reglab/statecodes huggingface dataset:
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 3 - BENEFITS AND PROVISIONS FOR PARTNERSHIP POLICIES AND CERTIFICATES › Section 58059 - Required Benefits for Partnership Policies and Certificates

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
No long-term care insurance policy or certificate may be
						approved, advertised, or solicited, in this state as a Partnership Long-Term
						Care Insurance Policy or Certificate which does not meet the standards of
						Article 3, and which has not been certified by the Department of Health
						Services and approved by the Commissioner of the Department of Insurance as a
						Partnership Long-Term Care Insurance Policy or Certificate. A Partnership
						Long-Term Care Insurance Policy or Certificate shall contain the following
						benefits and features:
(a) coverage
					 for either nursing facility and Residential Care Facility only, or
					 Comprehensive Benefits. Policies or Certificates covering only nursing facility
					 and Residential Care Facility benefits shall display prominently on page one
					 (1) of the Policy or Certificate:
"NURSING FACILITY AND RESIDENTIAL CARE FACILITY
						ONLY" POLICY [CERTIFICATE]
Policies or Certificates covering Nursing Facility,
						Residential Care Facility, and home and community-based benefits shall display
						prominently on page one (1) of the Policy or Certificate:
"COMPREHENSIVE" POLICY
						[CERTIFICATE]
(b) a
					 lifetime maximum benefit that is set in dollars and not in days or other units
					 of care;
(c) a lifetime maximum
					 benefit which at the time of purchase is equivalent in dollars to at least
					 three hundred sixty-five (365) times seventy percent (70%) of the Average Daily
					 Private Pay Rate for Nursing Facilities;
(d) if a Partnership Nursing Facility and
					 Residential Care Facility Only Policy or Certificate, it shall provide a
					 Residential Care Facility as well as a nursing facility benefit;
(e) if a Partnership Comprehensive Benefits
					 Policy or Certificate, it shall provide a Respite Care, a Residential Care
					 Facility, and a Nursing Facility Benefit as well as the following home and
					 community-based care benefits:
(1) Home
					 Health Care;
(2) Adult Day
					 Health/Social Care;
(3) Personal
					 Care Services;
(4) Homemaker
					 Services; and
(5) Hospice Care.
The definitions of these services must be identical to
						those contained in Article 1, and must appear verbatim in any Partnership
						Policy or Certificate.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 3 - BENEFITS AND PROVISIONS FOR PARTNERSHIP POLICIES AND CERTIFICATES › Section 58060 - Required Provisions for Partnership Policies and Certificates

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Partnership Long Term Care Policies or Certificates shall
						contain the following provisions:
(a) a
					 provision that benefits may not be paid in excess of actual charges.
(b) a provision that the long-term care
					 services covered by the Partnership Policy or Certificate may not be delivered
					 by a member of the individual's family, unless:
(1) the family member is a regular employee
					 of an organization which is providing the services; and
(2) the organization receives the payment for
					 the services; and
(3) the family
					 member receives no compensation other than the normal compensation for
					 employees in his or her job category.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 3 - BENEFITS AND PROVISIONS FOR PARTNERSHIP POLICIES AND CERTIFICATES › Section 58061 - Required Provisions to Allow the Increase or Decrease of Benefits in Partnership Policies or Certificates

