AB 2331: Medi-Cal: redetermination: developmental disability.
- Session Year: 2017-2018
- House: Assembly
- Latest Version Date: 2018-04-30
Existing law, the Lanterman Developmental Disabilities Services Act, requires the State Department of Developmental Services (department) to contract with regional centers to provide services and supports to individuals with developmental disabilities, or consumers, as defined, and their families. Existing law requires an individual to disclose to a regional center during an assessment whether he or she is eligible to receive health benefits, including under Medi-Cal. Existing law requires the department to maintain the confidentiality of information and records obtained in the course of providing intake, assessment, and services, as specified.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services (DHCS) and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law generally requires a county to redetermine a Medi-Cal beneficiarys eligibility to receive Medi-Cal benefits every 12 months and whenever the county receives information about changes in a beneficiarys circumstances that may affect his or her eligibility for Medi-Cal benefits.
This bill would instead require a consumer of services provided by a regional center to disclose during the initial intake whether he or she is enrolled in the Medi-Cal program. The bill would authorize the department to disclose to the county or DHCS information for the purposes of enabling the county or DHCS to perform determinations or redeterminations of eligibility for Medi-Cal beneficiaries.
This bill would require a county to perform the annual eligibility redetermination of a regional center consumer with information provided by the department, and that the county acquired during the last 36 months that is relevant to the beneficiarys Medi-Cal eligibility, and would authorize continued eligibility, until the county makes a specific determination based on facts clearly demonstrating that the beneficiary is no longer eligible for Medi-Cal benefits, as specified. The bill would require the department to make available to the counties and DHCS, on a regular basis to be determined by DHCS, a list identifying consumers receiving services at regional centers.
The bill would require the implementation of these provisions only if and to the extent that federal financial participation is available and any necessary federal approvals or waivers have been obtained. Because the bill would require counties to perform additional duties regarding Medi-Cal eligibility determinations related to department consumers, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
Existing law, the Lanterman Developmental Disabilities Services Act, requires the State Department of Developmental Services (department) to contract with regional centers to provide services and supports to individuals with developmental disabilities, or consumers, as defined, and their families. Existing law requires an individual to disclose to a regional center during an assessment whether he or she is eligible to receive health benefits, including under Medi-Cal. Existing law requires the department to maintain the confidentiality of information and records obtained in the course of providing intake, assessment, and services, as specified.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services (DHCS) and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law generally requires a county to redetermine a Medi-Cal beneficiarys eligibility to receive Medi-Cal benefits every 12 months and whenever the county receives information about changes in a beneficiarys circumstances that may affect his or her eligibility for Medi-Cal benefits.
This bill would instead require a consumer of services provided by a regional center to disclose during the initial intake whether he or she is enrolled in the Medi-Cal program. The bill would authorize the department to disclose to the county or DHCS information for the purposes of enabling the county or DHCS to perform determinations or redeterminations of eligibility for Medi-Cal beneficiaries.
This bill would require a county to perform a the annual eligibility redetermination only every 36 months for a Medi-Cal beneficiary who has a developmental disability and who is determined to be eligible for services by a regional center. of a regional center consumer with information provided by the department, and authorize continued eligibility, until the county makes a specific determination based on facts clearly demonstrating that the beneficiary is no longer eligible for Medi-Cal benefits, as specified. The bill would require the State Department of Developmental Services department to make available to the State Department of Health Care Services an updated list of individuals who meet this condition. The bill would require the State Department of Health Care Services to utilize the list, or any other information available to the department, as specified, in order to verify, every 12 months, the continued eligibility of the beneficiary due to a determination of eligibility for regional center services, until the county is required to perform a redetermination. counties and DHCS, on a regular basis to be determined by DHCS, a list identifying consumers receiving services at regional centers.
The bill would require the implementation of these provisions only if and to the extent that federal financial participation is available and any necessary federal approvals or waivers have been obtained. Because the bill would require counties to perform additional duties regarding Medi-Cal eligibility determinations related to department consumers, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law generally requires a county to redetermine a Medi-Cal beneficiarys eligibility to receive Medi-Cal benefits every 12 months and whenever the county receives information about changes in a beneficiarys circumstances that may affect his or her eligibility for Medi-Cal benefits.
Existing law, the Lanterman Developmental Disabilities Services Act, requires the State Department of Developmental Services to contract with regional centers to provide services and supports to individuals with developmental disabilities, as defined, and their families.
This bill would instead require a county to perform a redetermination only every 36 months for a Medi-Cal beneficiary who has a developmental disability and who is determined to be eligible for services by a regional center. The bill would require the State Department of Developmental Services to make available to the State Department of Health Care Services an updated list of individuals who meet this condition. The bill would require the State Department of Health Care Services to utilize the list, or any other information available to the department, as specified, in order to verify, every 12 months, the continued eligibility of the beneficiary due to a determination of eligibility for regional center services, until the county is required to perform a redetermination.
The bill would require the implementation of these provisions only if and to the extent that federal financial participation is available and any necessary federal approvals or waivers have been obtained.
All information and records obtained in the course of providing intake, assessment, and services under Division 4.1 (commencing with Section 4400), Division 4.5 (commencing with Section 4500), Division 6 (commencing with Section 6000), or Division 7 (commencing with Section 7100) to persons with developmental disabilities shall be confidential. Information and records obtained in the course of providing similar services to either voluntary or involuntary recipients prior to 1969 shall also be confidential. Information and records shall be disclosed only in any of the following cases:
(a)In communications between qualified professional persons, whether employed by a regional center or state developmental center, or not, in the provision of intake, assessment, and services or appropriate referrals. The consent of the person with a developmental disability, or his or her guardian or conservator, shall be obtained before information or records may be disclosed by regional center or state developmental center personnel to a professional not employed by the regional center or state developmental center, or a program not vendored by a regional center or state developmental center.
(b)When the person with a developmental disability, who has the capacity to give informed consent, designates individuals to whom information or records may be released, except that this chapter shall not be construed to compel a physician and surgeon, psychologist, social worker, marriage and family therapist, professional clinical counselor, nurse, attorney, or other professional to reveal information that has been given to him or her in confidence by a family member of the person unless a valid release has been executed by that family member.
(c)To the extent necessary for a claim, or for a claim or application to be made on behalf of a person with a developmental disability for aid, insurance, government benefit, or medical assistance to which he or she may be entitled.
(d)If the person with a developmental disability is a minor, dependent ward, or conservatee, and his or her parent, guardian, conservator, limited conservator with access to confidential records, or authorized representative, designates, in writing, persons to whom records or information may be disclosed, except that this chapter shall not be construed to compel a physician and surgeon, psychologist, social worker, marriage and family therapist, professional clinical counselor, nurse, attorney, or other professional to reveal information that has been given to him or her in confidence by a family member of the person unless a valid release has been executed by that family member.
(e)For research, if the Director of Developmental Services designates by regulation rules for the conduct of research and requires the research to be first reviewed by the appropriate institutional review board or boards. These rules shall include, but need not be limited to, the requirement that all researchers shall sign an oath of confidentiality as follows:
Date |
As a condition of doing research concerning persons with developmental disabilities who have received services from ____ (fill in the facility, agency or person), I, ____, agree to obtain the prior informed consent of persons who have received services to the maximum degree possible as determined by the appropriate institutional review board or boards for protection of human subjects reviewing my research, or the persons parent, guardian, or conservator, and I further agree not to divulge any information obtained in the course of the research to unauthorized persons, and not to publish or otherwise make public any information regarding persons who have received services so those persons who received services are identifiable.
I recognize that the unauthorized release of confidential information may make me subject to a civil action under provisions of the Welfare and Institutions Code.
Signed |
(f)To the courts, as necessary to the administration of justice.
(g)To governmental law enforcement agencies as needed for the protection of federal and state elective constitutional officers and their families.
(h)To the Senate Committee on Rules or the Assembly Committee on Rules for the purposes of legislative investigation authorized by the committee.
(i)To the courts and designated parties as part of a regional center report or assessment in compliance with a statutory or regulatory requirement, including, but not limited to, Section 1827.5 of the Probate Code, Sections 1001.22 and 1370.1 of the Penal Code, and Section 6502 of this code.
(j)To the attorney for the person with a developmental disability in any and all proceedings upon presentation of a release of information signed by the person, except that when the person lacks the capacity to give informed consent, the regional center or state developmental center director or designee, upon satisfying himself or herself of the identity of the attorney, and of the fact that the attorney represents the person, shall release all information and records relating to the person except that this article shall not be construed to compel a physician and surgeon, psychologist, social worker, marriage and family therapist, professional clinical counselor, nurse, attorney, or other professional to reveal information that has been given to him or her in confidence by a family member of the person unless a valid release has been executed by that family member.
(k)Upon written consent by a person with a developmental disability previously or presently receiving services from a regional center or state developmental center, the director of the regional center or state developmental center, or his or her designee, may release any information, except information that has been given in confidence by members of the family of the person with developmental disabilities, requested by a probation officer charged with the evaluation of the person after his or her conviction of a crime if the regional center or state developmental center director or designee determines that the information is relevant to the evaluation. The consent shall only be operative until sentence is passed on the crime of which the person was convicted. The confidential information released pursuant to this subdivision shall be transmitted to the court separately from the probation report and shall not be placed in the probation report. The confidential information shall remain confidential except for purposes of sentencing. After sentencing, the confidential information shall be sealed.
(l)Between persons who are trained and qualified to serve on multidisciplinary personnel teams pursuant to subdivision (d) of Section 18951. The information and records sought to be disclosed shall be relevant to the prevention, identification, management, or treatment of an abused child and his or her parents pursuant to Chapter 11 (commencing with Section 18950) of Part 6 of Division 9.
(m)When a person with a developmental disability dies from any cause, natural or otherwise, while hospitalized in a state developmental center, the State Department of Developmental Services, the physician and surgeon in charge of the client, or the professional in charge of the facility or his or her designee, shall release the patients medical record to a medical examiner, forensic pathologist, or coroner, upon request. Except for the purposes included in paragraph (8) of subdivision (b) of Section 56.10 of the Civil Code, a medical examiner, forensic pathologist, or coroner shall not disclose any information contained in the medical record obtained pursuant to this subdivision without a court order or authorization pursuant to paragraph (4) of subdivision (c) of Section 56.11 of the Civil Code.
(n)To authorized licensing personnel who are employed by, or who are authorized representatives of, the State Department of Public Health, and who are licensed or registered health professionals, and to authorized legal staff or special investigators who are peace officers who are employed by, or who are authorized representatives of, the State Department of Social Services, as necessary to the performance of their duties to inspect, license, and investigate health facilities and community care facilities, and to ensure that the standards of care and services provided in these facilities are adequate and appropriate and to ascertain compliance with the rules and regulations to which the facility is subject. The confidential information shall remain confidential except for purposes of inspection, licensing, or investigation pursuant to Chapter 2 (commencing with Section 1250) and Chapter 3 (commencing with Section 1500) of Division 2 of the Health and Safety Code, or a criminal, civil, or administrative proceeding in relation thereto. The confidential information may be used by the State Department of Public Health or the State Department of Social Services in a criminal, civil, or administrative proceeding. The confidential information shall be available only to the judge or hearing officer and to the parties to the case. Names that are confidential shall be listed in attachments separate to the general pleadings. The confidential information shall be sealed after the conclusion of the criminal, civil, or administrative hearings, and shall not subsequently be released except in accordance with this subdivision. If the confidential information does not result in a criminal, civil, or administrative proceeding, it shall be sealed after the State Department of Public Health or the State Department of Social Services decides that no further action will be taken in the matter of suspected licensing violations. Except as otherwise provided in this subdivision, confidential information in the possession of the State Department of Public Health or the State Department of Social Services shall not contain the name of the person with a developmental disability.
(o)To any board that licenses and certifies professionals in the fields of mental health and developmental disabilities pursuant to state law, when the Director of Developmental Services has reasonable cause to believe that there has occurred a violation of any provision of law subject to the jurisdiction of a board and the records are relevant to the violation. The information shall be sealed after a decision is reached in the matter of the suspected violation, and shall not subsequently be released except in accordance with this subdivision. Confidential information in the possession of the board shall not contain the name of the person with a developmental disability.
(p)(1)To governmental law enforcement agencies by the director of a regional center or state developmental center, or his or her designee, when (1) the person with a developmental disability has been reported lost or missing or (2) there is probable cause to believe that a person with a developmental disability has committed, or has been the victim of, murder, manslaughter, mayhem, aggravated mayhem, kidnapping, robbery, carjacking, assault with the intent to commit a felony, arson, extortion, rape, forcible sodomy, forcible oral copulation, assault or battery, or unlawful possession of a weapon, as provided in any provision listed in Section 16590 of the Penal Code.
(2)This subdivision shall be limited solely to information directly relating to the factual circumstances of the commission of the enumerated offenses and shall not include any information relating to the mental state of the patient or the circumstances of his or her treatment unless relevant to the crime involved.
