ARTICLE 4.3. Long-Term Care Integration Pilot Program

Heading of Article 4.3 renumbered from Article 4.05 by Stats. 1996, Ch. 124, Sec. 158.

§§ 14139.05–14139.62 · 31 sections

§ 14139.05 The Legislature finds and declares that: (a) Long-term care services in California include an uncoordinated array of categorical programs offering medical,…
§ 14139.1 (a) It is the intent of the Legislature to establish the Long-Term Care Integration Pilot Program that will integrate the financing and administration of…
§ 14139.11 The goals of this pilot program shall be to: (a) Provide a continuum of social and health services that foster independence and self-reliance, maintain…
§ 14139.12 It is the intent of the Legislature that the costs of this pilot program to the General Fund will not exceed the direct and indirect costs that existing…
§ 14139.13 (a) Any contract entered into pursuant to this article may be renewed if the long-term care services agency continues to meet the requirements of this article…
§ 14139.2 The department shall serve as the lead agency for the administration of this chapter. The department’s responsibilities shall include, but are not limited to:…
§ 14139.21 The department may accept funding from federal agencies, foundations or other nongovernmental sources and may contract with qualified consultants to assist…
§ 14139.22 (a) The department shall convene a working group that shall include the Director of Health Care Services, the Director of Social Services, and the Director of…
§ 14139.23 Upon the implementation of the pilot program, responsibility for administering the programs integrated within the pilot program shall be transferred to the…
§ 14139.24 The department shall seek all federal waivers necessary to allow for federal financial participation in the pilot program implemented pursuant to this article.…
§ 14139.25 Notwithstanding any other provision of this article, costs to the General Fund shall not exceed the amount that would have been expended in the absence of the…
§ 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)…
§ 14139.31 In order to be selected, a pilot project site shall demonstrate that it has an active advisory committee that includes consumers of long-term care services,…
§ 14139.32 (a) The administrative action plan shall identify the funds to be transferred into the consolidated long-term care services fund. (b) The funds shall include…
§ 14139.33 The administrative action plan shall delineate the services to be provided to all eligible beneficiaries. At a minimum, services to be provided shall include…
§ 14139.34 The administrative action plan may also include any of the following services: (a) Transportation. (b) Home modification. (c) Medical services, including, but…
§ 14139.35 The department may exempt a pilot project site from the requirements of subdivisions (d) and (f) of Section 14139.33 if both the following conditions are met:…
§ 14139.36 (a) If primary, ancillary, and acute care are not included among the services offered by a pilot project site, the administrative action plan shall include all…
§ 14139.37 The administrative action plan shall delineate specifically how the pooled funds will be used to deliver services to all eligible recipients in the geographic…
§ 14139.38 Participating counties shall continue their financial maintenance of effort for each of the programs integrated within the pilot program under this article.…
§ 14139.4 (a) The long-term care services agency shall be responsible and at risk for implementing the administrative action plan. The long-term care services agency…
§ 14139.41 (a) For purposes of this chapter, “eligible beneficiaries” shall be defined as persons meeting all the following criteria: (1) Are Medi-Cal eligible. (2) Are…
§ 14139.42 (a) Each pilot project site shall serve all eligible beneficiaries who live in the geographic area served by the long-term care services agency. In order to…
§ 14139.43 This article shall not preclude a long-term care services agency from entering into additional agreements, separate from the pilot project, to serve additional…
§ 14139.44 Pilot project sites shall ensure provider reimbursement rates that are adequate to maintain compliance with applicable federal and state requirements.
§ 14139.5 The department shall set a capitated rate of payment that is actuarially sound and that is based on the number of beneficiaries who are eligible for Medi-Cal…
§ 14139.51 If the department determines that a program or programs cannot reasonably be capitated, funds may be transferred separately from the capitation payment. The…
§ 14139.53 (a) The department shall develop criteria to ensure that pilot project sites maintain fiscal solvency, including, but not limited to, the following: (1) The…
§ 14139.6 (a) It is the intent of the Legislature that local entities that are potential participants in this pilot program shall be assured of sufficient time to plan…
§ 14139.61 The department may adopt emergency regulations as necessary to implement this article in accordance with the Administrative Procedure Act, Chapter 3.5…
§ 14139.62 Contingent on the availability of funding, the department shall evaluate the effectiveness of each pilot project on a schedule that coincides with federal…