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Partnership Long-Term Care Insurance Policies or
						Certificates shall contain:
(a) a
					 provision that gives the Policy or Certificate holder the option to elect, no
					 less frequently than on each anniversary date after the Policy or Certificate
					 is issued, to pay an extra premium for one or all of the following three
					 riders:
(1) a rider for a Nursing Facility and
					 Residential Care Facility Only expense reimbursable Policy or Certificate to
					 increase the amount of the nursing facility per diem benefit, so long as the
					 increase in the per diem amount is issued in multiples of ten (10) in ten
					 dollar ($10) increments;
(2) a
					 rider for a Comprehensive Benefit expense reimbursable Policy or Certificate to
					 increase the amount of the nursing facility per diem and the monthly home and
					 community-based care benefit, so long as the increase in the nursing facility
					 per diem amount is issued in multiples of ten (10) in ten dollar ($10)
					 increments and the monthly home and community-based care benefit is issued in
					 multiples of ten (10) and in the same ratio to the nursing facility per diem as
					 the ratio in the original Policy or Certificate;
(3) a rider for an expense reimbursable or
					 expense incurred Policy or Certificate to increase the lifetime maximum benefit
					 of either a Nursing Facility and Residential Care Facility Only or a
					 Comprehensive Benefits Policy or Certificate.
The Issuer may require the Policy or Certificate holder
						to undergo new underwriting, in addition to the payment of an additional
						premium, to qualify for the rider(s) elected. The Issuer may restrict the
						aggregate amount of additional coverage a Policy or Certificate holder may
						acquire by rider(s) to the maximum coverage allowed by this Section or the
						maximum the Issuer allows when issuing a new Partnership Policy or Certificate,
						whichever is less. The Issuer may use the same age restrictions for the
						issuance of any rider governed by this section as the age limits, if any, that
						the Issuer uses for the issuance or delivery of a new Partnership Policy or
						Certificate. The extra premium for the increased coverages elected by the
						Policy or Certificate holder shall be calculated in accordance with Section
						58066(a).
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 3 - BENEFITS AND PROVISIONS FOR PARTNERSHIP POLICIES AND CERTIFICATES › Section 58062 - Benefits and Provisions Allowable in Partnership Policies or Certificates

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Issuers are allowed to include the following optional
						benefits and provisions in Partnership Long-Term Care Policies and
						Certificates;
(a) additional benefits
					 over the minimum benefits required in Comprehensive Benefit Policies or
					 Certificates by Section
					 58059(e), so long
					 as these benefits are for Long-Term Care Services Countable Toward the Medi-Cal
					 Property Exemption.
(b) a provision
					 to prorate home and community-based care benefits based on the percentage of
					 the month a Policy or Certificate holder was eligible for benefits.
(c) a provision in expense reimbursable
					 Policies and Certificates that requires Policy or Certificate holders to pay
					 co-payments, not to exceed twenty percent (20%), toward the cost of any home
					 and community-based care benefits received in one day that exceed
					 $50.
(d) the use of a Preferred
					 Provider Organization (PPO) to deliver covered benefits and/or the use of a
					 Point-of-Service reimbursement schedule that provides different reimbursement
					 rates for Policy or Certificate holders who go out-of-plan to receive covered
					 benefits, provided that the reimbursement rates at least meet the minimum
					 benefits specified in Section
					 58050.
(e) a provision that institutional and home
					 and community-based care benefits need not be paid on the same day.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order, including amendment of subsection (d) transmitted to OAL
						12-30-93 and filed 1-28-94 (Register 94, No. 4).
3. Amendment of
						section heading, first paragraph and subsections (a) and (c), repealer of
						subsection (d) and subsection relettering filed 10-1-98 as an emergency;
						operative 10-1-98. Submitted to OAL for printing only pursuant to Welfare and
						Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Section
						  22005,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 3 - BENEFITS AND PROVISIONS FOR PARTNERSHIP POLICIES AND CERTIFICATES › Section 58063 - Prohibited Provisions in Partnership Policies or Certificates