(3)This subdivision shall not be construed as an exception to, or in any other way affecting, the provisions of Article 7 (commencing with Section 1010) of Chapter 4 of Division 8 of the Evidence Code, or Chapter 11 (commencing with Section 15600) and Chapter 13 (commencing with Section 15750) of Part 3 of Division 9.
(q)To the Division of Juvenile Facilities and Department of Corrections and Rehabilitation or any component thereof, as necessary to the administration of justice.
(r)To an agency mandated to investigate a report of abuse filed pursuant to either Section 11164 of the Penal Code or Section 15630 of this code for the purposes of either a mandated or voluntary report or when those agencies request information in the course of conducting their investigation.
(s)When a person with developmental disabilities, or the parent, guardian, or conservator of a person with developmental disabilities who lacks capacity to consent, fails to grant or deny a request by a regional center or state developmental center to release information or records relating to the person with developmental disabilities within a reasonable period of time, the director of the regional or developmental center, or his or her designee, may release information or records on behalf of that person provided both of the following conditions are met:
(1)Release of the information or records is deemed necessary to protect the persons health, safety, or welfare.
(2)The person, or the persons parent, guardian, or conservator, has been advised annually in writing of the policy of the regional center or state developmental center for release of confidential client information or records when the person with developmental disabilities, or the persons parent, guardian, or conservator, fails to respond to a request for release of the information or records within a reasonable period of time. A statement of policy contained in the clients individual program plan shall be deemed to comply with the notice requirement of this paragraph.
(t)(1)When an employee is served with a notice of adverse action, as defined in Section 19570 of the Government Code, the following information and records may be released:
(A)All information and records that the appointing authority relied upon in issuing the notice of adverse action.
(B)All other information and records that are relevant to the adverse action, or that would constitute relevant evidence as defined in Section 210 of the Evidence Code.
(C)The information described in subparagraphs (A) and (B) may be released only if both of the following conditions are met:
(i)The appointing authority has provided written notice to the consumer and the consumers legal representative or, if the consumer has no legal representative or if the legal representative is a state agency, to the clients rights advocate, and the consumer, the consumers legal representative, or the clients rights advocate has not objected in writing to the appointing authority within five business days of receipt of the notice, or the appointing authority, upon review of the objection has determined that the circumstances on which the adverse action is based are egregious or threaten the health, safety, or life of the consumer or other consumers and without the information the adverse action could not be taken.
(ii)The appointing authority, the person against whom the adverse action has been taken, and the persons representative, if any, have entered into a stipulation that does all of the following:
(I)Prohibits the parties from disclosing or using the information or records for any purpose other than the proceedings for which the information or records were requested or provided.
(II)Requires the employee and the employees legal representative to return to the appointing authority all records provided to them under this subdivision, including, but not limited to, all records and documents or copies thereof that are no longer in the possession of the employee or the employees legal representative because they were from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final except for the actual records and documents submitted to the administrative tribunal as a component of an appeal from the adverse action.
(III)Requires the parties to submit the stipulation to the administrative tribunal with jurisdiction over the adverse action at the earliest possible opportunity.
(2)For the purposes of this subdivision, the State Personnel Board may, prior to any appeal from adverse action being filed with it, issue a protective order, upon application by the appointing authority, for the limited purpose of prohibiting the parties from disclosing or using information or records for any purpose other than the proceeding for which the information or records were requested or provided, and to require the employee or the employees legal representative to return to the appointing authority all records provided to them under this subdivision, including, but not limited to, all records and documents from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final, except for the actual records and documents that are no longer in the possession of the employee or the employees legal representatives because they were submitted to the administrative tribunal as a component of an appeal from the adverse action.
(3)Individual identifiers, including, but not limited to, names, social security numbers, and hospital numbers, that are not necessary for the prosecution or defense of the adverse action, shall not be disclosed.
(4)All records, documents, or other materials containing confidential information protected by this section that have been submitted or otherwise disclosed to the administrative agency or other person as a component of an appeal from an adverse action shall, upon proper motion by the appointing authority to the administrative tribunal, be placed under administrative seal and shall not, thereafter, be subject to disclosure to any person or entity except upon the issuance of an order of a court of competent jurisdiction.
(5)For purposes of this subdivision, an adverse action becomes final when the employee fails to answer within the time specified in Section 19575 of the Government Code, or, after filing an answer, withdraws the appeal, or, upon exhaustion of the administrative appeal or of the judicial review remedies as otherwise provided by law.
(u)To the person appointed as the developmental services decisionmaker for a minor, dependent, or ward pursuant to Section 319, 361, or 726.
(v)To a protection and advocacy agency established pursuant to Section 4901, to the extent that the information is incorporated within any of the following:
(1)An unredacted facility evaluation report form or an unredacted complaint investigation report form of the State Department of Social Services. This information shall remain confidential and subject to the confidentiality requirements of subdivision (f) of Section 4903.
(2)An unredacted citation report, unredacted licensing report, unredacted survey report, unredacted plan of correction, or unredacted statement of deficiency of the State Department of Public Health, prepared by authorized licensing personnel or authorized representatives described in subdivision (n). This information shall remain confidential and subject to the confidentiality requirements of subdivision (f) of Section 4903.
(w)When a comprehensive assessment is conducted or updated pursuant to Section 4418.25, 4418.7, or 4648, a regional center is authorized to provide the assessment to the regional center clients rights advocate, who provides service pursuant to Section 4433.
(x)For purposes of this section, a reference to a medical examiner, forensic pathologist, or coroner means a coroner or deputy coroner, as described in subdivision (c) of Section 830.35 of the Penal Code, or a licensed physician who currently performs official autopsies on behalf of a county coroners office or a medical examiners office, whether as a government employee or under contract to that office.
(y)To authorized personnel who are employed by the Employment Development Department as necessary to enable the Employment Development Department to provide the information required to be disclosed to the State Department of Developmental Services pursuant to subdivision (ak) of Section 1095 of the Unemployment Insurance Code. The Employment Development Department shall maintain the confidentiality of any information provided to it by the Department of Developmental Services to the same extent as if the Employment Development Department had acquired the information directly.
(z)To authorized personnel who are employed by either a county or the State Department of Health Care Services as necessary to enable the county or the State Department of Health Care Services to perform determinations or redeterminations of eligibility for Medi-Cal beneficiaries pursuant to Section 14005.30 or 14005.37. The State Department of Health Care Services shall maintain the confidentiality of any information provided to it by the State Department of Developmental Services in accordance with Section 14100.2.
SEC. 2.Section 4642 of the Welfare and Institutions Code is amended to read:4642.(a)(1)Any person believed to have a developmental disability, and any person believed to have a high risk of parenting a developmentally disabled infant shall be eligible for initial intake and assessment services in the regional centers. In addition, any infant having a high risk of becoming developmentally disabled may be eligible for initial intake and assessment services in the regional centers. For purposes of this section, high-risk infant means a child less than 36 months of age whose genetic, medical, or environmental history is predictive of a substantially greater risk for developmental disability than that for the general population. The department, in consultation with the State Department of Public Health, shall develop specific risk and service criteria for the high-risk infant program on or before July 1, 1983. These criteria may be modified in subsequent years based on analysis of actual clinical experience.
(2)Initial intake shall be performed within 15 working days following request for assistance. Initial intake shall include, but need not be limited to, information and advice about the nature and availability of services provided by the regional center and by other agencies in the community, including guardianship, conservatorship, income maintenance, mental health, housing, education, work activity and vocational training, medical, dental, recreational, and other services or programs that may be useful to persons with developmental disabilities or their families. Intake shall also include a decision to provide assessment.
(b)(1)At the time of intake, the individual, or, where appropriate, the parents, legal guardian, or conservator, shall disclose whether he or she is enrolled in Medi-Cal and provide a copy of any health benefit card under which the consumer is eligible to receive Medi-Cal benefits.
(2)Information related to a consumers eligibility for Medi-Cal shall be released by the regional center or the department to the county or the State Department of Health Care Services for the purposes of enabling the county to perform determinations or redeterminations of eligibility for Medi-Cal beneficiaries pursuant to Section 14005.30 or 14005.37.
(c)A regional center shall communicate with the consumer and his or her family pursuant to this section in their native language, including providing alternative communication services, as required by Sections 11135 to 11139.7, inclusive, of the Government Code and implementing regulations.
SEC. 3.Section 14005.37 of the Welfare and Institutions Code is amended to read:14005.37.(a)Except as provided in Section 14005.39, a county shall perform redeterminations of eligibility for Medi-Cal beneficiaries every 12 months and shall promptly redetermine eligibility whenever the county receives information about changes in a beneficiarys circumstances that may affect eligibility for Medi-Cal benefits. The procedures for redetermining Medi-Cal eligibility described in this section shall apply to all Medi-Cal beneficiaries.
(b) Loss of eligibility for cash aid under the CalWORKs program shall not result in a redetermination under this section unless the reason for the loss of eligibility is one that would result in the need for a redetermination for a person whose eligibility for Medi-Cal under Section 14005.30 was determined without a concurrent determination of eligibility for cash aid under the CalWORKs program.
(c)A loss of contact, as evidenced by the return of mail marked in such a way as to indicate that it could not be delivered to the intended recipient or that there was no forwarding address, shall require a prompt redetermination according to the procedures set forth in this section.
(d)Except as otherwise provided in this section, Medi-Cal eligibility shall continue during the redetermination process described in this section and a beneficiarys Medi-Cal eligibility shall not be terminated under this section until the county makes a specific determination based on facts clearly demonstrating that the beneficiary is no longer eligible for Medi-Cal benefits under any basis and due process rights guaranteed under this division have been met. For the purposes of this subdivision, for a beneficiary who is subject to the use of MAGI-based financial methods, the determination of whether the beneficiary is eligible for Medi-Cal benefits under any basis shall include, but is not limited to, a determination of eligibility for Medi-Cal benefits on a basis that is exempt from the use of MAGI-based financial methods only if either of the following occurs:
(A)The county assesses the beneficiary as being potentially eligible under a program that is exempt from the use of MAGI-based financial methods, including, but not limited to, on the basis of age, blindness, disability, or the need for long-term care services and supports.
(B)The beneficiary requests that the county determine whether he or she is eligible for Medi-Cal benefits on a basis that is exempt from the use of MAGI-based financial methods.
(e)(1)For purposes of acquiring information necessary to conduct the eligibility redeterminations described in this section, a county shall gather information available to the county that is relevant to the beneficiarys Medi-Cal eligibility prior to contacting the beneficiary. Sources for these efforts shall include information contained in the beneficiarys file or other information, including more recent information available to the county, including, but not limited to, Medi-Cal, CalWORKs, and CalFresh case files of the beneficiary or of any of his or her immediate family members, which are open, or were closed within the last 90 days, information received under subdivision (z) of Section 4514 within the last 36 months, information accessed through any databases accessed under Sections 435.948, 435.949, and 435.956 of Title 42 of the Code of Federal Regulations, and and, wherever feasible, other sources of relevant information reasonably available to the county or to the county via the department.
(2)In the case of an annual redetermination, if, based upon information obtained pursuant to paragraph (1), the county is able to make a determination of continued eligibility, the county shall notify the beneficiary of both of the following:
(A)The eligibility determination and the information it is based on.
(B)That the beneficiary is required to inform the county via the Internet, by telephone, by mail, in person, or through other commonly available electronic means, in counties where that electronic communication is available, if any information contained in the notice is inaccurate but that the beneficiary is not required to sign and return the notice if all information provided on the notice is accurate.
(3)The county shall make all reasonable efforts not to send multiple notices during the same time period about eligibility. The notice of eligibility renewal shall contain other related information such as if the beneficiary is in a new Medi-Cal program.
(4)In the case of a redetermination due to a change in circumstances, if a county determines that the change in circumstances does not affect the beneficiarys eligibility status, the county shall not send the beneficiary a notice unless required to do so by federal law.
(f)(1)Except as provided in subdivision (g), in the case of an annual eligibility redetermination, if the county is unable to determine continued eligibility based on the information obtained pursuant to paragraph (1) of subdivision (e), the beneficiary shall be so informed and shall be provided with an annual renewal form, at least 60 days before the beneficiarys annual redetermination date, that is prepopulated with information that the county has obtained and that identifies any additional information needed by the county to determine eligibility. The form shall include all of the following:
(A)The requirement that he or she provide any necessary information to the county within 60 days of the date that the form is sent to the beneficiary.
(B)That the beneficiary may respond to the county via the Internet, by mail, by telephone, in person, or through other commonly available electronic means if those means are available in that county.
(C)That if the beneficiary chooses to return the form to the county in person or via mail, the beneficiary shall sign the form in order for it to be considered complete.
(D)The telephone number to call in order to obtain more information.
