California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 1 - Exemptions › Section 1300.43.14 - Employee Assistance Programs

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A health care service plan which,
				  pursuant to a contract with an employer, labor union or licensing board within
				  the Department of Consumer Affairs, consults with employees, members of their
				  families or licensees of such board to identify their health, mental health,
				  alcohol and substance abuse problems and refer them to health care providers
				  and other community resources for counseling, therapy or treatment, is exempt
				  from the provisions of the Act (other than Sections
				  1360,
				  1360.1,
				  1368 and
				  1381, relating to advertising,
				  client grievance procedures and the inspection of records by the Director) if
				  the plan complies with each of the following provisions, and the contracts of a
				  licensed health care service plan are exempt from the provisions of the Act if
				  they comply with each of the following provisions:
(1) The plan has filed a notice with the
				  Director as provided in subsection (c) within the preceding 24
				  months.
(2) The purpose of the
				  contract, insofar as it relates to the provision of services to clients is
				  either
(A) to maintain or improve employee
				  efficiency through identification and referrals for counseling, treatment or
				  therapy, in connection with personal problems affecting employee performance
				  and the contract does not provide for counseling, treatment or therapy with
				  respect to health, mental health, alcohol or substance abuse problems
				  or
(B) to identify alcohol and
				  substance abuse problems or mental health or health problems of DCA licensees
				  and refer them to appropriate health care providers or organizations for
				  treatment, and the plan does not provide for counseling, treatment or therapy
				  with respect to health, mental health, alcohol or substance abuse
				  problems.
(3) No client
				  or member of his or her family, directly or indirectly shall pay any prepaid or
				  periodic charge under the contract or pay any copayment, fee or other charge
				  for any service rendered under the contract in connection with a health, mental
				  health, alcohol or substance abuse problem. The payment of regular union dues
				  by an employee, a license fee by a DCA licensee, or of a benefit payment by an
				  employer on behalf of an employee and members of the employee's family which
				  does not affect the employee's compensation or other benefits is not a "prepaid
				  or periodic charge" for the purpose of this subsection.
(4) If such plan, its employees or
				  contracting consultants, or an affiliate of any of the foregoing, has a
				  financial interest in referrals made under the contract in connection with a
				  health, mental health, alcohol or substance abuse problem, such person prior to
				  making any such referral shall disclose to the contracting employer, union or
				  state licensing agency and to the person who is referred, the existence of such
				  financial interest; provided that neither the plan nor its employees shall
				  receive any payment, fee or commission directly or indirectly from any person
				  to whom an employee, licensee or family member is referred for counseling,
				  treatment or therapy. The disclosure requirement to the employer may be a
				  single blanket disclosure provided it identifies the providers to which
				  referrals will be made and identifies the financial interest
				  involved.
(5) The number of
				  sessions with any client under the contract shall not exceed 3 within any six
				  month period.
(6) Except as
				  otherwise provided in Division 2 (commencing with Section
				  500) of the Business and
				  Professions Code, the plan shall maintain a record for a period of not less
				  than two years of each session with a client concerning a health, mental
				  health, alcohol or substance abuse problem, and each consultation excluded from
				  the definition of "session." The record shall include the name of or identifier
				  for the client, the date and purpose of the session and the outcome if any,
				  including the name of the provider to which the client was referred. The
				  employee assistance program contracts and the records specified pursuant to
				  subparagraph (6) shall be available for inspection by the Director as provided
				  in Section
				  1381 of the Act.
(7) The plan and the personnel, facilities
				  and equipment of the plan, including that employed under contract, shall be
				  licensed or certified when required by applicable law and persons engaged in
				  identification and referral who are not licensed under Division 2 of the
				  Business and Professions Code shall be certified by any of the following
				  organizations:
(A) Any organization
				  accredited by the National Commission for Accreditation of Alcohol/Drug Abuse
				  Counselors' Credentialing Bodies, Inc.
(B) Alcoholism Council of
				  California.
(C) California
				  Association of Alcoholism and Drug Abuse Counselors.
(D) Association of Labor-Management
				  Administrators and Consultants on Alcoholism.
(8) Unless the plan is licensed under the
				  Act, no prepaid fees shall be collected more than 45 days in
				  advance.