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The following provisions may not be included in a
						Partnership Policy or Certificate:
(a)
					 a restoration of benefits;
(b) a
					 second Elimination Period;
(c) any
					 cap on the daily or weekly (as opposed to monthly) home and community-based
					 care benefits.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order, including amendment of subsection (c) transmitted to OAL
						12-30-93 and filed 1-28-94 (Register 94, No. 4).
3. Amendment of
						section heading and first paragraph filed 10-1-98 as an emergency; operative
						10-1-98. Submitted to OAL for printing only pursuant to Welfare and
						Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Section
						  22005,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 3 - BENEFITS AND PROVISIONS FOR PARTNERSHIP POLICIES AND CERTIFICATES › Section 58064 - Information for Establishing Allowable Benefits and Minimum and Maximum Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Department of Health Services shall distribute the
						following to assist in implementing the requirements of this Chapter.
(a) a Long Term Care Issuer's Bulletin to
					 participating Issuers. This Long Term Care Issuer's Bulletin, to be issued in
					 November of each year, will establish the Average Daily Private Pay Rate for
					 Nursing Facilities for the upcoming calendar year and establish the minimum
					 benefits that may be covered in all Partnership Policies and Certificates
					 issued or delivered in the upcoming calendar year; and,
(b) a list of Long-Term Care Services
					 Countable Toward the Medi-Cal Property Exemption as identified in Section
					 58003.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order, including amendment of subsection (b) transmitted to OAL
						12-30-93 and filed 1-28-94 (Register 94, No. 4).
3. Amendment of
						subsection (a) filed 10-1-98 as an emergency; operative 10-1-98. Submitted to
						OAL for printing only pursuant to Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Section
						  22005,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 4 - PREMIUM PROVISIONS › Section 58065 - Basic Premium Provisions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 The initial premiums for Partnership Policies and Certificates issued or
					 delivered shall either:
(1) remain level for
					 the life of the Policy or Certificate; or,
(2) increase annually at the rate of no more
					 than five percent (5%) for each year the Partnership Policy or Certificate is
					 in force, in order to provide inflation protection.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 5 - CARE MANAGEMENT PROVIDER AGENCY STANDARDS › Section 58068 - Care Management Provider Agency Functions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Care Management Provider Agency must
					 be capable of providing a professional assessment of a person's physical,
					 cognitive, social and emotional functional levels in order to identify
					 individual strengths and needs. The individual's current functional capacities,
					 family and other support systems, financial status and living arrangements must
					 be evaluated as well. The Care Management Provider Agency must be able to
					 develop a comprehensive Plan of Care that addresses identified needs in a cost
					 effective manner. When desired by the individual and determined necessary by
					 the Care Management Provider Agency, the Care Management Provider Agency must
					 be able to arrange for the delivery and coordination of services as well as
					 monitor their quality over an extended period.
1. New
						article 5 and section filed 8-30-93 as an emergency; operative 8-30-93
						(Register 93, No. 36). Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Sections
						  22005(a)
						  and
						  22006,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 5 - CARE MANAGEMENT PROVIDER AGENCY STANDARDS › Section 58069 - The Role of the Care Management Supervisor

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A Care Management Supervisor shall have
					 demonstrated expert ability in the Care Management role. This individual shall
					 also:
(1) support and clarify the role of the
					 Care Manager;
(2) be accessible to
					 Care Managers on a scheduled and as needed basis;
(3) provide guidance on decisions requiring
					 judgment, assist with problem situations, and approve Plans of Care and
					 discharge;
(4) demonstrate
					 administrative ability to explain goals, policies, and procedures, and assist
					 staff in adjusting to changes that occur;
(5) encourage the development of professional
					 growth and upgrading of skill through access to training and current
					 literature; and
(6) evaluate the
					 Care Manager's performance based on established criteria. The evaluation shall
					 include: a review of client records, observations of client visits, supervisory
					 conferences, and productivity measures.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 5 - CARE MANAGEMENT PROVIDER AGENCY STANDARDS › Section 58070 - Staff Qualifications

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Care Managers shall meet or exceed both
					 of the following qualifications:
(1) be a
					 registered nurse and/or graduate of an accredited four year college or
					 university with a degree in nursing, health, social work, gerontology or other
					 related area; and
(2) have a
					 minimum of two years of experience in the human service field, ideally in
					 community-based care. A master's degree in nursing, health, social work,
					 gerontology or a related field may be substituted for one year of
					 experience.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 5 - CARE MANAGEMENT PROVIDER AGENCY STANDARDS › Section 58071 - Staff Ratios

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Care Management staffing ratios shall not exceed the following:
(1) clients to Care Manager: 60:1 (total
					 clients in benefit status); and
(2)
					 Care Managers to Care Management Supervisor: 10:1.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 5 - CARE MANAGEMENT PROVIDER AGENCY STANDARDS › Section 58072 - Client Bill of Rights and Responsibilities