(2)The county shall attempt to contact the beneficiary via the Internet, by telephone, or through other commonly available electronic means, if those means are available in that county, during the 60-day period after the prepopulated form is mailed to the beneficiary to collect the necessary information if the beneficiary has not responded to the request for additional information or has provided an incomplete response.
(3)If the beneficiary has not provided any response to the written request for information sent pursuant to paragraph (1) within 60 days from the date the form is sent, the county shall terminate his or her eligibility for Medi-Cal benefits following the provision of timely notice.
(4)If the beneficiary responds to the written request for information during the 60-day period pursuant to paragraph (1) but the information provided is not complete, the county shall follow the procedures set forth in paragraph (3) of subdivision (h) to work with the beneficiary to complete the information.
(5)(A)The form required by this subdivision shall be developed by the department in consultation with the counties and representatives of eligibility workers and consumers.
(B)For beneficiaries whose eligibility is not determined using MAGI-based financial methods, the county may use existing renewal forms until the state develops prepopulated renewal forms to provide to beneficiaries. The department shall develop prepopulated renewal forms for use with beneficiaries whose eligibility is not determined using MAGI-based financial methods by January 1, 2015.
(g)(1)In the case of an annual eligibility redetermination of a beneficiary who has a developmental disability, as defined in subdivision (a) of Section 4512, and who receives is determined to be eligible for services by a regional center pursuant to Chapter 5 (commencing with Section 4620) of Division 4.5, the county shall gather information available to the county that utilize information that the county acquired during the last 36 months that is relevant to the beneficiarys Medi-Cal eligibility prior to contacting the beneficiary pursuant to subdivision (e). The county shall evaluate this information received in the last 36 months by the regional center from the consumer, as defined in subdivision (d) of Section 4512, to make a determination of continued eligibility without requesting additional information from the beneficiary. and consider the information as relevant for the purpose of the annual eligibility redetermination.
(2)In the case of an annual eligibility redetermination of a consumer, if the county is unable to determine continued eligibility based on the information obtained pursuant to paragraph (1) of subdivision (e) or paragraph (1) of this subdivision, the beneficiary shall be informed and shall be provided with an annual renewal form at least 60 days before the beneficiarys annual redetermination date that is prepopulated with information that the county has obtained and that identifies any additional information needed by the county to determine eligibility. The form shall include information set forth in paragraph (1) of subdivision (f).
(3)The State Department of Developmental Services shall disseminate to the counties and the State Department of Health Care Services, on a regular basis to be determined by the State Department of Health Care Services, a list identifying consumers receiving services at regional centers.
(4)The consumer shall maintain Medi-Cal eligibility during the redetermination process described in this section and Medi-Cal eligibility shall not be terminated under this section until the county makes a specific determination based on facts clearly demonstrating that the beneficiary is no longer eligible for Medi-Cal benefits under any basis and due process rights guaranteed under this division have been met.
(5)This subdivision shall be implemented only if if, and to the extent that that, federal financial participation is available available, and any necessary federal approvals have been obtained.
(h)(1)In the case of a redetermination due to change in circumstances, if a county cannot obtain sufficient information to redetermine eligibility pursuant to subdivision (e), the county shall send to the beneficiary a form that is prepopulated with the information that the county has obtained and that states the information needed to renew eligibility. The county shall only request information related to the change in circumstances. The county shall not request information or documentation that has been previously provided by the beneficiary, that is not absolutely necessary to complete the eligibility determination, or that is not subject to change. The county shall only request information for nonapplicants necessary to make an eligibility determination or for a purpose directly related to the administration of the state Medicaid plan. The form shall advise the individual to provide any necessary information to the county via the Internet, by telephone, by mail, in person, or through other commonly available electronic means and, if the individual will provide the form by mail or in person, to sign the form. The form shall include a telephone number to call in order to obtain more information. The form shall be developed by the department in consultation with the counties, representatives of consumers, and eligibility workers. A Medi-Cal beneficiary shall have 30 days from the date the form is mailed pursuant to this subdivision to respond. Except as provided in paragraph (2), failure to respond prior to the end of this 30-day period shall not impact his or her Medi-Cal eligibility.
(2)If the purpose for a redetermination under this section is a loss of contact with the Medi-Cal beneficiary, as evidenced by the return of mail marked in such a way as to indicate that it could not be delivered to the intended recipient or that there was no forwarding address, a return of the form described in this subdivision marked as undeliverable shall result in an immediate notice of action terminating Medi-Cal eligibility.
(3)During the 30-day period after the date of mailing of a form to the Medi-Cal beneficiary pursuant to this subdivision, the county shall attempt to contact the beneficiary by telephone, in writing, or other commonly available electronic means, in counties where that electronic communication is available, to request the necessary information if the beneficiary has not responded to the request for additional information or has provided an incomplete response. If the beneficiary does not supply the necessary information to the county within the 30-day limit, a 10-day notice of termination of Medi-Cal eligibility shall be sent.
(i)Beneficiaries shall be required to report any change in circumstances that may affect their eligibility within 10 calendar days following the date the change occurred.
(j)If within 90 days of termination of a Medi-Cal beneficiarys eligibility or a change in eligibility status pursuant to this section, the beneficiary submits to the county a signed and completed form or otherwise provides the needed information to the county, eligibility shall be redetermined by the county and if the beneficiary is found eligible, or the beneficiarys eligibility status has not changed, whichever applies, the termination shall be rescinded as though the form were submitted in a timely manner.
(k)If the information available to the county pursuant to the redetermination procedures of this section does not indicate a basis of eligibility, Medi-Cal benefits may be terminated so long as due process requirements have otherwise been met.
(l)The department shall, with the counties and representatives of consumers, including those with disabilities, and Medi-Cal eligibility workers, develop a timeframe for redetermination of Medi-Cal eligibility based upon disability, including ex parte review, the redetermination forms described in subdivisions (f) and (h), timeframes for responding to county or state requests for additional information, and the forms and procedures to be used. The forms and procedures shall be as consumer-friendly as possible for people with disabilities. The timeframe shall provide a reasonable and adequate opportunity for the Medi-Cal beneficiary to obtain and submit medical records and other information needed to establish eligibility for Medi-Cal based upon disability.
(m)The county shall consider blindness as continuing until the reviewing physician determines that a beneficiarys vision has improved beyond the applicable definition of blindness contained in the plan.
(n)The county shall consider disability as continuing until the review team determines that a beneficiarys disability no longer meets the applicable definition of disability contained in the plan.
(o)In the case of a redetermination due to a change in circumstances, if a county determines that the beneficiary remains eligible for Medi-Cal benefits, the county shall begin a new 12-month eligibility period.
(p)For individuals determined ineligible for Medi-Cal by a county following the redetermination procedures set forth in this section, the county shall determine eligibility for other insurance affordability programs and if the individual is found to be eligible, the county shall, as appropriate, transfer the individuals electronic account to other insurance affordability programs via a secure electronic interface.
(q)Any renewal form or notice shall be accessible to persons who are limited-English proficient and persons with disabilities consistent with all federal and state requirements.
(r)The requirements to provide information in subdivisions (e) and (h), and to report changes in circumstances in subdivision (i), may be provided through any of the modes of submission allowed in Section 435.907(a) of Title 42 of the Code of Federal Regulations, including an Internet Web site identified by the department, telephone, mail, in person, and other commonly available electronic means as authorized by the department.
(s)Forms required to be signed by a beneficiary pursuant to this section shall be signed under penalty of perjury. Electronic signatures, telephonic signatures, and handwritten signatures transmitted by electronic transmission shall be accepted.
(t)For purposes of this section, MAGI-based financial methods means income calculated using the financial methodologies described in Section 1396a(e)(14) of Title 42 of the United States Code, and as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any subsequent amendments.
(u)When contacting a beneficiary under paragraphs (2) and (4) of subdivision (f), and paragraph (3) of subdivision (h), a county shall first attempt to use the method of contact identified by the beneficiary as the preferred method of contact, if a method has been identified.
(v)The department shall seek federal approval to extend the annual redetermination date under this section for a three-month period for those Medi-Cal beneficiaries whose annual redeterminations are scheduled to occur between January 1, 2014, and March 31, 2014.
(w)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, or make specific this section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted. The department shall adopt regulations by July 1, 2017, in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. Beginning six months after the effective date of this section, and notwithstanding Section 10231.5 of the Government Code, the department shall provide a status report to the Legislature on a semiannual basis, in compliance with Section 9795 of the Government Code, until regulations have been adopted.
(x)This section shall be implemented only if and to the extent that federal financial participation is available and any necessary federal approvals have been obtained.
(y)This section shall become operative on January 1, 2014.
SEC. 4.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
All information and records obtained in the course of providing intake, assessment, and services under Division 4.1 (commencing with Section 4400), Division 4.5 (commencing with Section 4500), Division 6 (commencing with Section 6000), or Division 7 (commencing with Section 7100) to persons with developmental disabilities shall be confidential. Information and records obtained in the course of providing similar services to either voluntary or involuntary recipients prior to 1969 shall also be confidential. Information and records shall be disclosed only in any of the following cases:
(a)In communications between qualified professional persons, whether employed by a regional center or state developmental center, or not, in the provision of intake, assessment, and services or appropriate referrals. The consent of the person with a developmental disability, or his or her guardian or conservator, shall be obtained before information or records may be disclosed by regional center or state developmental center personnel to a professional not employed by the regional center or state developmental center, or a program not vendored by a regional center or state developmental center.
(b)When the person with a developmental disability, who has the capacity to give informed consent, designates individuals to whom information or records may be released, except that this chapter shall not be construed to compel a physician and surgeon, psychologist, social worker, marriage and family therapist, professional clinical counselor, nurse, attorney, or other professional to reveal information that has been given to him or her in confidence by a family member of the person unless a valid release has been executed by that family member.
(c)To the extent necessary for a claim, or for a claim or application to be made on behalf of a person with a developmental disability for aid, insurance, government benefit, or medical assistance to which he or she may be entitled.
(d)If the person with a developmental disability is a minor, dependent ward, or conservatee, and his or her parent, guardian, conservator, limited conservator with access to confidential records, or authorized representative, designates, in writing, persons to whom records or information may be disclosed, except that this chapter shall not be construed to compel a physician and surgeon, psychologist, social worker, marriage and family therapist, professional clinical counselor, nurse, attorney, or other professional to reveal information that has been given to him or her in confidence by a family member of the person unless a valid release has been executed by that family member.
(e)For research, if the Director of Developmental Services designates by regulation rules for the conduct of research and requires the research to be first reviewed by the appropriate institutional review board or boards. These rules shall include, but need not be limited to, the requirement that all researchers shall sign an oath of confidentiality as follows:
Date |
As a condition of doing research concerning persons with developmental disabilities who have received services from ____ (fill in the facility, agency or person), I, ____, agree to obtain the prior informed consent of persons who have received services to the maximum degree possible as determined by the appropriate institutional review board or boards for protection of human subjects reviewing my research, or the persons parent, guardian, or conservator, and I further agree not to divulge any information obtained in the course of the research to unauthorized persons, and not to publish or otherwise make public any information regarding persons who have received services so those persons who received services are identifiable.
I recognize that the unauthorized release of confidential information may make me subject to a civil action under provisions of the Welfare and Institutions Code.
Signed |
(f)To the courts, as necessary to the administration of justice.
(g)To governmental law enforcement agencies as needed for the protection of federal and state elective constitutional officers and their families.
(h)To the Senate Committee on Rules or the Assembly Committee on Rules for the purposes of legislative investigation authorized by the committee.
(i)To the courts and designated parties as part of a regional center report or assessment in compliance with a statutory or regulatory requirement, including, but not limited to, Section 1827.5 of the Probate Code, Sections 1001.22 and 1370.1 of the Penal Code, and Section 6502 of this code.
(j)To the attorney for the person with a developmental disability in any and all proceedings upon presentation of a release of information signed by the person, except that when the person lacks the capacity to give informed consent, the regional center or state developmental center director or designee, upon satisfying himself or herself of the identity of the attorney, and of the fact that the attorney represents the person, shall release all information and records relating to the person except that this article shall not be construed to compel a physician and surgeon, psychologist, social worker, marriage and family therapist, professional clinical counselor, nurse, attorney, or other professional to reveal information that has been given to him or her in confidence by a family member of the person unless a valid release has been executed by that family member.
(k)Upon written consent by a person with a developmental disability previously or presently receiving services from a regional center or state developmental center, the director of the regional center or state developmental center, or his or her designee, may release any information, except information that has been given in confidence by members of the family of the person with developmental disabilities, requested by a probation officer charged with the evaluation of the person after his or her conviction of a crime if the regional center or state developmental center director or designee determines that the information is relevant to the evaluation. The consent shall only be operative until sentence is passed on the crime of which the person was convicted. The confidential information released pursuant to this subdivision shall be transmitted to the court separately from the probation report and shall not be placed in the probation report. The confidential information shall remain confidential except for purposes of sentencing. After sentencing, the confidential information shall be sealed.
