California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 1 - Department Administration › Article 2 - Administration › Section 1010 - Consumer Participation Program

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Intent and Regulatory Purpose.
This regulation, in accordance with section
					 1348.9 of the Health & Safety
					 Code, establishes the Department's procedure and criteria, for determining
					 discretionary awards of reasonable Advocacy and Witness Fees on the basis that
					 a Participant Represent the Interests of Consumers in a Proceeding and has made
					 a Substantial Contribution to the Department in its deliberations. Nothing in
					 this article shall be construed to require any person or organization to seek
					 compensation pursuant to this article.
(b) Definitions.
For purposes of this section, the following definitions
					 shall apply:
(1) "Advocacy and Witness
				  Fees" means the amount of compensation a Participant requests for expenses
				  incurred through representing the interests of consumers in any proceeding
				  relating to legislatively authorized guidance, the adoption of any regulation,
				  or the issuance of an order or decision by the Director, including a decision
				  not to adopt a regulation or take an action. The rate used to determine
				  Advocacy and Witness Fees shall not exceed the Market Rate as defined in this
				  section.
(2) "Advocacy Award" means
				  the amount awarded to a Participant, which may be all or part of the Advocacy
				  and Witness Fees requested. The Advocacy Award shall be the amount the
				  Designated Hearing Officer determines to be reasonably incurred by the
				  Participant while representing the interests of consumers during a Proceeding.
				  An approved Participant may request an Interim Advocacy Award and/or final
				  payment of the Advocacy Award consistent with the provisions below.
(3) "Application for an Advocacy Award" is
				  the request for Advocacy and Witness Fees filed by a Participant whose Petition
				  to Participate has been granted. The information that must be included in the
				  Application for an Advocacy Award is outlined in subsection (d).
(4) "Designated Hearing Officer" will be the
				  Director of the Department or his or her designee. The Designated Hearing
				  Officer shall determine the Advocacy Award to be awarded to a Participant for a
				  particular Proceeding. An appeal of an Advocacy Award or denial of an
				  Application for an Advocacy Award will be submitted to the Director.
(5) "Interim Advocacy Award" is the amount
				  the Designated Hearing Officer awards as a result of a request for Interim
				  Compensation. An Interim Advocacy Award does not require or preclude the
				  Designated Hearing Officer from granting an Advocacy Award at a later stage of
				  the Proceeding.
(6) "Interim
				  Compensation" is a one-time request for Advocacy and Witness Fees made by a
				  Participant. The purpose of Interim Compensation is to allow a Participant to
				  request compensation although a Proceeding is ongoing and the Participant may
				  incur future costs. The Participant requesting Interim Compensation must still
				  file a Petition to Participate and an Application for an Advocacy Award. A
				  request for Interim Compensation does not require or preclude a Participant
				  from requesting additional Advocacy and Witness Fees at a later stage of the
				  Proceeding.
(7) "Legislatively
				  Authorized Guidance" means guidance issued by the Department that has been
				  exempted from the processes mandated by the Administrative Procedures
				  Act.
(8) "Market Rate" is the
				  prevailing rate for comparable services in the private sector in the Los
				  Angeles and San Francisco Bay Areas. The rate a Participant uses to determine
				  the Advocacy and Witness Fees shall not exceed the Market Rate.
(9) "Participant" means a person or
				  organization whose Petition to Participate, filed under subsection (c) has been
				  granted by the Designated Hearing Officer.
(10) "Petition to Participate" is the request
				  by a person or organization to participate in a Proceeding and seek an award of
				  Advocacy and Witness Fees that is submitted to the Director. The information
				  that must be included in the Petition to Participate is outlined in subsection
				  (c).
(11) "Proceeding" mean an
				  administrative decision-making process relating to legislatively authorized
				  guidance, the adoption of any regulation, or the issuance of an order or
				  decision by the Director, including a decision not to adopt a regulation or
				  take an action. For purposes of this article, an order or decision shall not
				  include the resolution of individual grievances, complaints, or
				  cases.
(12) "Represents the
				  Interests of Consumers" means the Participant has a record of advocacy on
				  behalf of health care consumers in administrative or legislative proceedings. A
				  Participant that represents, in whole or in part, any entity regulated by the
				  Department shall not be eligible for compensation.
(13) "Submit to the Director" means to send
				  material to The Director electronically at dmhc.ca.gov or via regular mail
				  addressed to The Director, Department of Managed Health Care, 980 9th Street,
				  Suite 500, Sacramento, CA 95814.
(14) "Substantial Contribution" means the
				  Participant significantly assisted the Department during a Proceeding by
				  presenting relevant issues, evidence, or arguments which were helpful and
				  seriously considered, and the Participant's involvement resulted in more
				  relevant, credible, and non-frivolous information being available to the
				  Director.