reglab/housing_qa huggingface dataset:
CA Welf & Inst Code § 14482 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8 - Prepaid Plans|ARTICLE 6 - Conflict of Interest|Section 14482.

14482.  No prepaid health plan shall contract with any subcontractor other than the plan’s subsidiary corporation, its parent corporation, or another subsidiary of its parent corporation, or an affiliate of the prepaid health plan whose financial statements are consolidated with that of the prepaid health plan at the time of the annual audit by the independent auditors of the plan and when the quarterly and annual financial statements are filed with the Director of the Department of Managed Health Care, if any of the following persons connected with the plan have a substantial financial interest, as defined by Section 14478, in such subcontractor:(a) Any person also having a substantial financial interest in the plan.(b) Any director, officer, partner, trustee, or employee of the plan.(c) Any member of the immediate family of any person designated in (a) or (b).(Amended by Stats. 2000, Ch. 857, Sec. 97. Effective January 1, 2001.)
CA Welf & Inst Code § 14490 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8 - Prepaid Plans|ARTICLE 7 - Pilot Programs|Section 14490.

14490.  In providing benefits under this chapter and Chapter 7 (commencing with Section 14000), the director shall aggressively seek the development of alternative forms of financing and delivering health care services. In carrying out the intent of this article, the director shall contract with institutional providers, counties, or other organizations to establish pilot programs that demonstrate the value, or lack thereof, of such a program in delivering or financing health care services in such a manner. Each pilot program shall be for a specified duration not to exceed five years, and each pilot program shall be evaluated annually for its efficiency, effectiveness, and quality.Upon a finding by the director that a pilot program contributes substantially to the availability of high quality health services and that those services are cost-effective, the director shall enter into a contract for a period of up to five years.Where the director recommends implementation of a pilot program on a permanent basis, but finds that he or she is not able to implement on a permanent basis that program immediately upon conclusion of the program’s term, he or she may extend the duration of the pilot program until the evaluation or permanent implementation can be accomplished. The extension shall be for a term not in excess of one year, but may be renewed for additional one-year terms, provided that the director has completed an evaluation to include findings that would qualify an extension.(Amended by Stats. 1997, Ch. 17, Sec. 154. Effective January 1, 1998.)
CA Welf & Inst Code § 14491 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8 - Prepaid Plans|ARTICLE 7 - Pilot Programs|Section 14491.

14491.  The director shall pursue the feasibility of establishing the following as pilot programs:(a) A capitated, risk-assuming contract with one or more regional fiscal intermediaries.(b) A capitated, risk-assuming contract with acute care hospitals within a county or region.(c) A capitated, risk-assuming contract with one or more organizations which provide payment to a specified class or classes of providers.For purposes of this section, “risk-assuming” means the pilot program contractor agrees to assume the risk of utilization of services or costs of services, or both.(Added by Stats. 1977, Ch. 1036.)
CA Welf & Inst Code § 14493 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8 - Prepaid Plans|ARTICLE 7 - Pilot Programs|Section 14493.

14493.  The director shall also consider programs which demonstrate an innovative and economical use of health personnel and are approved pursuant to Article 18 (commencing with Section 429.70), Chapter 2, Part 1, Division 1 of the Health and Safety Code.(Added by Stats. 1977, Ch. 1036.)
CA Welf & Inst Code § 14494 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8 - Prepaid Plans|ARTICLE 7 - Pilot Programs|Section 14494.

14494.  The director may enter into other contracts under this article which do one or more of the following:(a) Demonstrate an innovative and economical use of health personnel.(b) Emphasize preventive care.(c) Stress new methods for controlling utilization of services.(d) Stress new methods of reviewing provider competency or quality of care.(e) Stress a more economical organization of health care resources and delivery systems.(f) Provide an incentive to beneficiaries to seek the most economical level of care.(g) Demonstrate innovative methods for health care financing, such as prospective budgeting in regard to enrolled population or volume of services.(h) Test or demonstrate the feasibility of allowing California citizens to purchase Medi-Cal coverage at a premium rate determined by the department on an actuarial basis.(Added by Stats. 1977, Ch. 1036.)
CA Welf & Inst Code § 14495 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8 - Prepaid Plans|ARTICLE 7 - Pilot Programs|Section 14495.