(l)Between persons who are trained and qualified to serve on multidisciplinary personnel teams pursuant to subdivision (d) of Section 18951. The information and records sought to be disclosed shall be relevant to the prevention, identification, management, or treatment of an abused child and his or her parents pursuant to Chapter 11 (commencing with Section 18950) of Part 6 of Division 9.
(m)When a person with a developmental disability dies from any cause, natural or otherwise, while hospitalized in a state developmental center, the State Department of Developmental Services, the physician and surgeon in charge of the client, or the professional in charge of the facility or his or her designee, shall release the patients medical record to a medical examiner, forensic pathologist, or coroner, upon request. Except for the purposes included in paragraph (8) of subdivision (b) of Section 56.10 of the Civil Code, a medical examiner, forensic pathologist, or coroner shall not disclose any information contained in the medical record obtained pursuant to this subdivision without a court order or authorization pursuant to paragraph (4) of subdivision (c) of Section 56.11 of the Civil Code.
(n)To authorized licensing personnel who are employed by, or who are authorized representatives of, the State Department of Public Health, and who are licensed or registered health professionals, and to authorized legal staff or special investigators who are peace officers who are employed by, or who are authorized representatives of, the State Department of Social Services, as necessary to the performance of their duties to inspect, license, and investigate health facilities and community care facilities, and to ensure that the standards of care and services provided in these facilities are adequate and appropriate and to ascertain compliance with the rules and regulations to which the facility is subject. The confidential information shall remain confidential except for purposes of inspection, licensing, or investigation pursuant to Chapter 2 (commencing with Section 1250) and Chapter 3 (commencing with Section 1500) of Division 2 of the Health and Safety Code, or a criminal, civil, or administrative proceeding in relation thereto. The confidential information may be used by the State Department of Public Health or the State Department of Social Services in a criminal, civil, or administrative proceeding. The confidential information shall be available only to the judge or hearing officer and to the parties to the case. Names that are confidential shall be listed in attachments separate to the general pleadings. The confidential information shall be sealed after the conclusion of the criminal, civil, or administrative hearings, and shall not subsequently be released except in accordance with this subdivision. If the confidential information does not result in a criminal, civil, or administrative proceeding, it shall be sealed after the State Department of Public Health or the State Department of Social Services decides that no further action will be taken in the matter of suspected licensing violations. Except as otherwise provided in this subdivision, confidential information in the possession of the State Department of Public Health or the State Department of Social Services shall not contain the name of the person with a developmental disability.
(o)To any board that licenses and certifies professionals in the fields of mental health and developmental disabilities pursuant to state law, when the Director of Developmental Services has reasonable cause to believe that there has occurred a violation of any provision of law subject to the jurisdiction of a board and the records are relevant to the violation. The information shall be sealed after a decision is reached in the matter of the suspected violation, and shall not subsequently be released except in accordance with this subdivision. Confidential information in the possession of the board shall not contain the name of the person with a developmental disability.
(p)(1)To governmental law enforcement agencies by the director of a regional center or state developmental center, or his or her designee, when (1) the person with a developmental disability has been reported lost or missing or (2) there is probable cause to believe that a person with a developmental disability has committed, or has been the victim of, murder, manslaughter, mayhem, aggravated mayhem, kidnapping, robbery, carjacking, assault with the intent to commit a felony, arson, extortion, rape, forcible sodomy, forcible oral copulation, assault or battery, or unlawful possession of a weapon, as provided in any provision listed in Section 16590 of the Penal Code.
(2)This subdivision shall be limited solely to information directly relating to the factual circumstances of the commission of the enumerated offenses and shall not include any information relating to the mental state of the patient or the circumstances of his or her treatment unless relevant to the crime involved.
(3)This subdivision shall not be construed as an exception to, or in any other way affecting, the provisions of Article 7 (commencing with Section 1010) of Chapter 4 of Division 8 of the Evidence Code, or Chapter 11 (commencing with Section 15600) and Chapter 13 (commencing with Section 15750) of Part 3 of Division 9.
(q)To the Division of Juvenile Facilities and Department of Corrections and Rehabilitation or any component thereof, as necessary to the administration of justice.
(r)To an agency mandated to investigate a report of abuse filed pursuant to either Section 11164 of the Penal Code or Section 15630 of this code for the purposes of either a mandated or voluntary report or when those agencies request information in the course of conducting their investigation.
(s)When a person with developmental disabilities, or the parent, guardian, or conservator of a person with developmental disabilities who lacks capacity to consent, fails to grant or deny a request by a regional center or state developmental center to release information or records relating to the person with developmental disabilities within a reasonable period of time, the director of the regional or developmental center, or his or her designee, may release information or records on behalf of that person provided both of the following conditions are met:
(1)Release of the information or records is deemed necessary to protect the persons health, safety, or welfare.
(2)The person, or the persons parent, guardian, or conservator, has been advised annually in writing of the policy of the regional center or state developmental center for release of confidential client information or records when the person with developmental disabilities, or the persons parent, guardian, or conservator, fails to respond to a request for release of the information or records within a reasonable period of time. A statement of policy contained in the clients individual program plan shall be deemed to comply with the notice requirement of this paragraph.
(t)(1)When an employee is served with a notice of adverse action, as defined in Section 19570 of the Government Code, the following information and records may be released:
(A)All information and records that the appointing authority relied upon in issuing the notice of adverse action.
(B)All other information and records that are relevant to the adverse action, or that would constitute relevant evidence as defined in Section 210 of the Evidence Code.
(C)The information described in subparagraphs (A) and (B) may be released only if both of the following conditions are met:
(i)The appointing authority has provided written notice to the consumer and the consumers legal representative or, if the consumer has no legal representative or if the legal representative is a state agency, to the clients rights advocate, and the consumer, the consumers legal representative, or the clients rights advocate has not objected in writing to the appointing authority within five business days of receipt of the notice, or the appointing authority, upon review of the objection has determined that the circumstances on which the adverse action is based are egregious or threaten the health, safety, or life of the consumer or other consumers and without the information the adverse action could not be taken.
(ii)The appointing authority, the person against whom the adverse action has been taken, and the persons representative, if any, have entered into a stipulation that does all of the following:
(I)Prohibits the parties from disclosing or using the information or records for any purpose other than the proceedings for which the information or records were requested or provided.
(II)Requires the employee and the employees legal representative to return to the appointing authority all records provided to them under this subdivision, including, but not limited to, all records and documents or copies thereof that are no longer in the possession of the employee or the employees legal representative because they were from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final except for the actual records and documents submitted to the administrative tribunal as a component of an appeal from the adverse action.
(III)Requires the parties to submit the stipulation to the administrative tribunal with jurisdiction over the adverse action at the earliest possible opportunity.
(2)For the purposes of this subdivision, the State Personnel Board may, prior to any appeal from adverse action being filed with it, issue a protective order, upon application by the appointing authority, for the limited purpose of prohibiting the parties from disclosing or using information or records for any purpose other than the proceeding for which the information or records were requested or provided, and to require the employee or the employees legal representative to return to the appointing authority all records provided to them under this subdivision, including, but not limited to, all records and documents from any source containing confidential information protected by this section, and all copies of those records and documents, within 10 days of the date that the adverse action becomes final, except for the actual records and documents that are no longer in the possession of the employee or the employees legal representatives because they were submitted to the administrative tribunal as a component of an appeal from the adverse action.
(3)Individual identifiers, including, but not limited to, names, social security numbers, and hospital numbers, that are not necessary for the prosecution or defense of the adverse action, shall not be disclosed.
(4)All records, documents, or other materials containing confidential information protected by this section that have been submitted or otherwise disclosed to the administrative agency or other person as a component of an appeal from an adverse action shall, upon proper motion by the appointing authority to the administrative tribunal, be placed under administrative seal and shall not, thereafter, be subject to disclosure to any person or entity except upon the issuance of an order of a court of competent jurisdiction.
(5)For purposes of this subdivision, an adverse action becomes final when the employee fails to answer within the time specified in Section 19575 of the Government Code, or, after filing an answer, withdraws the appeal, or, upon exhaustion of the administrative appeal or of the judicial review remedies as otherwise provided by law.
(u)To the person appointed as the developmental services decisionmaker for a minor, dependent, or ward pursuant to Section 319, 361, or 726.
(v)To a protection and advocacy agency established pursuant to Section 4901, to the extent that the information is incorporated within any of the following:
(1)An unredacted facility evaluation report form or an unredacted complaint investigation report form of the State Department of Social Services. This information shall remain confidential and subject to the confidentiality requirements of subdivision (f) of Section 4903.
(2)An unredacted citation report, unredacted licensing report, unredacted survey report, unredacted plan of correction, or unredacted statement of deficiency of the State Department of Public Health, prepared by authorized licensing personnel or authorized representatives described in subdivision (n). This information shall remain confidential and subject to the confidentiality requirements of subdivision (f) of Section 4903.
(w)When a comprehensive assessment is conducted or updated pursuant to Section 4418.25, 4418.7, or 4648, a regional center is authorized to provide the assessment to the regional center clients rights advocate, who provides service pursuant to Section 4433.
(x)For purposes of this section, a reference to a medical examiner, forensic pathologist, or coroner means a coroner or deputy coroner, as described in subdivision (c) of Section 830.35 of the Penal Code, or a licensed physician who currently performs official autopsies on behalf of a county coroners office or a medical examiners office, whether as a government employee or under contract to that office.
(y)To authorized personnel who are employed by the Employment Development Department as necessary to enable the Employment Development Department to provide the information required to be disclosed to the State Department of Developmental Services pursuant to subdivision (ak) of Section 1095 of the Unemployment Insurance Code. The Employment Development Department shall maintain the confidentiality of any information provided to it by the Department of Developmental Services to the same extent as if the Employment Development Department had acquired the information directly.
(z)To authorized personnel who are employed by either a county or the State Department of Health Care Services as necessary to enable the county or the State Department of Health Care Services to perform determinations or redeterminations of eligibility for Medi-Cal beneficiaries pursuant to Section 14005.30 or 14005.37. The State Department of Health Care Services shall maintain the confidentiality of any information provided to it by the State Department of Developmental Services in accordance with Section 14100.2.
SEC. 2.Section 4642 of the Welfare and Institutions Code is amended to read:4642.(a)(1)Any person believed to have a developmental disability, and any person believed to have a high risk of parenting a developmentally disabled infant shall be eligible for initial intake and assessment services in the regional centers. In addition, any infant having a high risk of becoming developmentally disabled may be eligible for initial intake and assessment services in the regional centers. For purposes of this section, high-risk infant means a child less than 36 months of age whose genetic, medical, or environmental history is predictive of a substantially greater risk for developmental disability than that for the general population. The department, in consultation with the State Department of Public Health, shall develop specific risk and service criteria for the high-risk infant program on or before July 1, 1983. These criteria may be modified in subsequent years based on analysis of actual clinical experience.
(2)Initial intake shall be performed within 15 working days following request for assistance. Initial intake shall include, but need not be limited to, information and advice about the nature and availability of services provided by the regional center and by other agencies in the community, including guardianship, conservatorship, income maintenance, mental health, housing, education, work activity and vocational training, medical, dental, recreational, and other services or programs that may be useful to persons with developmental disabilities or their families. Intake shall also include a decision to provide assessment.
(b)(1)At the time of intake, the individual, or, where appropriate, the parents, legal guardian, or conservator, shall disclose whether he or she is enrolled in Medi-Cal and provide a copy of any health benefit card under which the consumer is eligible to receive Medi-Cal benefits.
(2)Information related to a consumers eligibility for Medi-Cal shall be released by the regional center or the department to the county or the State Department of Health Care Services for the purposes of enabling the county to perform determinations or redeterminations of eligibility for Medi-Cal beneficiaries pursuant to Section 14005.30 or 14005.37.
(b)(c)A regional center shall communicate with the consumer and his or her family pursuant to this section in their native language, including providing alternative communication services, as required by Sections 11135 to 11139.7, inclusive, of the Government Code and implementing regulations.
SECTION 1.SEC. 3.Section 14005.37 of the Welfare and Institutions Code is amended to read:14005.37.(a)Except as provided in Sections 14005.38 and Section 14005.39, a county shall perform redeterminations of eligibility for Medi-Cal beneficiaries every 12 months and shall promptly redetermine eligibility whenever the county receives information about changes in a beneficiarys circumstances that may affect eligibility for Medi-Cal benefits. The procedures for redetermining Medi-Cal eligibility described in this section shall apply to all Medi-Cal beneficiaries.
(b) Loss of eligibility for cash aid under the CalWORKs program shall not result in a redetermination under this section unless the reason for the loss of eligibility is one that would result in the need for a redetermination for a person whose eligibility for Medi-Cal under Section 14005.30 was determined without a concurrent determination of eligibility for cash aid under the CalWORKs program.
