2023 California Code › Welfare and Institutions Code - WIC › DIVISION 9 - PUBLIC SOCIAL SERVICES › PART 3 - AID AND MEDICAL ASSISTANCE › CHAPTER 7 - Basic Health Care › ARTICLE 4.3 - Long-Term Care Integration Pilot Program › Section 14139.3.

14139.3. (a) Pilot project sites may be comprised of a single county, a multicounty unit, or a subcounty unit.
(b) Each selected site shall do all of the following:
(1) Establish a consolidated long-term care services fund that shall accommodate state and federal fiscal and auditing requirements, shall be used solely for the purposes described in this article, and shall not be used for any county pooled investment fund.
(2) Identify a local entity, that may be either a governmental entity or a not-for-profit private agency, to administer the fund. The local entity may be one that already exists, or may be established for the express purpose of administering the fund. This agency shall be designated as the long-term care services agency and shall contract with the department to carry out this article.
(3) Develop and provide to the department an administrative action plan that shall include, but is not limited to:
(A) A complete description of the covered scope of services and programs to be integrated.
(B) A complete description of the proposed long-term care delivery system and how it will improve system efficiency and enhance service quality.
(C) Demonstration of a willingness and commitment by the long-term care services agency to work with local community groups, providers, and consumers to obtain their input.
(D) Proposed measurable performance outcomes that the pilot program is designed to achieve.
(E) A description of the expected impact on current program services to Medi-Cal eligible beneficiaries and consumers of non-Medi-Cal services included in the integrated system.
(F) Assurance of minimal disruption to current recipients of long-term care services during the phase-in of the pilot project.
(G) Reasonable assurance that services provided will be responsive to the religious, cultural, and language needs of beneficiaries.
(H) Assurances that providers who serve the needs of special populations such as religious and cultural groups or residents of multilevel facilities as defined in paragraph (9) of subdivision (d) of Section 15432 of the Government Code and community care retirement communities as defined in subdivision (u) of Section 1771 of the Health and Safety Code, will be able to continue to serve those persons when willing to contract under the same terms and conditions as similar providers.
(I) Specific alternative concepts, requirements, staffing patterns, or methods for providing services under the pilot project.
(J) A process to assure that Medi-Cal dollars are appropriately expended in accordance with federal requirements.
(K) A description of how the pilot project site will maintain adequate fiscal control and ensure quality of care for beneficiaries.
(L) A description of how the pilot project site will coordinate, relate to, or integrate with Medi-Cal managed care plans, local managed care plans, and other organizations which provide services not part of the pilot project.
(M) A proposed timeline for planning and startup of the pilot project.
(N) An estimate of costs and savings.
(O) Demonstration of the financial viability of the plan.
(c) The administrative action plan shall reflect a planning process that includes long-term care consumers, their families, and organizations that represent them, organizations that provide long-term care services, and representatives of employees who deliver direct long-term care services. The planning process may include, but is not limited to, the members of the local advisory committee required pursuant to Section 14139.31.
(d) The administrative action plan shall receive the approval of the county board of supervisors before it is submitted to the department for final state approval. The board of supervisors shall present evidence of the commitment to the administrative action plan of all publicly funded agencies that currently serve consumers who will be eligible under the pilot project, and all publicly and nonpublicly funded agencies that will be responsible for providing services under the pilot project. This evidence may include resolutions adopted by agency governing bodies, memoranda of understanding, or other agreements pertinent to the implementation of the plan.
(Added by Stats. 1995, Ch. 875, Sec. 1. Effective January 1, 1996.)