14495.  In establishing pilot programs, the director may do the following:(a) Provide benefits based on class of recipient, class of benefit, geographical area, or any other reasonable classification.(b) Modify, to the extent permitted by federal law, the scope and duration of benefits provided by Section 14132. The extent of coverage may be limited to a fixed number of days or to amount or duration of services.(c) Modify, to the extent permitted by federal law, Medi-Cal eligibility determination processes or criteria.(d) Allow for the provision of Medi-Cal benefits on a prepaid basis in a given geographical area exclusively by the pilot program.(e) Assign persons eligible for Medi-Cal benefits to a pilot program or a prepaid health plan on a pilot basis, provided such persons shall be entitled to disenroll for any cause for a period of 30 days following the effective date of enrollment and to receive a Medi-Cal card pursuant to Section 14017.(Added by Stats. 1977, Ch. 1036.)
CA Welf & Inst Code § 14496 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8 - Prepaid Plans|ARTICLE 7 - Pilot Programs|Section 14496.

14496.  (a) Alternate methods of payment for a pilot program may include, but shall not be limited to, a prospectively negotiated reimbursement rate, fee-for-service, retainer, capitation, or other basis.(b) In order to implement expeditiously the budgeting decisions of the Legislature, the director shall, to the extent permitted by federal law, adopt regulations setting rates payable to providers which reflect such decisions 30 days after the enactment of the Budget Act and of any other appropriation which changes the level of funding for Medi-Cal services. The proposed regulations shall be submitted to the Department of Finance five days prior to the date of adoption. With the written approval of the Department of Finance, the director shall adopt such regulations as emergency regulations in accordance with the provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340), Part 1, Division 3, Title 2 of the Government Code). For purposes of such act, the adoption of such regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health, and safety or general welfare.(c) In order to implement expeditiously the budgeting decisions of the Legislature, the director and the contractor shall, to the extent permitted by federal law, amend the pilot project contract to reflect such decisions 60 days after the enactment of the Budget Act and of any other appropriation which changes the level of funding for Medi-Cal services. Any approvals, ratifications, reviews, or analyses of such amendments required to be undertaken by any state agency or state department shall be completed within the 60-day period specified in this subdivision.(Amended by Stats. 1990, Ch. 1516, Sec. 3. Effective September 30, 1990.)
CA Welf & Inst Code § 14497 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8 - Prepaid Plans|ARTICLE 7 - Pilot Programs|Section 14497.

14497.  The director shall call a public hearing pursuant to Section 14300 prior to entering into or renewing a pilot program. The director shall make available to the public a statement of objectives, program proposal, pilot program contract, and other details regarding the pilot program not less than five days prior to the public hearing.(Added by Stats. 1977, Ch. 1036.)
CA Welf & Inst Code § 14499.6 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8 - Prepaid Plans|ARTICLE 7 - Pilot Programs|Section 14499.6.

14499.6.  (a) The Santa Barbara Regional Health Authority may arrange with out-of-county Selective Provider Contracting Program hospitals that have negotiated hospital contracts and per diem rates under Article 5.1 (commencing with Section 14165) of Chapter 7, to provide medically justified emergency services or to provide specialized hospital services not available within Santa Barbara County to Medi-Cal beneficiaries who reside in Santa Barbara County. The authority may arrange medically justified inpatient hospital services with out-of-county program hospitals for those beneficiaries whose county of residence for purposes of eligibility determination is Santa Barbara, but who for medical or legal reasons physically reside in a county other than Santa Barbara.(b) The out-of-county program hospitals shall not charge the authority more than their program negotiated rates when providing hospital services to authority patients under this section, except as provided in subdivision (c).(c) In cases where an out-of-county program hospital can demonstrate that the cost of the services it is rendering to authority patients was not contemplated in the case mix and acuity assumptions on which the program rates are based, the program hospital and the authority shall negotiate in good faith equitable rates for payment for the provision of hospital services to authority patients. The established program rate shall serve as the base for those negotiations.(d) (1) Notwithstanding any other provision of law, any records maintained by the authority which would enable a determination to be made regarding rates negotiated pursuant to Article 5.1 (commencing with Section 14165) of Chapter 7, shall be exempt from the Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code).(2) The authority shall establish guidelines to ensure that these rates are maintained as confidential records and that access to these records is restricted.(3) The authority shall submit the established guidelines to the department for approval.(Amended by Stats. 1993, Ch. 263, Sec. 6. Effective January 1, 1994. Superseded on January 1, 2023; see amendment by Stats. 2021, Ch. 615.)
CA Welf & Inst Code § 14499.6 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8 - Prepaid Plans|ARTICLE 7 - Pilot Programs|Section 14499.6.