(c)A loss of contact, as evidenced by the return of mail marked in such a way as to indicate that it could not be delivered to the intended recipient or that there was no forwarding address, shall require a prompt redetermination according to the procedures set forth in this section.
(d)Except as otherwise provided in this section, Medi-Cal eligibility shall continue during the redetermination process described in this section and a beneficiarys Medi-Cal eligibility shall not be terminated under this section until the county makes a specific determination based on facts clearly demonstrating that the beneficiary is no longer eligible for Medi-Cal benefits under any basis and due process rights guaranteed under this division have been met. For the purposes of this subdivision, for a beneficiary who is subject to the use of MAGI-based financial methods, the determination of whether the beneficiary is eligible for Medi-Cal benefits under any basis shall include, but is not limited to, a determination of eligibility for Medi-Cal benefits on a basis that is exempt from the use of MAGI-based financial methods only if either of the following occurs:
(A)The county assesses the beneficiary as being potentially eligible under a program that is exempt from the use of MAGI-based financial methods, including, but not limited to, on the basis of age, blindness, disability, or the need for long-term care services and supports.
(B)The beneficiary requests that the county determine whether he or she is eligible for Medi-Cal benefits on a basis that is exempt from the use of MAGI-based financial methods.
(e)(1)For purposes of acquiring information necessary to conduct the eligibility redeterminations described in this section, a county shall gather information available to the county that is relevant to the beneficiarys Medi-Cal eligibility prior to contacting the beneficiary. Sources for these efforts shall include information contained in the beneficiarys file or other information, including more recent information available to the county, including, but not limited to, Medi-Cal, CalWORKs, and CalFresh case files of the beneficiary or of any of his or her immediate family members, which are open, or were closed within the last 90 days, information received under subdivision (z) of Section 4514 within the last 36 months, information accessed through any databases accessed under Sections 435.948, 435.949, and 435.956 of Title 42 of the Code of Federal Regulations, and wherever feasible, other sources of relevant information reasonably available to the county or to the county via the department.
(2)In the case of an annual redetermination, if, based upon information obtained pursuant to paragraph (1), the county is able to make a determination of continued eligibility, the county shall notify the beneficiary of both of the following:
(A)The eligibility determination and the information it is based on.
(B)That the beneficiary is required to inform the county via the Internet, by telephone, by mail, in person, or through other commonly available electronic means, in counties where that electronic communication is available, if any information contained in the notice is inaccurate but that the beneficiary is not required to sign and return the notice if all information provided on the notice is accurate.
(3)The county shall make all reasonable efforts not to send multiple notices during the same time period about eligibility. The notice of eligibility renewal shall contain other related information such as if the beneficiary is in a new Medi-Cal program.
(4)In the case of a redetermination due to a change in circumstances, if a county determines that the change in circumstances does not affect the beneficiarys eligibility status, the county shall not send the beneficiary a notice unless required to do so by federal law.
(f)(1)In Except as provided in subdivision (g), in the case of an annual eligibility redetermination, if the county is unable to determine continued eligibility based on the information obtained pursuant to paragraph (1) of subdivision (e), the beneficiary shall be so informed and shall be provided with an annual renewal form, at least 60 days before the beneficiarys annual redetermination date, that is prepopulated with information that the county has obtained and that identifies any additional information needed by the county to determine eligibility. The form shall include all of the following:
(A)The requirement that he or she provide any necessary information to the county within 60 days of the date that the form is sent to the beneficiary.
(B)That the beneficiary may respond to the county via the Internet, by mail, by telephone, in person, or through other commonly available electronic means if those means are available in that county.
(C)That if the beneficiary chooses to return the form to the county in person or via mail, the beneficiary shall sign the form in order for it to be considered complete.
(D)The telephone number to call in order to obtain more information.
(2)The county shall attempt to contact the beneficiary via the Internet, by telephone, or through other commonly available electronic means, if those means are available in that county, during the 60-day period after the prepopulated form is mailed to the beneficiary to collect the necessary information if the beneficiary has not responded to the request for additional information or has provided an incomplete response.
(3)If the beneficiary has not provided any response to the written request for information sent pursuant to paragraph (1) within 60 days from the date the form is sent, the county shall terminate his or her eligibility for Medi-Cal benefits following the provision of timely notice.
(4)If the beneficiary responds to the written request for information during the 60-day period pursuant to paragraph (1) but the information provided is not complete, the county shall follow the procedures set forth in paragraph (3) of subdivision (g) (h) to work with the beneficiary to complete the information.
(5)(A)The form required by this subdivision shall be developed by the department in consultation with the counties and representatives of eligibility workers and consumers.
(B)For beneficiaries whose eligibility is not determined using MAGI-based financial methods, the county may use existing renewal forms until the state develops prepopulated renewal forms to provide to beneficiaries. The department shall develop prepopulated renewal forms for use with beneficiaries whose eligibility is not determined using MAGI-based financial methods by January 1, 2015.
(g)(1)In the case of an annual eligibility redetermination of a beneficiary who has a developmental disability, as defined in subdivision (a) of Section 4512, and who receives services by a regional center pursuant to Chapter 5 (commencing with Section 4620) of Division 4.5, the county shall gather information available to the county that is relevant to the beneficiarys Medi-Cal eligibility prior to contacting the beneficiary pursuant to subdivision (e). The county shall evaluate information received in the last 36 months by the regional center from the consumer, as defined in subdivision (d) of Section 4512, to make a determination of continued eligibility without requesting additional information from the beneficiary.
(2)In the case of an annual eligibility redetermination of a consumer, if the county is unable to determine continued eligibility based on the information obtained pursuant to paragraph (1) of subdivision (e) or paragraph (1) of this subdivision, the beneficiary shall be informed and shall be provided with an annual renewal form at least 60 days before the beneficiarys annual redetermination date that is prepopulated with information that the county has obtained and that identifies any additional information needed by the county to determine eligibility. The form shall include information set forth in paragraph (1) of subdivision (f).
(3)The State Department of Developmental Services shall disseminate to the counties and the State Department of Health Care Services, on a regular basis to be determined by the State Department of Health Care Services, a list identifying consumers receiving services at regional centers.
(4)The consumer shall maintain Medi-Cal eligibility during the redetermination process described in this section and Medi-Cal eligibility shall not be terminated under this section until the county makes a specific determination based on facts clearly demonstrating that the beneficiary is no longer eligible for Medi-Cal benefits under any basis and due process rights guaranteed under this division have been met.
(5)This subdivision shall be implemented only if and to the extent that federal financial participation is available and any necessary federal approvals have been obtained.
(g)(h)(1)In the case of a redetermination due to change in circumstances, if a county cannot obtain sufficient information to redetermine eligibility pursuant to subdivision (e), the county shall send to the beneficiary a form that is prepopulated with the information that the county has obtained and that states the information needed to renew eligibility. The county shall only request information related to the change in circumstances. The county shall not request information or documentation that has been previously provided by the beneficiary, that is not absolutely necessary to complete the eligibility determination, or that is not subject to change. The county shall only request information for nonapplicants necessary to make an eligibility determination or for a purpose directly related to the administration of the state Medicaid plan. The form shall advise the individual to provide any necessary information to the county via the Internet, by telephone, by mail, in person, or through other commonly available electronic means and, if the individual will provide the form by mail or in person, to sign the form. The form shall include a telephone number to call in order to obtain more information. The form shall be developed by the department in consultation with the counties, representatives of consumers, and eligibility workers. A Medi-Cal beneficiary shall have 30 days from the date the form is mailed pursuant to this subdivision to respond. Except as provided in paragraph (2), failure to respond prior to the end of this 30-day period shall not impact his or her Medi-Cal eligibility.
(2)If the purpose for a redetermination under this section is a loss of contact with the Medi-Cal beneficiary, as evidenced by the return of mail marked in such a way as to indicate that it could not be delivered to the intended recipient or that there was no forwarding address, a return of the form described in this subdivision marked as undeliverable shall result in an immediate notice of action terminating Medi-Cal eligibility.
(3)During the 30-day period after the date of mailing of a form to the Medi-Cal beneficiary pursuant to this subdivision, the county shall attempt to contact the beneficiary by telephone, in writing, or other commonly available electronic means, in counties where that electronic communication is available, to request the necessary information if the beneficiary has not responded to the request for additional information or has provided an incomplete response. If the beneficiary does not supply the necessary information to the county within the 30-day limit, a 10-day notice of termination of Medi-Cal eligibility shall be sent.
(h)(i)Beneficiaries shall be required to report any change in circumstances that may affect their eligibility within 10 calendar days following the date the change occurred.
(i)(j)If within 90 days of termination of a Medi-Cal beneficiarys eligibility or a change in eligibility status pursuant to this section, the beneficiary submits to the county a signed and completed form or otherwise provides the needed information to the county, eligibility shall be redetermined by the county and if the beneficiary is found eligible, or the beneficiarys eligibility status has not changed, whichever applies, the termination shall be rescinded as though the form were submitted in a timely manner.
(j)(k)If the information available to the county pursuant to the redetermination procedures of this section does not indicate a basis of eligibility, Medi-Cal benefits may be terminated so long as due process requirements have otherwise been met.
(k)(l)The department shall, with the counties and representatives of consumers, including those with disabilities, and Medi-Cal eligibility workers, develop a timeframe for redetermination of Medi-Cal eligibility based upon disability, including ex parte review, the redetermination forms described in subdivisions (f) and (g), (h), timeframes for responding to county or state requests for additional information, and the forms and procedures to be used. The forms and procedures shall be as consumer-friendly as possible for people with disabilities. The timeframe shall provide a reasonable and adequate opportunity for the Medi-Cal beneficiary to obtain and submit medical records and other information needed to establish eligibility for Medi-Cal based upon disability.
(l)(m)The county shall consider blindness as continuing until the reviewing physician determines that a beneficiarys vision has improved beyond the applicable definition of blindness contained in the plan.
(m)(n)The county shall consider disability as continuing until the review team determines that a beneficiarys disability no longer meets the applicable definition of disability contained in the plan.
(n)(o)In the case of a redetermination due to a change in circumstances, if a county determines that the beneficiary remains eligible for Medi-Cal benefits, the county shall begin a new 12-month eligibility period.
(o)(p)For individuals determined ineligible for Medi-Cal by a county following the redetermination procedures set forth in this section, the county shall determine eligibility for other insurance affordability programs and if the individual is found to be eligible, the county shall, as appropriate, transfer the individuals electronic account to other insurance affordability programs via a secure electronic interface.
(p)(q)Any renewal form or notice shall be accessible to persons who are limited-English proficient and persons with disabilities consistent with all federal and state requirements.
(q)(r)The requirements to provide information in subdivisions (e) and (g), (h), and to report changes in circumstances in subdivision (h), (i), may be provided through any of the modes of submission allowed in Section 435.907(a) of Title 42 of the Code of Federal Regulations, including an Internet Web site identified by the department, telephone, mail, in person, and other commonly available electronic means as authorized by the department.
(r)(s)Forms required to be signed by a beneficiary pursuant to this section shall be signed under penalty of perjury. Electronic signatures, telephonic signatures, and handwritten signatures transmitted by electronic transmission shall be accepted.
(s)(t)For purposes of this section, MAGI-based financial methods means income calculated using the financial methodologies described in Section 1396a(e)(14) of Title 42 of the United States Code, and as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any subsequent amendments.
(t)(u)When contacting a beneficiary under paragraphs (2) and (4) of subdivision (f), and paragraph (3) of subdivision (g), (h), a county shall first attempt to use the method of contact identified by the beneficiary as the preferred method of contact, if a method has been identified.
(u)(v)The department shall seek federal approval to extend the annual redetermination date under this section for a three-month period for those Medi-Cal beneficiaries whose annual redeterminations are scheduled to occur between January 1, 2014, and March 31, 2014.
(v)(w)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, or make specific this section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted. The department shall adopt regulations by July 1, 2017, in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. Beginning six months after the effective date of this section, and notwithstanding Section 10231.5 of the Government Code, the department shall provide a status report to the Legislature on a semiannual basis, in compliance with Section 9795 of the Government Code, until regulations have been adopted.
(w)(x)This section shall be implemented only if and to the extent that federal financial participation is available and any necessary federal approvals have been obtained.
(x)(y)This section shall become operative on January 1, 2014.