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A Care Management Provider Agency shall
					 have a written list of rights and legal responsibilities which shall be
					 presented to each client or his or her representative at the time of assessment
					 or as soon as possible thereafter. The list shall include:
(1) a description of available services, and
					 unit charges and billing mechanisms (where applicable);
(2) a policy on which services are covered by
					 the insurance benefit and which services need to be paid for out-of-pocket
					 (where applicable);
(3) the
					 criteria for admission to service and discharge from service;
(4) a right to be informed of the name of
					 their Care Manager and of the manner in which that person may be
					 contacted;
(5) a right for active
					 client participation in the development and implementation of the Plan of Care.
					 The client or officially designated representative shall, prior to
					 implementation, receive a copy of the Plan of Care and a written list of all
					 potential service providers to be involved in implementation of the Plan of
					 Care;
(6) a right for the client or
					 officially designated representative to be fully informed of the client's
					 health condition;
(7) a provision
					 for the confidential treatment of all client information retained by the agency
					 and a requirement for written consent to release information to persons not
					 otherwise authorized under law to receive it;
(8) a policy regarding client access to the
					 case record;
(9) an explanation of
					 the appeal procedure and the right to file an appeal of benefit eligibility or
					 Plan of Care service authorization decisions without discrimination or reprisal
					 from the agency;
(10) procedures
					 for registering and resolving complaints; and
(11) a right to a discharge plan when the
					 Care Management Provider Agency services are about to be terminated. If the
					 Policy or Certificate holder is immediately eligible for Medi-Cal, the Care
					 Management Provider Agency will prepare a transition plan. The transition plan
					 and/or discharge plan must be provided to the Policy or Certificate holder
					 within 30 days after receipt of notification from the Issuer that coverage will
					 be exhausted.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 5 - CARE MANAGEMENT PROVIDER AGENCY STANDARDS › Section 58073 - Quality Assurance

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 A Care Management Provider Agency shall have a written quality assurance
					 program which shall include but not be limited to:
(1) Annual program evaluation. The agency's
					 board of directors (or their appointed designees) shall, at least Annually,
					 review policies and make recommendations on:
(A) admission and discharge
					 criteria;
(B) Plans of Care and
					 records;
(C) personnel
					 qualifications;
(D) quality
					 assurance program;
(E) delivery of
					 Care Management services; and
(F)
					 methods for assuring the quality of direct services provided including whether
					 client needs as identified in the Plans of Care were met, assessing client
					 satisfaction and incorporating client suggestions.
The written minutes of this annual program evaluation
						meeting shall document the dates of the meeting(s), attendance, agenda and
						recommendations.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 5 - CARE MANAGEMENT PROVIDER AGENCY STANDARDS › Section 58074 - Annual Report of the Agency's Quality Assurance Program

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An Annual written report of the agency's
					 quality assurance program shall be prepared and submitted to the governing
					 authority. The report shall summarize all findings and recommendations
					 resulting from the quality assurance activities. This report and documentation
					 of all actions on the findings or recommendations shall be available to the
					 contracting Issuer(s) and the Department of Health Services (DHS).
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Sections
						  22005(a)
						  and
						  22006,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 5 - CARE MANAGEMENT PROVIDER AGENCY STANDARDS › Section 58075 - Objectivity and Impartiality

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 To insure objectivity, the Care Management Provider Agencies which also provide
					 other services included in an insured's Plan of Care will be required to
					 document that clients were made aware of a full array of services, and the
					 costs and availability of other providers of these services.
(b) Individuals who provide direct care as
					 described in Section
					 58059(e) cannot
					 also act as Care Managers for assessment and care planning.
(c) Direct service providers and Care
					 Managers should not report to the same clinical supervisor.
(d) Employees of the Issuer cannot also act
					 as Care Managers for assessment and care planning.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Sections
						  22005(a)
						  and
						  22006,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 5 - CARE MANAGEMENT PROVIDER AGENCY STANDARDS › Section 58076 - Policy Manual

