Welfare and Institutions Code - WIC § 14132.56

Cal. WIC § 14132.56

California Statutes

(a)

(1) Only to the extent required by the federal government and effective no sooner than required by the federal government, behavioral health treatment (BHT) shall be a covered Medi-Cal service for individuals under years of age.

(2) It is the intent of the Legislature that, to the extent the federal government requires BHT to be a covered Medi-Cal service, the department shall seek statutory authority to implement this new benefit in Medi-Cal.

(3) For purposes of this section, “behavioral health treatment” or “BHT” means professional services and treatment programs, including applied behavior analysis (ABA) and evidence-based intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorder or autism, and are administered by the department as described in the approved state plan. (

b) The department shall implement, or continue to implement, this

section only after all of the following occurs or has occurred:

(1) The department receives all necessary federal approvals to obtain federal funds for the service.

(2) The department seeks an appropriation that would provide the necessary state funding estimated to be required for the applicable fiscal year.

(3) The department consults with stakeholders. (

c) The department shall develop and define eligibility criteria, provider participation criteria, utilization controls, and delivery system structure for services under this section, subject to limitations allowable under federal law, in consultation with stakeholders. (d)

(1) The department, commencing on the effective date of the act that added this subdivision until March 31, 2017, inclusive, may make available to individuals described in paragraph (2) contracted services to assist those individuals with health insurance enrollment, without regard to whether federal funds are available for the contracted services.

(2) The contracted services described in paragraph (1) may be provided only to an individual under years of age whom the department identifies as no longer eligible for Medi-Cal solely due to the transition of BHT coverage from the waiver program under

Section 1915(

c) of the federal Social Security Act to the Medi-Cal state plan in accordance with this

section and who meets all of the following criteria: (

A) They were enrolled in the home and community-based services waiver for persons with developmental disabilities under

Section 1915(

c) of the Social Security Act as of January 31, 2016. (

B) They were deemed to be institutionalized in order to establish eligibility under the terms of the waiver. (

C) They have not been found eligible under any other federally funded Medi-Cal criteria without a spend down of excess income. (

D) They have received a BHT service from a regional center for persons with developmental disabilities as provided in

Chapter 5 (commencing with

Section 4620) of Division 4.5. (

e) Notwithstanding

Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, or make specific this

section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until regulations are adopted. The department shall adopt regulations by July 1, 2017, in accordance with the requirements of

Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code. Notwithstanding

Section 10231.5 of the Government Code, beginning six months after the effective date of this section, the department shall provide semiannual status reports to the Legislature, in compliance with

Section of the Government Code, until regulations have been adopted. (

f) For the purposes of implementing this section, the department may enter into exclusive or nonexclusive contracts on a bid or negotiated basis, including contracts for the purpose of obtaining subject matter expertise or other technical assistance. Contracts may be statewide or on a more limited geographic basis. Contracts entered into or amended under this subdivision shall be exempt from

Part 2 (commencing with

Section 10100) of Division of the Public Contract Code,

Section of the Government Code, and

Chapter 6 (commencing with

Section 14825) of

Part 5.5 of Division of the Government Code, and shall be exempt from the review or approval of any division of the Department of General Services. (

g) The department may seek approval of any necessary state plan amendments or waivers to implement this section. The department shall make any state plan amendments or waiver requests public at least days prior to submitting to the federal Centers for Medicare and Medicaid Services, and the department shall work with stakeholders to address the public comments in the state plan amendment or waiver request. (

h) This

section shall be implemented only to the extent that federal financial participation is available and any necessary federal approvals have been obtained.

Document details

CollectionCalifornia Statutes
CitationCal. WIC § 14132.56
Date2023-07-10
Typestatute
Languageen
SourceCA_STAT
IdentifierWIC14132.56.202342145

Welfare and Institutions Code - WIC § 14132.56

Cal. WIC § 14132.56

California Statutes

Welfare and Institutions Code - WIC § 14132.56

Cal. WIC § 14132.56

California Statutes

(a)

(1) Only to the extent required by the federal government and effective no sooner than required by the federal government, behavioral health treatment (BHT) shall be a covered Medi-Cal service for individuals under years of age.