SEC. 2.Section 14005.38 is added to the Welfare and Institutions Code, to read:14005.38.(a)Notwithstanding Section 14005.37, a county shall perform a redetermination of eligibility only every 36 months for a Medi-Cal beneficiary who has a developmental disability, as defined in Section 4512, and who is determined to be eligible for services by a regional center pursuant to Chapter 5 (commencing with Section 4620) of Division 4.5.(b)The provisions of Section 14005.37, except for the requirement of eligibility redetermination every 12 months, shall continue to apply to the redetermination of eligibility for a Medi-Cal beneficiary described in subdivision (a).(c)The State Department of Developmental Services shall make available to the department an updated list of individuals who have been determined to be eligible for services by regional centers pursuant to Chapter 5 (commencing with Section 4620) of Division 4.5.(d)Until the county is required to perform a redetermination of eligibility according to the timeframe described in subdivision (a), the department shall utilize the list described in subdivision (c), or any other information available to the department, for purposes of identifying any change of circumstances, including, but not limited to, those events described in Section 14005.39, in order to verify, every 12 months, the continued eligibility of a Medi-Cal beneficiary due to a determination of eligibility for regional center services pursuant to subdivision (a) without requesting additional information from the beneficiary. Medi-Cal eligibility shall continue during the verification process described in this subdivision, and a beneficiarys Medi-Cal eligibility shall not be terminated as a result of a delay in the verification process.(e)This section shall be implemented only if and to the extent that federal financial participation is available and any necessary federal approvals or waivers have been obtained.SEC. 4.If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.
(a)Except as provided in Section Sections 14005.38 and 14005.39, a county shall perform redeterminations of eligibility for Medi-Cal beneficiaries every 12 months and shall promptly redetermine eligibility whenever the county receives information about changes in a beneficiarys circumstances that may affect eligibility for Medi-Cal benefits. The procedures for redetermining Medi-Cal eligibility described in this section shall apply to all Medi-Cal beneficiaries.
(b) Loss of eligibility for cash aid under that the CalWORKs program shall not result in a redetermination under this section unless the reason for the loss of eligibility is one that would result in the need for a redetermination for a person whose eligibility for Medi-Cal under Section 14005.30 was determined without a concurrent determination of eligibility for cash aid under the CalWORKs program.
(c)A loss of contact, as evidenced by the return of mail marked in such a way as to indicate that it could not be delivered to the intended recipient or that there was no forwarding address, shall require a prompt redetermination according to the procedures set forth in this section.
(d)Except as otherwise provided in this section, Medi-Cal eligibility shall continue during the redetermination process described in this section and a beneficiarys Medi-Cal eligibility shall not be terminated under this section until the county makes a specific determination based on facts clearly demonstrating that the beneficiary is no longer eligible for Medi-Cal benefits under any basis and due process rights guaranteed under this division have been met. For the purposes of this subdivision, for a beneficiary who is subject to the use of MAGI-based financial methods, the determination of whether the beneficiary is eligible for Medi-Cal benefits under any basis shall include, but is not limited to, a determination of eligibility for Medi-Cal benefits on a basis that is exempt from the use of MAGI-based financial methods only if either of the following occurs:
(A)The county assesses the beneficiary as being potentially eligible under a program that is exempt from the use of MAGI-based financial methods, including, but not limited to, on the basis of age, blindness, disability, or the need for long-term care services and supports.
(B)The beneficiary requests that the county determine whether he or she is eligible for Medi-Cal benefits on a basis that is exempt from the use of MAGI-based financial methods.
(e)(1)For purposes of acquiring information necessary to conduct the eligibility redeterminations described in this section, a county shall gather information available to the county that is relevant to the beneficiarys Medi-Cal eligibility prior to contacting the beneficiary. Sources for these efforts shall include information contained in the beneficiarys file or other information, including more recent information available to the county, including, but not limited to, Medi-Cal, CalWORKs, and CalFresh case files of the beneficiary or of any of his or her immediate family members, which are open, or were closed within the last 90 days, information accessed through any databases accessed under Sections 435.948, 435.949, and 435.956 of Title 42 of the Code of Federal Regulations, and wherever feasible, other sources of relevant information reasonably available to the county or to the county via the department.
(2)In the case of an annual redetermination, if, based upon information obtained pursuant to paragraph (1), the county is able to make a determination of continued eligibility, the county shall notify the beneficiary of both of the following:
(A)The eligibility determination and the information it is based on.
(B)That the beneficiary is required to inform the county via the Internet, by telephone, by mail, in person, or through other commonly available electronic means, in counties where such that electronic communication is available, if any information contained in the notice is inaccurate but that the beneficiary is not required to sign and return the notice if all information provided on the notice is accurate.
(3)The county shall make all reasonable efforts not to send multiple notices during the same time period about eligibility. The notice of eligibility renewal shall contain other related information such as if the beneficiary is in a new Medi-Cal program.
(4)In the case of a redetermination due to a change in circumstances, if a county determines that the change in circumstances does not affect the beneficiarys eligibility status, the county shall not send the beneficiary a notice unless required to do so by federal law.
(f)(1)In the case of an annual eligibility redetermination, if the county is unable to determine continued eligibility based on the information obtained pursuant to paragraph (1) of subdivision (e), the beneficiary shall be so informed and shall be provided with an annual renewal form, at least 60 days before the beneficiarys annual redetermination date, that is prepopulated with information that the county has obtained and that identifies any additional information needed by the county to determine eligibility. The form shall include all of the following:
(A)The requirement that he or she provide any necessary information to the county within 60 days of the date that the form is sent to the beneficiary.
(B)That the beneficiary may respond to the county via the Internet, by mail, by telephone, in person, or through other commonly available electronic means if those means are available in that county.
(C)That if the beneficiary chooses to return the form to the county in person or via mail, the beneficiary shall sign the form in order for it to be considered complete.
(D)The telephone number to call in order to obtain more information.
(2)The county shall attempt to contact the beneficiary via the Internet, by telephone, or through other commonly available electronic means, if those means are available in that county, during the 60-day period after the prepopulated form is mailed to the beneficiary to collect the necessary information if the beneficiary has not responded to the request for additional information or has provided an incomplete response.
(3)If the beneficiary has not provided any response to the written request for information sent pursuant to paragraph (1) within 60 days from the date the form is sent, the county shall terminate his or her eligibility for Medi-Cal benefits following the provision of timely notice.
(4)If the beneficiary responds to the written request for information during the 60-day period pursuant to paragraph (1) but the information provided is not complete, the county shall follow the procedures set forth in paragraph (3) of subdivision (g) to work with the beneficiary to complete the information.
(5)(A)The form required by this subdivision shall be developed by the department in consultation with the counties and representatives of eligibility workers and consumers.
(B)For beneficiaries whose eligibility is not determined using MAGI-based financial methods, the county may use existing renewal forms until the state develops prepopulated renewal forms to provide to beneficiaries. The department shall develop prepopulated renewal forms for use with beneficiaries whose eligibility is not determined using MAGI-based financial methods by January 1, 2015.
(g)(1)In the case of a redetermination due to change in circumstances, if a county cannot obtain sufficient information to redetermine eligibility pursuant to subdivision (e), the county shall send to the beneficiary a form that is prepopulated with the information that the county has obtained and that states the information needed to renew eligibility. The county shall only request information related to the change in circumstances. The county shall not request information or documentation that has been previously provided by the beneficiary, that is not absolutely necessary to complete the eligibility determination, or that is not subject to change. The county shall only request information for nonapplicants necessary to make an eligibility determination or for a purpose directly related to the administration of the state Medicaid plan. The form shall advise the individual to provide any necessary information to the county via the Internet, by telephone, by mail, in person, or through other commonly available electronic means and, if the individual will provide the form by mail or in person, to sign the form. The form shall include a telephone number to call in order to obtain more information. The form shall be developed by the department in consultation with the counties, representatives of consumers, and eligibility workers. A Medi-Cal beneficiary shall have 30 days from the date the form is mailed pursuant to this subdivision to respond. Except as provided in paragraph (2), failure to respond prior to the end of this 30-day period shall not impact his or her Medi-Cal eligibility.
(2)If the purpose for a redetermination under this section is a loss of contact with the Medi-Cal beneficiary, as evidenced by the return of mail marked in such a way as to indicate that it could not be delivered to the intended recipient or that there was no forwarding address, a return of the form described in this subdivision marked as undeliverable shall result in an immediate notice of action terminating Medi-Cal eligibility.
(3)During the 30-day period after the date of mailing of a form to the Medi-Cal beneficiary pursuant to this subdivision, the county shall attempt to contact the beneficiary by telephone, in writing, or other commonly available electronic means, in counties where such that electronic communication is available, to request the necessary information if the beneficiary has not responded to the request for additional information or has provided an incomplete response. If the beneficiary does not supply the necessary information to the county within the 30-day limit, a 10-day notice of termination of Medi-Cal eligibility shall be sent.
(h)Beneficiaries shall be required to report any change in circumstances that may affect their eligibility within 10 calendar days following the date the change occurred.
(i)If within 90 days of termination of a Medi-Cal beneficiarys eligibility or a change in eligibility status pursuant to this section, the beneficiary submits to the county a signed and completed form or otherwise provides the needed information to the county, eligibility shall be redetermined by the county and if the beneficiary is found eligible, or the beneficiarys eligibility status has not changed, whichever applies, the termination shall be rescinded as though the form were submitted in a timely manner.
(j)If the information available to the county pursuant to the redetermination procedures of this section does not indicate a basis of eligibility, Medi-Cal benefits may be terminated so long as due process requirements have otherwise been met.
(k)The department shall, with the counties and representatives of consumers, including those with disabilities, and Medi-Cal eligibility workers, develop a timeframe for redetermination of Medi-Cal eligibility based upon disability, including ex parte review, the redetermination forms described in subdivisions (f) and (g), timeframes for responding to county or state requests for additional information, and the forms and procedures to be used. The forms and procedures shall be as consumer-friendly as possible for people with disabilities. The timeframe shall provide a reasonable and adequate opportunity for the Medi-Cal beneficiary to obtain and submit medical records and other information needed to establish eligibility for Medi-Cal based upon disability.
(l)The county shall consider blindness as continuing until the reviewing physician determines that a beneficiarys vision has improved beyond the applicable definition of blindness contained in the plan.
(m)The county shall consider disability as continuing until the review team determines that a beneficiarys disability no longer meets the applicable definition of disability contained in the plan.
(n)In the case of a redetermination due to a change in circumstances, if a county determines that the beneficiary remains eligible for Medi-Cal benefits, the county shall begin a new 12-month eligibility period.
(o)For individuals determined ineligible for Medi-Cal by a county following the redetermination procedures set forth in this section, the county shall determine eligibility for other insurance affordability programs and if the individual is found to be eligible, the county shall, as appropriate, transfer the individuals electronic account to other insurance affordability programs via a secure electronic interface.
(p)Any renewal form or notice shall be accessible to persons who are limited-English proficient and persons with disabilities consistent with all federal and state requirements.
(q)The requirements to provide information in subdivisions (e) and (g), and to report changes in circumstances in subdivision (h), may be provided through any of the modes of submission allowed in Section 435.907(a) of Title 42 of the Code of Federal Regulations, including an Internet Web site identified by the department, telephone, mail, in person, and other commonly available electronic means as authorized by the department.
(r)Forms required to be signed by a beneficiary pursuant to this section shall be signed under penalty of perjury. Electronic signatures, telephonic signatures, and handwritten signatures transmitted by electronic transmission shall be accepted.
(s)For purposes of this section, MAGI-based financial methods means income calculated using the financial methodologies described in Section 1396a(e)(14) of Title 42 of the United States Code, and as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any subsequent amendments.
(t)When contacting a beneficiary under paragraphs (2) and (4) of subdivision (f), and paragraph (3) of subdivision (g), a county shall first attempt to use the method of contact identified by the beneficiary as the preferred method of contact, if a method has been identified.
(u)The department shall seek federal approval to extend the annual redetermination date under this section for a three-month period for those Medi-Cal beneficiaries whose annual redeterminations are scheduled to occur between January 1, 2014, and March 31, 2014.
(v)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, or make specific this section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted. The department shall adopt regulations by July 1, 2017, in accordance with the requirements of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. Beginning six months after the effective date of this section, and notwithstanding Section 10231.5 of the Government Code, the department shall provide a status report to the Legislature on a semiannual basis, in compliance with Section 9795 of the Government Code, until regulations have been adopted.
(w)This section shall be implemented only if and to the extent that federal financial participation is available and any necessary federal approvals have been obtained.
(x)This section shall become operative on January 1, 2014.
SEC. 2.Section 14005.38 is added to the Welfare and Institutions Code, to read:14005.38.(a)Notwithstanding Section 14005.37, a county shall perform a redetermination of eligibility only every 36 months for a Medi-Cal beneficiary who has a developmental disability, as defined in Section 4512, and who is determined to be eligible for services by a regional center pursuant to Chapter 5 (commencing with Section 4620) of Division 4.5.
(b)The provisions of Section 14005.37, except for the requirement of eligibility redetermination every 12 months, shall continue to apply to the redetermination of eligibility for a Medi-Cal beneficiary described in subdivision (a).
(c)The State Department of Developmental Services shall make available to the department an updated list of individuals who have been determined to be eligible for services by regional centers pursuant to Chapter 5 (commencing with Section 4620) of Division 4.5.