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Prior to the Care Management Provider Agency being approved by the State, and
					 with an Annual update thereafter, the Care Management Provider Agency must file
					 the following with the Department of Health Services and with each Issuer with
					 whom they contract:
(1) an organizational
					 chart; and
(2) a policy manual that
					 includes the following:
(A) job
					 descriptions;
(B) Care Manager
					 training requirements;
(C) Care
					 Manager availability and turn-around time for conducting assessments and
					 developing Plans of Care;
(D)
					 personal policies;
(E) the appeals
					 procedure;
(F) the client bill of
					 rights and responsibilities as described in Section
					 58072;
(G) the agency's quality assurance program
					 (including the Annual program evaluation, the Quarterly service record review
					 and verification that the Annual documentation of clinical competence has been
					 completed);
(H) data collection
					 procedures (including confidentiality safeguards);
(I) records retention procedures;
					 and
(J) documentation of efforts to
					 provide culturally sensitive services.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 6 - ISSUER REPORTING REQUIREMENTS AND AUDIT INFORMATION › Section 58077 - Issuer Reporting Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Unless otherwise noted, the requirements of this Section
						refer to Issuer documentation and reporting requirements for Partnership
						Policies and Certificates. Reports are due thirty (30) days after the close of
						reporting periods specified for the respective reports. Issuers shall submit
						the following reports, which are all part of the Long-Term Care Insurance
						Uniform Data Set.
(a) Report on new
					 purchasers. Each Issuer shall maintain a registry of new purchasers and submit
					 on a Quarterly basis aligned with the State Fiscal Year, a report to the
					 Department of Health Services that will include the following information on
					 all individuals who purchased a Partnership Policy or Certificate during the
					 reporting period:
(1) name, address, telephone
					 number, date of birth, sex, marital status, and Social Security
					 number;
(2) Policy or Certificate
					 identification information, including the following:
(A) Policy or Certificate form
					 number;
(B) Policy or Certificate
					 category (individual, organization-sponsored, or group);
(C) effective date of coverage;
(D) Policy type (Nursing Facility and
					 Residential Care Facility Only; Comprehensive Benefit; Single Life; or
					 Multi-Life);
(3) Policy
					 or Certificate Elimination Period in days;
(4) the maximum daily benefit for nursing
					 facility care and monthly benefit for home and community-based care;
(5) maximum lifetime benefit amount in
					 dollars;
(6) any options and riders
					 in force;
(7) purchase type
					 (upgrade from non-Partnership policy or certificate of reporting company,
					 conversion, replacement of another company's policy or certificate, or new
					 issue);
(8) for expense-incurred
					 Policies or Certificates, the percentage of expenses payable;
(9) the annual premium for the Policy or
					 Certificate, the premium payment mode (also known as the "premium frequency"),
					 and the type of premium (level, indexed, or lump sum); and
(10) the name and address of the Authorized
					 Designee to be notified in the event that the Policy is in danger of lapsing
					 due to unpaid premium.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 6 - ISSUER REPORTING REQUIREMENTS AND AUDIT INFORMATION › Section 58079 - Reporting to the Policy or Certificate Holder on the Medi-Cal Property Exemption

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each Issuer
					 shall send a Medi-Cal Property Exemption Report (rev. 12/93) at least Quarterly
					 to each Policy or Certificate holder for whom any benefit payments were made
					 since the last Medi-Cal Property Exemption report. Each Medi-Cal Property
					 Exemption report shall include the dollar amounts of benefits paid by the
					 Policy or Certificate for the Policy or Certificate holder in the following
					 order and for the periods specified:
(1) the
					 cumulative amount of benefits paid prior to the current reporting period that
					 counted towards the Medi-Cal Property Exemption;
(2) the amount paid during the current
					 reporting period regardless of qualification for the Medi-Cal Property
					 Exemption;
(3) the amount paid
					 during the current reporting period that counts towards the Medi-Cal Property
					 Exemption; and
(4) the total
					 cumulative amount paid to date that counts towards the Medi-Cal Property
					 Exemption (i.e., the amounts reported in (1)+(3)). This amount should be
					 clearly indicated with a label "Medi-Cal Property Exemption To Date".
(5) the remaining benefit
					 amount.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 6 - ISSUER REPORTING REQUIREMENTS AND AUDIT INFORMATION › Section 58080 - Preparing a Service Summary