(2) It is the intent of the Legislature that, to the extent the federal government requires BHT to be a covered Medi-Cal service, the department shall seek statutory authority to implement this new benefit in Medi-Cal.

(3) For purposes of this section, “behavioral health treatment” or “BHT” means professional services and treatment programs, including applied behavior analysis (ABA) and evidence-based intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorder or autism, and are administered by the department as described in the approved state plan. (

b) The department shall implement, or continue to implement, this

section only after all of the following occurs or has occurred:

(1) The department receives all necessary federal approvals to obtain federal funds for the service.

(2) The department seeks an appropriation that would provide the necessary state funding estimated to be required for the applicable fiscal year.

(3) The department consults with stakeholders. (

c) The department shall develop and define eligibility criteria, provider participation criteria, utilization controls, and delivery system structure for services under this section, subject to limitations allowable under federal law, in consultation with stakeholders. (d)

(1) The department, commencing on the effective date of the act that added this subdivision until March 31, 2017, inclusive, may make available to individuals described in paragraph (2) contracted services to assist those individuals with health insurance enrollment, without regard to whether federal funds are available for the contracted services.

(2) The contracted services described in paragraph (1) may be provided only to an individual under years of age whom the department identifies as no longer eligible for Medi-Cal solely due to the transition of BHT coverage from the waiver program under

Section 1915(

c) of the federal Social Security Act to the Medi-Cal state plan in accordance with this

section and who meets all of the following criteria: (

A) They were enrolled in the home and community-based services waiver for persons with developmental disabilities under

Section 1915(

c) of the Social Security Act as of January 31, 2016. (

B) They were deemed to be institutionalized in order to establish eligibility under the terms of the waiver. (

C) They have not been found eligible under any other federally funded Medi-Cal criteria without a spend down of excess income. (

D) They have received a BHT service from a regional center for persons with developmental disabilities as provided in

Chapter 5 (commencing with

Section 4620) of Division 4.5. (

e) Notwithstanding

Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code, the department, without taking any further regulatory action, shall implement, interpret, or make specific this

section by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until regulations are adopted. The department shall adopt regulations by July 1, 2017, in accordance with the requirements of

Chapter 3.5 (commencing with

Section 11340) of Part of Division of Title of the Government Code. Notwithstanding

Section 10231.5 of the Government Code, beginning six months after the effective date of this section, the department shall provide semiannual status reports to the Legislature, in compliance with

Section of the Government Code, until regulations have been adopted. (

f) For the purposes of implementing this section, the department may enter into exclusive or nonexclusive contracts on a bid or negotiated basis, including contracts for the purpose of obtaining subject matter expertise or other technical assistance. Contracts may be statewide or on a more limited geographic basis. Contracts entered into or amended under this subdivision shall be exempt from

Part 2 (commencing with

Section 10100) of Division of the Public Contract Code,

Section of the Government Code, and

Chapter 6 (commencing with

Section 14825) of

Part 5.5 of Division of the Government Code, and shall be exempt from the review or approval of any division of the Department of General Services. (

g) The department may seek approval of any necessary state plan amendments or waivers to implement this section. The department shall make any state plan amendments or waiver requests public at least days prior to submitting to the federal Centers for Medicare and Medicaid Services, and the department shall work with stakeholders to address the public comments in the state plan amendment or waiver request. (

h) This

section shall be implemented only to the extent that federal financial participation is available and any necessary federal approvals have been obtained.

Document details

CollectionCalifornia Statutes
CitationCal. WIC § 14132.56
Date2023-07-10
Typestatute
Languageen
SourceCA_STAT
IdentifierWIC14132.56.202342145