(d)Until the county is required to perform a redetermination of eligibility according to the timeframe described in subdivision (a), the department shall utilize the list described in subdivision (c), or any other information available to the department, for purposes of identifying any change of circumstances, including, but not limited to, those events described in Section 14005.39, in order to verify, every 12 months, the continued eligibility of a Medi-Cal beneficiary due to a determination of eligibility for regional center services pursuant to subdivision (a) without requesting additional information from the beneficiary. Medi-Cal eligibility shall continue during the verification process described in this subdivision, and a beneficiarys Medi-Cal eligibility shall not be terminated as a result of a delay in the verification process.
(e)This section shall be implemented only if and to the extent that federal financial participation is available and any necessary federal approvals or waivers have been obtained.
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Date
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Status
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|---|---|
| May 25, 2018 | In committee: Held under submission. |
| May 23, 2018 | In committee: Set, first hearing. Referred to APPR. suspense file. |
| May 1, 2018 | Re-referred to Com. on APPR. |
| Apr 30, 2018 | Read second time and amended. |
| Apr 26, 2018 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 7. Noes 0.) (April 24). |
| Apr 18, 2018 | From committee: Do pass and re-refer to Com. on HUM. S. (Ayes 15. Noes 0.) (April 17). Re-referred to Com. on HUM. S. |
| Apr 12, 2018 | Re-referred to Com. on HEALTH. |
| Apr 11, 2018 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended. |
| Apr 3, 2018 | In committee: Hearing postponed by committee. |
| Mar 1, 2018 | Referred to Coms. on HEALTH and HUM. S. |
| Feb 14, 2018 | From printer. May be heard in committee March 16. |
| Feb 13, 2018 | Read first time. To print. |
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Date
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Description
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Location
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Votes
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|---|---|---|---|---|
| Apr 24, 2018 | Do pass as amended, and be re-referred to the Committee on [Appropriations] with recommendation: To Consent Calendar | Assembly Standing Committee on Human Services |
Passed |
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| Apr 17, 2018 | Do pass and be re-referred to the Committee on [Human Services] | Assembly Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| Arc and United Cerebral Palsy California Coalition | * Support | Apr 17, 2018 |
| Association Of Regional Center Agencies | ** Support | Apr 22, 2018 |
| Association of Regional Central Agencies | * Support | Apr 17, 2018 |
| California Association Of Health Plans | * Support | Apr 17, 2018 |
| County Directors Welfare Association | * Support | Apr 17, 2018 |
| Local Health Plans Of California | ** Support | Apr 15, 2018 |
| National Association of Social Workers | * Support | Apr 17, 2018 |
| National Association Of Social Workers, California Chapter | ** Support | Apr 15, 2018 |
| State Council on Developmental Disabilities | ** Support | Apr 15, 2018 |
| The Western Center on Law and Poverty | * Support | Apr 17, 2018 |
Date of Hearing: May 23, 2018
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez Fletcher, Chair
ABPCA Bill Id:AB 2331
Author:(Weber) – As Amended Ver:April 30, 2018
Policy Committee: | Health | Vote: | 15 - 0 |
Human Services | 7 - 0 |
Urgency: No State Mandated Local Program: Yes Reimbursable: No
SUMMARY:
This bill contains multiple requirements intended to facilitate continuous Medi-Cal enrollment for regional center consumers. Specifically, this bill:
- Allows the Department of Developmental Services (DDS) to share data with a county or with the Department of Health Care Services (DHCS) for Medi-Cal eligibility determination or redetermination.
- Requires an individual, during the intake process for receiving regional center services for a developmental disability, to disclose whether they are enrolled in Medi-Cal.
- Requires a county, for purposes of eligibility determinations, to use information the county acquired during the last 36 months that is relevant to the beneficiary’s Medi-Cal eligibility, prior to contacting the beneficiary.
- Requires the beneficiary to be informed and be provided with an annual renewal form at least 60 days before the beneficiary’s annual redetermination date. Requires the form to be prepopulated with information the county has obtained, and identify any additional information needed by the county to determine eligibility.
- Requires DDS to disseminate to counties and DHCS on a regular basis a list identifying consumers receiving services at regional centers.
- Requires the county to maintain a regional center consumer's Medi-Cal eligibility during the redetermination process described in the bill, contingent on federal financial participation.
FISCAL EFFECT:
- Ongoing minor administrative costs to DDS for data-sharing, not likely to exceed $100,000 GF annually.
- Ongoing administrative costs to DHCS in the range of $125,000 (GF/federal) annually, likely for one to three years, for data-sharing, establishing policy guidance, and providing technical assistance.
- Unknown, potentially significant Medi-Cal health care benefits costs, to the extent the processes in this bill streamline redetermination for Medi-Cal eligibility (GF/federal).
COMMENTS:
- Purpose. This bill is intended to maintain Medi-Cal eligibility for developmentally disabled children though improved coordination between DDS and DHCS.
- Background. DDS and 21 regional centers – private nonprofit entities that contract with DDS to carry out many of the state’s responsibilities– deliver services to persons with developmental disabilities.
DHCS is the Medi-Cal state administrative entity, but county human services agencies are responsible for local Medi-Cal administration and eligibility determination. To qualify based for Medi-Cal on income, individuals must have a modified adjusted gross income (MAGI) that is below 138% of the federal poverty level. There are other ways to qualify for Medi-Cal based on linkages to programs such as CalWORKS, but recipients of regional center services are not categorically Medi-Cal eligible.
About 60% of the 158,000 children receiving regional center services are enrolled in Medi-Cal. Of these, about 13,000 are institutionally deemed, which means a child's income is counted separately from their family's income and they receive at least one "waiver" service – a service provided in Medi-Cal through which some provision of federal law is waived. Generally, in this case, children who qualify for institutional placement are instead receiving home- and community-based services through Medi-Cal.
Some developmentally disabled children are also medically fragile. By requiring data-sharing and streamlined eligibility redeterminations, this bill is intended to ensure any child who qualifies can stay enrolled in Medi-Cal.
- Related Legislation. A number of bills being heard today in this committee address Medi-Cal eligibility and enrollment.
AB 2718 (Friedman) replaces the initial 6-month eligibility period for families transitioning off CalWORKS with a 12-month eligibility period.
AB 2579 (Burke) creates a streamlined Medi-Cal enrollment gateway through the Women, Infants, and Children (WIC) program.
AB 2430 (Arambula) expands coverage for aged and disabled individuals by increasing the eligibility threshold to 138% of the federal poverty level.
AB 2965 (Arambula) provides Medi-Cal coverage regardless of immigration status.
- Staff Comments. The impact of this bill is somewhat unclear, because it is unclear whether certain information older than 12 months, such as income information, can be used to determine eligibility under federal law.
Costs to DDS would be negligible if DDS provided data to DHCS directly, instead of to each county.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
Date of Hearing: April 24, 2018
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Blanca Rubio, Chair
ABPCA Bill Id:AB 2331 (
Author:Weber) – As Amended Ver:April 11, 2018
SUBJECT: Medi-Cal: redetermination: developmental disability.
SUMMARY: Adopts requirements, including sharing of certain information between regional centers and the Department of Developmental Services (DDS) and the counties and the Department of Health Care Services (DHCS), designed to facilitate uninterrupted redetermination of Medi-Cal eligibility for individuals with developmental disabilities.
Specifically, this bill:
- Permits disclosure of information and records obtained while providing intake, assessment, and services to individuals with developmental disabilities to authorized personnel who are employed by either a county or DHCS as necessary to enable the county or DHCS to perform determinations or redeterminations of Medi-Cal eligibility, and further, includes information received by a county or DHCS in this manner in the last 36 months in the list of information delineated in current law which counties shall gather for purposes of redetermination of Medi-Cal eligibility, as specified.
- Requires an individual or, where appropriate, certain representatives of an individual, as specified, to, at the time of regional center intake, disclose whether the individual is enrolled in Medi-Cal and to provide a copy of any health benefit card under which the consumer is eligible to receive Medi-Cal benefits.
- Requires information related to a consumer’s eligibility for Medi-Cal to be released by the regional center or DDS to the county or DHCS for purposes of enabling the county to perform determinations or redeterminations of Medi-Cal eligibility, as specified.
- Requires the following, as specified, only if and to the extent that federal financial participation is available and any necessary federal approvals have been obtained:
- The county, in cases of annual redetermination of Medi-Cal eligibility for a beneficiary who has a developmental disability and who receives regional center services, to gather information available to the county that is relevant to the beneficiary’s Medi-Cal eligibility prior to contacting the beneficiary;
- The county to evaluate information received in the last 36 months by the regional center from the consumer to make a determination of continued eligibility without requesting additional information from the beneficiary;
- The beneficiary, in certain cases where the county is unable to determine continued Medi-Cal eligibility, to be informed of this fact and to be provided an annual renewal form no less than 60 days before the beneficiary’s annual redetermination date that is prepopulated with information already obtained by the county, that identifies information that is still needed, and that contains certain additional information;
- DDS to disseminate, on a regular basis determined by DHCS, to the counties and to DHCS a list identifying consumers receiving services at regional centers;
- The consumer to maintain Medi-Cal eligibility during the redetermination process; and
- Medi-Cal eligibility to not be terminated until the county makes a specific determination on facts clearly demonstrating that the beneficiary is no longer eligible for Medi-Cal benefits under any basis and due process rights have been met.
- Makes technical changes.
EXISTING LAW:
- Establishes the Lanterman Developmental Disabilities Services Act, which declares California’s responsibility for providing an array of services and supports to meet the needs of each person with developmental disabilities in the least restrictive environment, regardless of age or degree of disability, and to support their integration into the mainstream life of the community. (WIC 4500, et seq.)
- Establishes the jurisdiction of DDS over state developmental centers (DCs), including Sonoma, Fairview and Porterville DCs, as specified. (WIC 4440 et seq.)
- Establishes a system of nonprofit regional centers to provide fixed points of contact in the community for all persons with developmental disabilities and their families, to coordinate services and supports best suited to them throughout their lifetime. (WIC 4620)
- Establishes the Medi-Cal program, which is administered by DHCS, under which qualified low-income persons receive health care benefits and, in part, which is governed and funded by federal Medicaid program provisions. (42 U.S.C. 1396 et seq., WIC 14000 et seq.)
- Requires all information and records obtained in the course of providing intake, assessment, and services to individuals with developmental disabilities to be confidential, with certain exceptions, as specified. (WIC 4514)
- Establishes requirements regarding regional center initial intake and assessment of individuals, as specified. (WIC 4642)
- Establishes requirements for the determination and redetermination of Medi-Cal eligibility. (WIC 14005.30, 14005.37)
FISCAL EFFECT: Unknown.
COMMENTS:
Developmental services: Developmental disabilities are disabilities that originate before an individual attains 18 years of age, are expected to continue indefinitely, and constitute a substantial disability for that individual; they include intellectual disabilities, cerebral palsy, epilepsy, and autism spectrum disorders (ASD). Other developmental disabilities are those disabling conditions similar to an intellectual disability that require treatment (i.e., care and management) similar to that required by individuals with an intellectual disability.
The Lanterman Act (Welfare and Institutions Code Section 4500 et seq.) declares the state’s responsibility for providing an array of services and supports to meet the needs of each person with developmental disabilities in the least restrictive environment, regardless of age or degree of disability, and to support their integration into the mainstream life of the community. The Lanterman Act entitles each eligible individual to treatment and habilitation services and supports in the least restrictive environment. Services provided under the Act are designed to enable all consumers to live more independent and productive lives in the community.
DDS and 21 regional centers – private nonprofit entities established pursuant to the Lanterman Act, that contract with DDS to carry out many of the state’s responsibilities under the Act – share responsibility for the implementation of the Lanterman Act service system. The 21 regional centers provide services such as residential placements, supported living services, respite care, transportation, day treatment programs, work support programs, and various social and therapeutic activities; they currently serve approximately 332,000 consumers.
As of March 28th of this year, 588 consumers resided at one of California’s three developmental centers —and one state-operated, specialized community facility—which provide 24-hour habilitation and medical and social treatment services; this population is broken out as follows across the four settings:
Fairview Developmental Center: 128
Porterville Developmental Center: 280
Sonoma Developmental Center: 132
Canyon Springs Community Facility: 48
Consumers, their authorized representatives, and one or more regional center representatives, among others, work together as an individual program plan (IPP) team to develop an IPP for the consumer, which is based on the consumer’s needs and choices, and guides the services provided to the consumer through the developmental services system. The Lanterman Act requires the IPP to promote integration in one’s community and to maximize opportunities for each consumer to develop relationships, increase control over his or her life, be part of community life, and acquire increasingly positive roles in the community. The IPP must place the highest preference on services and supports that enable minors to live with their families and adults to live as independently as possible in the community.