14499.6.  (a) The Santa Barbara Regional Health Authority may arrange with out-of-county Selective Provider Contracting Program hospitals that have negotiated hospital contracts and per diem rates under Article 5.1 (commencing with Section 14165) of Chapter 7, to provide medically justified emergency services or to provide specialized hospital services not available within Santa Barbara County to Medi-Cal beneficiaries who reside in Santa Barbara County. The authority may arrange medically justified inpatient hospital services with out-of-county program hospitals for those beneficiaries whose county of residence for purposes of eligibility determination is Santa Barbara, but who for medical or legal reasons physically reside in a county other than Santa Barbara.(b) The out-of-county program hospitals shall not charge the authority more than their program negotiated rates when providing hospital services to authority patients under this section, except as provided in subdivision (c).(c) In cases where an out-of-county program hospital can demonstrate that the cost of the services it is rendering to authority patients was not contemplated in the case mix and acuity assumptions on which the program rates are based, the program hospital and the authority shall negotiate in good faith equitable rates for payment for the provision of hospital services to authority patients. The established program rate shall serve as the base for those negotiations.(d) (1) Notwithstanding any other provision of law, any records maintained by the authority that would enable a determination to be made regarding rates negotiated pursuant to Article 5.1 (commencing with Section 14165) of Chapter 7, shall be exempt from the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).(2) The authority shall establish guidelines to ensure that these rates are maintained as confidential records and that access to these records is restricted.(3) The authority shall submit the established guidelines to the department for approval.(Amended by Stats. 2021, Ch. 615, Sec. 458. (AB 474) Effective January 1, 2022. Operative January 1, 2023, pursuant to Sec. 463 of Stats. 2021, Ch. 615.)
CA Welf & Inst Code § 14499.7 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8 - Prepaid Plans|ARTICLE 8 - Medi-Cal At-Risk Fiscal Intermediaries|Section 14499.7.

14499.7.  The department may contract with one or more fiscal intermediaries in order to pay for benefits authorized under this chapter and Chapter 7 (commencing with Section 14000). Contracts entered into pursuant to this article may be awarded on a bid or nonbid basis.(Added by Stats. 1985, Ch. 1579, Sec. 4.)
CA Welf & Inst Code § 14499.71 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8 - Prepaid Plans|ARTICLE 8 - Medi-Cal At-Risk Fiscal Intermediaries|Section 14499.71.

14499.71.  For the purposes of this article, “fiscal intermediary” means an entity that agrees to pay for covered services provided to Medi-Cal eligibles in exchange for a premium, subscription charge, or capitation payment; to assume an underwriting risk; and is licensed by the Director of the Department of Managed Health Care under the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code).(Amended by Stats. 2015, Ch. 455, Sec. 54. (SB 804) Effective January 1, 2016.)
CA Welf & Inst Code § 14499.73 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8 - Prepaid Plans|ARTICLE 8 - Medi-Cal At-Risk Fiscal Intermediaries|Section 14499.73.

14499.73.  A contract entered into under this article shall provide that a fiscal intermediary meets both of the following criteria:(a) The fiscal intermediary shall provide or arrange for an adequate number of primary care physicians and supportive specialty care physicians.(b) The fiscal intermediary shall implement a management and information reporting system in order to determine the costs of each type of health care service rendered to Medi-Cal recipients.(Added by Stats. 1985, Ch. 1579, Sec. 4.)
CA Welf & Inst Code § 14499.74 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8 - Prepaid Plans|ARTICLE 8 - Medi-Cal At-Risk Fiscal Intermediaries|Section 14499.74.

14499.74.  In determining the capitated rates to be paid to a fiscal intermediary during the first year of contracting under this article, the department shall utilize an acceptable actuarial process and historical data concerning Medi-Cal recipients in the geographical area which will, or is being, served by the fiscal intermediary. During the remaining years of the contract with the fiscal intermediary, the department shall utilize data concerning Medi-Cal expenditures for delivery of services based on the fee-for-service experience in comparable geographic areas. The capitated rates shall not exceed the total per capita amount (including the cost of adjustments to provide actuarial equivalence) which would be payable for all services and requirements covered under the fiscal intermediary contract adopted pursuant to this article if all those services and requirements were to be furnished to Medi-Cal beneficiaries under the fee-for-service Medi-Cal program provided for by Chapter 7 (commencing with Section 14000).(Added by Stats. 1985, Ch. 1579, Sec. 4.)
CA Welf & Inst Code § 14499.75 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8 - Prepaid Plans|ARTICLE 8 - Medi-Cal At-Risk Fiscal Intermediaries|Section 14499.75.

14499.75.  A fiscal intermediary may contract for the provision of services with any provider who would be eligible to provide services if services were to be provided on a fee-for-service basis without the use of a fiscal intermediary pursuant to this article.(Added by Stats. 1985, Ch. 1579, Sec. 4.)
CA Welf & Inst Code § 14499.77 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8 - Prepaid Plans|ARTICLE 8 - Medi-Cal At-Risk Fiscal Intermediaries|Section 14499.77.