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each Issuer shall prepare a Service
					 Summary at the client's request specifically for the Policy or Certificate
					 holder applying for Medi-Cal. The Issuer shall also prepare a Service Summary
					 and sent it to the Policy or Certificate holder and the Department of Health
					 Services when the Policy or Certificate holder has exhausted his or her
					 benefits under the Policy or Certificate or when the Policy or Certificate
					 ceases to be in force for a reason other than the death of the Policy or
					 Certificate holder, whichever occurs first. This Service Summary will be in a
					 standardized form and format prescribed by the Department of Health Services.
This Service Summary is prepared in addition to the
						information requirements described in Section
						58078.
(b) Each Issuer shall notify the policy or
					 certificate holder and the Care Manager Provider Agency one hundred twenty
					 (120) days prior to the date when coverage for each Policy or Certificate is
					 about to be exhausted. A copy of the Issuer's notification shall be forwarded
					 to the Department of Health Services at the same time it is forwarded to the
					 Care Manager Provider Agency.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
3. New subsection (b) filed 10-1-98 as an emergency; operative
						10-1-98. Submitted to OAL for printing only pursuant to Welfare and
						Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order,
						including further amendment of subsection (b), transmitted to OAL 1-28-99 and
						filed 3-15-99 (Register 99, No. 12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Sections
						  22004,
						  22005(f),
						  and
						  22006,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 6 - ISSUER REPORTING REQUIREMENTS AND AUDIT INFORMATION › Section 58081 - Plan of Action for Information and Document Maintenance

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each Issuer shall, prior to certification
					 by the Department of Health Services, submit to the Department a plan for
					 complying with the information maintenance and documentation requirements set
					 forth in Article 6 of this Chapter. No Policy or Certificate shall be certified
					 until the Department of Health Services has approved the Issuer's documentation
					 plan for the Policy or Certificate. The documentation plan will include the
					 following:
(1) the location where records will
					 be kept. Records required for purposes of the California Partnership for
					 Long-Term Care must be available at no more than three (3) locations, each of
					 which shall be easily accessible to the California Partnership for Long-Term
					 Care;
(2) the Issuer shall agree to
					 give the Department of Health Services, or its appointed designee, access to
					 all information described in Section
					 58078 of this Chapter on an
					 aggregate basis and on an individual basis for all Policy or Certificate
					 holders. Access to information on persons who have not applied for Medi-Cal is
					 required in order for the Department of Health Services, or its appointed
					 designee, to determine if an Issuer's system for documenting the Medi-Cal
					 Property Exemption is functioning correctly. The Department of Health Services
					 shall determine the frequency of access to the data and the size of samples for
					 auditing purposes.
(3) the name,
					 job title, address, and telephone number of the person primarily responsible
					 for the maintenance of the information required and for acting as liaison with
					 the Department of Health Services concerning the information;
(4) methods for determining when insurance
					 benefits or prepaid benefits qualify for the Medi-Cal Property Exemption,
					 including the following:
(A) documentation of
					 the Insured Event;
(B) description
					 of services;
(C) documentation of
					 charges and benefits paid; and
(D)
					 documentation of Plans of Care;
(5) description of electronic and manual
					 systems which will be used in maintaining the required information;
(6) information that will be retained which
					 is needed to comply with this rule; and
(7) copies of forms and descriptions of
					 standard procedures for maintaining and reporting the information required,
					 including the specific electronic medium which will be used to report required
					 information and a description of the relevant files.
California Code of Regulations › Title 22 - Social Security › Division 4 - Environmental Health › Chapter 1 - Introduction › Article 1 - Definitions › Section 60001 - Department

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Whenever the term "department" or "Department" is used in
					 this division, it means the State Department of Public Health, unless otherwise
					 specified.
1. New
					 Division 4 (Sections
					 60001-60180, not consecutive)
					 filed 7-2-74 as an emergency; effective upon filing. Certificate of Compliance
					 included (Register 74, No. 27).
2. Amendment filed 6-30-78 as an
					 emergency; designated effective at 11:59 p.m. on 6-30-78 (Register 78, No.
					 26).
3. Certificate of Compliance transmitted to OAH 10-27-78; filed
					 10-31-78 (Register 78, No. 44).
4. Editorial correction of NOTE
					 filed 7-2-84 (Register 84, No. 27).
5. Amendment of section and NOTE
					 filed 5-22-2012; operative 6-21-2012 (Register 2012, No.
					 21).
Note: Authority cited: Sections
						131052
						and
						131200,
						Health and Safety Code. Reference: Section
						20,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 4 - Environmental Health › Chapter 1 - Introduction › Article 1 - Definitions › Section 60002 - State Board

