduled package of services required under the terms and conditions of the demonstration project that shall be limited to those services provided within an approved CEED project's provider network and service delivery system.(4) A provider network and service delivery system that seeks to promote the viability of the existing safety net health care system that serves the population to be covered by the CEED project. The provider network and service delivery system shall meet the standards established in the terms and conditions of the demonstration project.(5) Development of an outreach and enrollment plan that reaches potential project enrollees and begins to prepare to transition eligible individuals to Medi-Cal coverage in 2014, or alternatively, to coverage through the California Health Benefit Exchange.(6) A quality measurement and quality monitoring system.(7) Data tracking systems to provide the department with required data for quality monitoring, quality improvement, and evaluation.(8) Demonstration of how the CEED project will provide consumer assistance to individuals applying for, participating in, or accessing, services in the CEED projects, including the availability of materials that provide information on all of the following: (A) The scope of covered services.(B) The exceptions, reductions, and limitations that apply to covered services.(C) Any premium, copayment, or deductible requirements that may be incurred by the enrollee.(D) The participating providers in the CEED project network.(E) The medical homes within the CEED project network from which the enrollee may select.(F) The CEED project's telephone number or numbers that may be used by an enrollee to receive additional information about the covered services or participating providers.(9) Ability to meet program requirements, standards, and performance measurements developed by the department, in consultation with participating counties, for the CEED projects.
Ca. Welf. and Inst. Code § 15910.2Amended by Stats 2011 ch 296 (AB 1023),s 338, eff. 1/1/2012.Amended by Stats 2011 ch 86 (AB 1066),s 28, eff. 7/13/2011.Added by Stats 2010 ch 723 (AB 342),s 2, eff. 10/19/2010.