Medi-Cal: Through the federal Medicaid program, Medi-Cal offers free or low-cost health coverage to low-income adults, families, seniors, individuals with disabilities, pregnant women, and foster youth. DHCS is the state administrative entity, but county human services agencies are responsible for administering Medi-Cal at the local level. Under Medi-Cal, recipients can receive dental, vision, long term care, behavior health, and other benefits. As of January of this year, DHCS reported that there were over 13.5 million individuals certified as eligible for Medi-Cal. To qualify based on income, individuals must have a modified adjusted gross income (MAGI) that is below 138% of the Federal Poverty Level. Individuals enrolled in CalFresh, CalWORKs, foster care or adoption assistance, refugee assistance, and Supplemental Security Income/State Supplemental Payment (SSI/SSP) can also get Medi-Cal.
Federal regulations (42 C.F.R. 435.96) require Medicaid (in California, Medi-Cal) eligibility to be redetermined once every 12 months; conforming state law requires redeterminations of eligibility for Medi-Cal beneficiaries every 12 months. The redetermination process typically focuses on verification of a beneficiary’s income. If a county human services agency, which administers Medi-Cal, is unable to determine an individual’s continued eligibility based on information it has obtained, the beneficiary will be asked to remit an annual redetermination form, which the individual must be provided not less than 60 days prior to the beneficiary’s annual redetermination date; the individual must return the form within 60 days from the date it was sent. The county will terminate eligibility for Medi-Cal benefits, after providing timely notice, if the individual does not respond to a written request for information within 60 days from the date the form is sent.
Need for this bill: According to the author, “Individuals with developmental disabilities are a particularly vulnerable population. They often have complex healthcare needs that require specialized medical supervision. During the annual Medi-Cal redetermination process, some of these individuals lose coverage largely as a result of bureaucratic barriers to a swift reauthorization process, putting them at high risk for negative health outcomes given their lack of access. These individuals by and large have few assets and little to no income, already placing incredible burdens on their families. Add on top of that a loss of insurance coverage and the threat to the patient’s health and family’s financial solvency becomes imminent. Unnecessary hospitalizations are far more likely because patients only have the emergency room for medical care, leading to increased costs for both the state and family. Legislation is needed to protect this vulnerable and often forgotten population’s access to healthcare.”
Recommended amendments: In order to provide clarification of processes, committee staff recommends the following amendments beginning on line 37 of page 16 of the bill:
35
(g) (1) In the case of an annual eligibility redetermination of
36
a beneficiary who has a developmental disability, as defined in
37
subdivision (a) of Section 4512, and who receives is determined to be eligible for services by a
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regional center pursuant to Chapter 5 (commencing with Section
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4620) of Division 4.5, the county shall gather utilize information available
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to the county that is relevant to the beneficiary’s Medi-Cal
P17 1
eligibility prior to contacting the beneficiary pursuant to
2
subdivision (e). The county shall evaluate information received in available to it from
3
the last 36 months and consider it as relevant as it would consider information from the last 12 months by the regional center from the consumer, as
4
defined in subdivision (d) of Section 4512, to make a determination
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of continued eligibility without requesting additional information
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from the beneficiary.
SECOND COMMITTEE OF REFERENCE. This bill was previously heard in the Assembly Health Committee on April 17, 2018 and was approved on a 15-0 vote.
REGISTERED SUPPORT / OPPOSITION:
Support: Association of Regional Center Agencies
Opposition: None on file.
Analysis Prepared by: Daphne Hunt / HUM. S. / (916) 319-2089
Date of Hearing: April 17, 2018
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
ABPCA Bill Id:AB 2331
Author:(Weber) – As Amended Ver: April 11, 2018
SUBJECT: Medi-Cal: redetermination: developmental disability.
SUMMARY: Establishes a new mechanism for annual redetermination of Medi-Cal eligibility for a beneficiary with a developmental disability. Requires a county, prior to contacting a beneficiary for the annual redetermination, to gather information, including information obtained by a regional center during intake and assessment within the last 36 months and use this information to make a determination of continuous eligibility without requesting additional information from the beneficiary. Specifically, this bill:
- Allows the disclosure of information and records obtained in the course of intake, assessment and services to persons with developmental disabilities to authorized personnel who are employed by either a county or the Department of Health Care Services (DHCS) to perform determinations or redeterminations of eligibility for Medi-Cal beneficiaries, as specified. Requires DHCS to maintain the confidentiality of any information provided to it by the Department of Developmental Services (DDS) for purposes of the Medi-Cal program.
- Requires at the time of intake in the regional centers, the individual, or where appropriate, the parents, legal guardian or conservator, to disclose whether the individual is enrolled in Medi-Cal and provide a copy of any health benefit card under which the consumer is eligible to receive Medi-Cal services.
- Requires information related to a consumer’s eligibility for Medi-Cal to be released by the regional center or DDS to the county or DHCS for the purposes of enabling the county to perform determinations or redeterminations for Medi-Cal beneficiaries, as specified.
- Requires a county, prior to contacting a beneficiary for the annual redeterminations of Medi-Cal eligibility, to gather information received at intake as specified in 1) above within the last 36 months. Requires a county to evaluate information received in the last 36 months by the regional center from the consumer, to make a determination of continued eligibility without requesting additional information from the beneficiary.
- Provides that if a county is unable to determine continuous eligibility pursuant to 1) above, to inform the beneficiary and provide the beneficiary with an annual renewal form at least 60 days before the beneficiary’s annual redetermination date that is prepopulated with information that the county has obtained and that identifies any additional information needed by the county to determine eligibility. Conforms to existing requirements the information included in the form.
- Requires DDS to disseminate to the counties and DHCS, on a regular basis to be determined by DHCS, a list identifying consumers receiving services at regional centers.
- Requires a consumer to maintain Medi-Cal eligibility during the redetermination consistent with existing requirements.
- Implements this bill only if and to the extent that federal financial participation (FFP) is available and any necessary federal approvals have been obtained.
- Makes other technical and conforming changes.
EXISTING LAW:
- Establishes the Medi-Cal program, administered by DHCS, under which low income individuals are eligible for medical coverage.
- Requires a county to perform redeterminations of eligibility for Medi-Cal beneficiaries every 12 months and to promptly redetermine eligibility whenever the county receives information about changes in a beneficiary’s circumstances that may affect eligibility for Medi-Cal benefits.
- Requires Medi-Cal eligibility to continue during the redetermination process and prohibits DHCS from terminating a beneficiary’s Medi-Cal eligibility until the county makes a specific determination based on facts clearly demonstrating that the beneficiary is no longer eligible for Medi-Cal benefits, as specified.
- Establishes DDS to, among other functions, administer the Lanterman Developmental Disabilities Act which gives people with developmental disabilities the right to services and supports that enable them to live a more independent and normal life.
- Defines developmental disability as a disability that originates before an individual attains 18 years of age; continues, or can be expected to continue, indefinitely; and constitutes a substantial disability for that individual. Includes in this definition intellectual disability, cerebral palsy, epilepsy, autism, and disabling conditions found to be closely related to intellectual disability or to require treatment similar to that required for individuals with an intellectual disability, but shall not include other handicapping conditions that are solely physical in nature.
- Defines services and supports for persons with developmental disabilities as specialized services and supports or special adaptations of generic services and supports directed toward the alleviation of a developmental disability or toward the social, personal, physical, or economic habilitation or rehabilitation of an individual with a developmental disability, or toward the achievement and maintenance of independent, productive, and normal lives.
- Requires the state to contract with regional centers to assist in delivering services and supports best suited to individuals with developmental disability.
- Requires all information and records obtained by a regional center in the course of providing intake and assessment, for specified services to persons with developmental disabilities to be confidential. Specifies the circumstances when disclosure is authorized.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, individuals with developmental disabilities are a particularly vulnerable population. There are approximately 330,000 individuals statewide receiving services from regional centers. They often have complex healthcare needs that require specialized medical supervision. During the annual Medi-Cal redetermination process, some of these beneficiaries, nearly all of whom will eventually be redetermined to be eligible, lose coverage for a significant period of time, putting them at high risk for negative health outcomes given their lack of access. These individuals by and large have few assets and little to no income, already placing incredible burdens on their families. Add on to that a loss of insurance coverage and the threat to the patient’s health and family’s financial solvency becomes imminent. Hospitalizations are more likely because patients only have the emergency room for medical care, leading to increased costs for both the state and family. The author concludes that legislation is needed to protect this vulnerable and often forgotten population’s access to healthcare. This bill will decrease the burden of annual redeterminations for developmentally disabled beneficiaries and their families by expanding the amount of information a county uses to determine eligibility.
- BACKGROUND.
- Annual Redeterminations. Title 42, Code of Federal Regulations, Section 435.916 (a) requires counties to redetermine eligibility of Medicaid (Medi-Cal in California) clients with respect to circumstances that may change at least once every 12 months. State law conforms to federal law by requiring redetermination to be completed annually and may be required at other times in accordance with general standards established by DHCS. County human services agencies administer the Medi-Cal program on behalf of the state. Counties are responsible for verifying eligibility, including annual redeterminations. For initial eligibility to qualify for Medi-Cal, applicants must comply with certain requirements including providing proof of residency, and verification of income and assets. Once qualified, a Medi-Cal beneficiary must comply with annual redetermination to continue eligibility into the program. During redeterminations, a beneficiary must not be requested to provide information that is not relevant to ongoing eligibility or that has already been provided with respect to eligibility criteria not subject to change (i.e. date of birth, social security number, or U.S. citizenship). Generally, the redetermination process focuses on beneficiary income verification. If the county is unable to determine continued eligibility based on information it has obtained, the beneficiary will be provided an annual redetermination form, at least 60 days before the beneficiary’s annual redetermination date. The form is prepopulated with information that the county has obtained and that identifies any additional information needed by the county to determine eligibility. A beneficiary must return the form within 60 days of the date the form is sent to the beneficiary. A beneficiary may respond to the county via the Internet, mail, telephone, in person or through other commonly available electronic means if available to the county. A beneficiary may also return the form in person or via mail. If the beneficiary does not respond to a written request for information within 60 days from the date the form is sent, the county will terminate eligibility for Medi-Cal benefits after timely notice is provided.
- The Home and Community-Based Services for the Developmentally Disabled (HCBS-DD) Waiver. Since 1983, California has administered a Medicaid 1915(c) HCBS-DD Waiver for individuals with developmental disabilities. The HCBS-DD Waiver is administered by DDS and authorizes home and community-based services for developmentally disabled persons who are regional center consumers. Twenty-one regional centers throughout California purchase and coordinate services and supports for individuals with developmental disabilities. The HCBS-DD Waiver services make it possible for consumers to live in the community instead of an intermediate care facility for the developmentally disabled or a state developmental center. The HCBS-DD Waiver is currently the largest HCBS waiver in California as well as the nation. The HCBS-DD Waiver also provides a federal funding match for services that are necessary for achieving individual goals.
- SUPPORT. The Local Health Plans of California supports a prior version of this bill and states that requiring less frequent redetermination will help Medi-Cal beneficiaries with developmental disabilities maintain consistent coverage and care. Western Center on Law & Poverty (WCLP) contends that this bill is a necessary step to ensure that Californians with developmental disabilities do not experience breaks in aid by minimizing the paperwork required by counties and beneficiaries. WCLP points out that the population on Medi-Cal who are eligible for services at a regional center are not likely to have substantial changes to their eligibility from year to year given the requirement that they have a “substantial disability.”
- PREVIOUS LEGISLATION. SB 1X 1 (Ed Hernandez and Steinberg), Chapter 4, Statutes of 2013-14 First Extraordinary Session, implemented the federal Patient Protection and Affordable Care Act in California. SB 1X 1, among various provisions, eliminated the semi-annual status report requirement for redetermination and instead adopted the 12 months redetermination pursuant to federal law. SB 1X 1 also established requirements for counties prior to terminating eligibility for Medi-Cal.
- POLICY COMMENTS.
- Federal approval is necessary. This bill requires counties to use information obtained in the last 36 months for an annual Medi-Cal redetermination. As stated above, federal law requires redetermination at least once every 12 months. Thus, a federal approval is necessary and implementation of this bill is contingent on obtaining federal approval and FFP.
- County implementation. Currently, counties cannot easily determine which of the Medi-Cal population could qualify under this bill because there is no uniform way of identifying the developmentally disabled population. Although this bill would require DDS to provide a list that identifies these consumers, it is unclear if this process is an efficient mechanism or an additional burden on counties.
- Alternative approach. In an effort to assist Medi-Cal recipients with developmental disabilities and since this bill would require federal approval, the Committee may wish to instead require DHCS to establish a stakeholder process to review the current redetermination procedures and determine how to streamline the process.
- DOUBLE-REFERRAL. This bill is double referred; should it pass out of this committee, it will be referred to Assembly Human Services Committee.
REGISTERED SUPPORT / OPPOSITION:
Support
Association of Regional Center Agencies
Local Health Plans of California
National Association of Social Workers, California Chapter
State Council on Developmental Disabilities
Western Center on Law & Poverty
Opposition
None on file.
Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097
Bill Author
Bill Co-Author(s):