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Whenever the term "State Board" is used in this division,
					 it means the State Water Resources Control Board, unless otherwise
					 specified.
1. Change
					 without regulatory effect adopting new section filed 6-2-2015 pursuant to
					 section 100, title 1, California Code of
					 Regulations (Register 2015, No. 23).
Note: Authority cited: Section
						116271,
						Health and Safety Code. Reference: Section
						116271,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 4 - Environmental Health › Chapter 1 - Introduction › Article 1 - Definitions › Section 60003 - Director

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Whenever the term "director" is used in this division, it
					 means the Director, State Department of Public Health, unless otherwise
					 specified.
1. Amendment
					 filed 6-30-78 as an emergency; designated effective at 11:59 p.m. on 6-30-78
					 (Register 78, No. 26).
2. Certificate of Compliance transmitted to
					 OAH 10-27-78; filed 10-31-78 (Register 78, No. 44).
3. Editorial
					 correction of NOTE filed 7-2-84 (Register 84, No. 27).
4. Amendment
					 of section and NOTE filed 5-22-2012; operative 6-21-2012 (Register 2012, No.
					 21).
Note: Authority cited: Sections
						131052
						and
						131200,
						Health and Safety Code. Reference: Section
						21,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 4 - Environmental Health › Chapter 1 - Introduction › Article 1 - Definitions › Section 60091 - Chemical Toilet. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1.
					 Renumbering from Section
					 60091 to
					 66016 filed 5-10-79; effective
					 thirtieth day thereafter (Register 79, No. 19). For former history, see
					 Register 78, No. 51.
Note: Authority cited: Section
						25210,
						Health and Safety Code. Reference: Section
						25210,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 4 - Environmental Health › Chapter 1 - Introduction › Article 1 - Definitions › Section 60093 - Chemical Toilet Additive. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1.
					 Renumbering from Section
					 60093 to
					 66020 filed 5-10-79; effective
					 thirtieth day thereafter (Register 79, No. 19). For former history see Register
					 78, No. 51.
Note: Authority cited: Section
						25210,
						Health and Safety Code. Reference: Section
						25210,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 4 - Environmental Health › Chapter 1 - Introduction › Article 1 - Definitions › Section 60095 - Chemical Toilet Waste. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1.
					 Renumbering from Section
					 60095 to
					 66024 filed 5-1-79; effective
					 thirtieth day thereafter (Register 79, No. 18). For former history, see
					 Register 78, No. 51.
Note: Authority cited: Section
						25210,
						Health and Safety Code. Reference: Section
						25210,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 4 - Environmental Health › Chapter 1 - Introduction › Article 2 - Monitoring and Reporting Requirements - Scope › Section 60098 - Monitoring and Reporting Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The phrase "The monitoring and reporting requirements as
					 specified in regulations adopted by the department that pertain to maximum
					 contaminant levels" as used in Health and Safety Code section
					 116275,
					 subdivision (c)(3) includes, but is not limited to, the requirements of
					 Articles 18 and 20 of Chapter 15, Title 22, California Code of
					 Regulations.
1. New
					 article 2 (section
					 60098) and section filed
					 5-22-2012; operative 6-21-2012 (Register 2012, No.
					 21).
Note: Authority cited: Sections
						131052
						and
						131200,
						Health and Safety Code. Reference: Section
						116275,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 4 - Environmental Health › Chapter 2 - Regulations for the Implementation of the California Environmental Quality Act › Article 1 - General Requirements and Categorical Exemptions › Section 60100 - General Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Department of Health Services incorporates by reference
					 the objectives, criteria, and procedures as delineated in Chapters 1, 2, 2.5,
					 2.6, 3, 4, 5, and 6, Division 13, Public Resources Code, Sections
					 21000
					 et seq., and the Guidelines for the Implementation of the California
					 Environmental Quality Act, Title 14, Division 6, Chapter 3, California
					 Administrative Code, Sections
					 15000 et seq.
1. New
					 Chapter 2 (Sections
					 60100 and
					 60101) filed 1-2-86; effective
					 thirtieth day thereafter (Register 86, No. 1). For history of former Chapter 2,
					 see Registers 79, No. 19 and 77, No. 42.
Note: Authority cited: Title 14, Section
						15022(d),
						California Administrative Code; Section
						208,
						Health and Safety Code; and Section
						21082,
						Public Resources Code. Reference: Sections
						21000 et seq., Public Resources
						Code.
California Code of Regulations › Title 22 - Social Security › Division 4 - Environmental Health › Chapter 2 - Regulations for the Implementation of the California Environmental Quality Act › Article 1 - General Requirements and Categorical Exemptions › Section 60101 - Specific Activities Within Categorical Exempt Classes