14499.77.  All services, except those specified for exclusion by the department, received by Medi-Cal recipients residing in the geographical area served by the fiscal intermediary shall be paid for by the fiscal intermediary. Services shall be provided only by providers which have entered into agreements with the fiscal intermediary, unless authorized by the fiscal intermediary.(Added by Stats. 1985, Ch. 1579, Sec. 4.)
CA Welf & Inst Code § 14520 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8.7 - Adult Day Health Care Programs|ARTICLE 1 - General Provisions|Section 14520.

14520.  This chapter shall be known and may be cited as the Adult Day Health Medi-Cal Law.(Added by Stats. 1977, Ch. 1066.)
CA Welf & Inst Code § 14521 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8.7 - Adult Day Health Care Programs|ARTICLE 1 - General Provisions|Section 14521.

14521.  It is the intent of the Legislature in enacting this chapter to establish adult day health care as a Medi-Cal benefit and allow persons eligible to receive the benefits under Chapter 7 (commencing with Section 14000) of this part, and who have medical or psychiatric impairments, to receive adult day health care services. It is the intent of the Legislature in authorizing this Medi-Cal benefit to establish and continue a community-based system of quality adult day health care services that will accomplish all of the following:(a) Ensure that elderly persons and adults with disabilities will not be institutionalized prematurely and inappropriately.(b) Provide appropriate health and social services designed to maintain elderly persons in their own communities.(c) Establish adult day health care centers in locations easily accessible to persons who are economically disadvantaged.(d) Encourage the establishment of rural alternative adult day health care centers that are designed to make adult day health care accessible to elderly persons and adults with disabilities living in rural areas.(Amended by Stats. 2008, Ch. 648, Sec. 7. Effective January 1, 2009.)
CA Welf & Inst Code § 14521.1 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8.7 - Adult Day Health Care Programs|ARTICLE 1 - General Provisions|Section 14521.1.

14521.1.   If a conflict exists between existing regulations and adult day health care laws in effect on and after January 1, 2007, the department shall, until new regulations are adopted, issue guidance to adult day health care providers through provider bulletins to clarify the adult day health care laws and regulations that are in effect.(Amended by Stats. 2012, Ch. 728, Sec. 208. (SB 71) Effective January 1, 2013.)
CA Welf & Inst Code § 14522 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8.7 - Adult Day Health Care Programs|ARTICLE 1 - General Provisions|Section 14522.

14522.  Unless the context otherwise requires, the definitions contained in Part 7 (commencing with Section 14000) of this part and in Chapter 3.5 (commencing with Section 1570) of Division 2 of the Health and Safety Code shall govern the construction of this chapter.(Added by Stats. 1977, Ch. 1066.)
CA Welf & Inst Code § 14522.3 (2021)
2021 California Code|Welfare and Institutions Code - WIC|DIVISION 9 - PUBLIC SOCIAL SERVICES|PART 3 - AID AND MEDICAL ASSISTANCE|CHAPTER 8.7 - Adult Day Health Care Programs|ARTICLE 1 - General Provisions|Section 14522.3.

14522.3.  The following definitions shall apply for the purposes of this chapter:(a) “Activities of daily living” (ADL) means activities performed by the participant for essential living purposes, including bathing, dressing, self-feeding, toileting, ambulation, and transferring.(b) “Instrumental activities of daily living” (IADL) means functions or tasks of independent living, including hygiene, medication management, transportation, money management, shopping, meal preparation, laundry, accessing resources, and housework.(c) “Personal health care provider” means the participant’s personal physician, physician’s assistant, or nurse practitioner, operating within his or her scope of practice.(d) “Care coordination” means the process of obtaining information from, or providing information to, the participant, the participant’s family, the participant’s primary health care provider, or social services agencies to facilitate the delivery of services designed to meet the needs of the participant, as identified by one or more members of the multidisciplinary team.(e) “Facilitated participation” means an interaction to support a participant’s involvement in a group or individual activity, whether or not the participant takes active part in the activity itself.(f) “Group work” means a social work service in which a variety of therapeutic methods are applied within a small group setting to promote participants’ self-expression and positive adaptation to their environment.(g) “Professional nursing” means services provided by a registered nurse or licensed vocational nurse functioning within his or her scope of practice.(h) “Psychosocial” means a participant’s psychological status in relation to the participant’s social and physical environment.(Added by Stats. 2006, Ch. 691, Sec. 2. Effective January 1, 2007. Repealed as of date prescribed in Section 14522.4. After repeal, see related provisions in Section 14522.4.)