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The following specific activities are determined by the
					 Department to fall within the classes of categorical exemptions set forth in
					 Sections 15300 et seq. of Title 14 of the
					 California Administrative Code:
(a)
				  Class 1: Existing Facilities.
(1) Any interior
				  or exterior alteration of water treatment units, water supply systems, and pump
				  station buildings where the alteration involves the addition, deletion, or
				  modification of mechanical, electrical, or hydraulic controls.
(2) Maintenance, repair, replacement, or
				  reconstruction to any water treatment process units, including structures,
				  filters, pumps, and chlorinators.
California Code of Regulations › Title 22 - Social Security › Division 4 - Environmental Health › Chapter 3 - Water Recycling Criteria › Article 1 - Definitions › Section 60301 - Definitions. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 Chapter 4 (§§
											60301-60357, not consecutive)
					 filed 4-2-75; effective thirtieth day thereafter (Register 75, No.
					 14).
2. Renumbering of Chapter 4 (Sections
					 60301-60357, not consecutive) to
					 Chapter 3 (Sections
					 60301-60357, not consecutive),
					 filed 10-14-77; effective thirtieth day thereafter (Register 77, No.
					 42).
3. Amendment of chapter heading, repealer of section and
					 amendment of NOTE filed 11-2-2000; operative 12-2-2000 (Register 2000, No.
					 44).
Note: Authority cited: Section
						13521, Water
						Code. Reference: Sections
						13520 and
						13521, Water
						Code.
California Code of Regulations › Title 22 - Social Security › Division 4 - Environmental Health › Chapter 3 - Water Recycling Criteria › Article 1 - Definitions › Section 60301.050 - 24-Hour Composite Sample

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"24-hour Composite Sample" means an aggregate sample
					 derived from no fewer than eight discrete samples collected at equal time
					 intervals or collected proportional to the flow rate over the compositing
					 period. The aggregate sample shall reflect the average source water quality
					 covering the composite 24-hour sample period.
1. New
					 section filed 6-18-2014 as an emergency; operative 6-18-2014. Submitted to OAL
					 for filing and printing only. This adoption is not subject to OAL review and
					 shall remain in effect until revised by the Department of Public Health
					 pursuant to Water Code section
					 13562.5
					 (Register 2014, No. 25).
Note: Authority cited: Sections
						13521,
						13562 and
						13562.5, Water
						Code; and Sections
						131052
						and
						131200,
						Health and Safety Code. Reference: Sections
						13520,
						13522,
						13522.5,
						13523,
						13523.1,
						13524,
						13560,
						13561 and
						13562.5, Water
						Code.
California Code of Regulations › Title 22 - Social Security › Division 4 - Environmental Health › Chapter 3 - Water Recycling Criteria › Article 1 - Definitions › Section 60301.080 - Added Tracer

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Added Tracer" means a non-reactive substance, with
					 measureable characteristics distinctly different from the receiving
					 groundwater, intentionally added to the water applied at a Groundwater
					 Replenishment Reuse Project (GRRP) for the purpose of being a tracer such that
					 the tracer can be readily identified in the groundwater downgradient of the
					 GRRP to determine the underground retention time of the applied
					 water.
1. New
					 section filed 6-18-2014 as an emergency; operative 6-18-2014. Submitted to OAL
					 for filing and printing only. This adoption is not subject to OAL review and
					 shall remain in effect until revised by the Department of Public Health
					 pursuant to Water Code section
					 13562.5
					 (Register 2014, No. 25).
Note: Authority cited: Sections
						13521,
						13562 and
						13562.5, Water
						Code; and Sections
						131052
						and
						131200,
						Health and Safety Code. Reference: Sections
						13520,
						13522,
						13522.5,
						13523,
						13523.1,
						13524,
						13560,
						13561 and
						13562.5, Water
						Code.