PART 3.3. Health Care Coverage Assistance [15800. - 15895.]
Part 3.3 added by Stats. 2013, Ch. 23, Sec. 68.
§§ 15800–15895 · 84 sections
CHAPTER 1. General Provisions §§ 15800–15806 · 8 sections
- § 15800 (a) (1) Commencing October 1, 2013, the State Department of Health Care Services shall administer the AIM-Linked Infants Program to address the health care…
- § 15801 (a) The terms of all regulations and orders adopted by the Managed Risk Medical Insurance Board in effect preceding July 1, 2014, that relate to the operation…
- § 15802 (a) The State Department of Health Care Services may issue rules and regulations to carry out the purposes of this part. (b) Notwithstanding subdivision (a) or…
- § 15802.5 Effective on July 1, 2014, all permanent or probationary civil service employees who are employed by the Managed Risk Medical Insurance Board shall be…
- § 15803 (a) To implement this part and clause (ii) of subparagraph (A) of paragraph (6) of subdivision (a) of Section 12693.70 of the Insurance Code, the State…
- § 15804 On October 1, 2013, or when the State Department of Health Care Services has implemented Chapter 2 (commencing with Section 15810), whichever occurs later, the…
- § 15805 (a) (1) The Managed Risk Medical Insurance Board shall provide the State Department of Health Care Services any data, information, or record concerning the…
- § 15806 (a) A contract, lease, license, bond, or any other agreement to which the Managed Risk Medical Insurance Board is a party is not void or voidable by reason of…
CHAPTER 2. Medi-Cal Access Program §§ 15810–15849 · 29 sections
- § 15810 (a) This chapter, formerly known as the AIM-Linked Infants Program, shall be known, and may be cited, as the Medi-Cal Access Program. (b) This section shall…
- § 15811 (a) The definitions contained in this section govern the construction of this chapter, unless the context requires otherwise. (b) “Access-linked infant” means…
- § 15814 (a) The department, in coordination with the California Tobacco Control Program of the State Department of Public Health, shall develop protocols relating to…
- § 15818 (a) Each participating health plan contracting with the department pursuant to this chapter shall provide health education services related to tobacco use to…
- § 15822 Health care services under the program shall include, but are not limited to, all of the following: (a) Preventive, screening, diagnostic, and treatment…
- § 15824 To the extent permitted by federal law, services for individuals eligible under this chapter shall be provided, at the department’s discretion and to the…
- § 15826 (a) The department shall administer the program and may do all of the following: (1) Determine eligibility criteria for the program. These criteria shall…
- § 15827 (a) The department shall administer the program in a manner that ensures that program expenditures do not exceed amounts available in the fund. (b) This…
- § 15828 The department shall coordinate with other state agencies, as appropriate, to help ensure continuity of health care services.
- § 15830 (a) The department may contract with a variety of health plans and types of health care service delivery systems in order to offer subscribers a choice of…
- § 15832 (a) To be eligible to participate in the program, a person shall meet all of the requirements in either paragraph (1) or (2): (1) (A) Be pregnant or in the… see note
- § 15833 (a) A person eligible pursuant to paragraph (1) of subdivision (a) of Section 15832 shall not be eligible to participate in the program if, at the time of…
- § 15834 A person shall not be eligible for covered services under the program if those services are covered through private health care coverage arrangements at the…
- § 15835 (a) Subscribers enrolled pursuant to paragraph (1) of subdivision (a) of Section 15832 shall not be disenrolled for failure to pay subscriber contributions.…
- § 15836 (a) If a subscriber is dissatisfied with any action, or failure to act, that has occurred in connection with eligibility or covered services under this…
- § 15838 (a) A provider who is furnished documentation of a subscriber’s enrollment in the program shall not seek reimbursement or attempt to obtain payment for any…
- § 15839 (a) Services that would be covered under the program that are provided to pregnant women who, after receiving those services, are subsequently determined to be…
- § 15840 (a) (1) At a minimum, coverage provided pursuant to this chapter shall be provided to subscribers during one pregnancy, and until the end of the month in which… see note
- § 15841 (a) Through its courts, statutes, and under its Constitution, California protects a woman’s right to reproductive privacy. California reaffirms these…
- § 15842 Notwithstanding any other law, for a subscriber who is determined by the California Children’s Services Program to be eligible for benefits under the program…
- § 15844 A child enrolled in the program under this chapter who has a medical condition that is eligible for services pursuant to the California Children’s Services…
- § 15846 The department shall encourage all providers who provide services under the program to have viable protocols for screening and referring children needing…
- § 15847 (a) It shall constitute unfair competition for purposes of Chapter 5 (commencing with Section 17200) of Part 2 of Division 7 of the Business and Professions…
- § 15847.3 (a) It shall constitute an unfair labor practice contrary to public policy, and enforceable under Section 95 of the Labor Code, for any employer to refer an…
- § 15847.5 (a) It shall constitute an unfair labor practice contrary to public policy and enforceable under Section 95 of the Labor Code for any employer to change the…
- § 15847.7 (a) For purposes of Sections 15847, 15847.3, and 15847.5, “group health coverage” includes any health care service plan, self-insured employee welfare benefit…
- § 15848 (a) The Perinatal Insurance Fund is continued in existence in the State Treasury under the administration of the department. (b) Amounts deposited in the fund…
- § 15848.5 (a) The department shall authorize the expenditure of money in the fund to cover program expenses, including program expenses that exceed subscriber…
- § 15849 (a) Effective July 1, 2022, to the extent allowable under federal law, notwithstanding the provisions of this chapter to the contrary, the department may elect…
CHAPTER 3. County Children’s Health Initiative Program §§ 15850–15864 · 17 sections
- § 15850 This chapter shall be known, and may be cited, as the County Children’s Health Initiative Program (CCHIP).
- § 15850.1 For purposes of this chapter, the following definitions shall apply: (a) “Administrative costs” means those expenses that are described in Section…
- § 15850.5 (a) Notwithstanding any other law, except as provided in subdivision (b), each applicant who was participating in CCHIP, formerly known as the County Health…
- § 15852 (a) The County Health Initiative Matching Fund is hereby continued in existence within the State Treasury. The fund shall accept funding, including but not…
- § 15853 (a) (1) An applicant that will provide an intergovernmental transfer may submit a proposal to the department for funding for the purpose of providing… see note
- § 15854 (a) The department, in consultation with other appropriate parties, shall establish the criteria for evaluating an applicant’s proposal, which shall include,…
- § 15854.5 (a) Effective July 1, 2022, to the extent allowable under federal law, and notwithstanding the provisions of this chapter to the contrary, the department may…
- § 15855 The department shall review each funding proposal submitted by an applicant in accordance with the criteria described in Section 15854 and based on that…
- § 15856 (a) Upon its approval of a proposal that shall include any allowable amount of federal funds under Title XXI of the Social Security Act (42 U.S.C. Sec. 1397aa…
- § 15857 Each health care service plan, specialized health care service plan, and health insurer that contracts to provide health care benefits under this chapter shall…
- § 15858 (a) The department shall administer the provisions of this chapter and may do all of the following: (1) Administer the expenditure of moneys from the fund. (2)…
- § 15859 All expenses incurred by the department in administering this chapter, including, but not limited to, expenses for developing standards and processes to…
- § 15860 Nothing in this chapter creates a right or an entitlement to the provision of health insurance coverage or health care benefits. Except as provided in Section…
- § 15861 To the extent necessary to obtain federal financial participation for projects approved pursuant to this chapter, the department shall apply for one or more…
- § 15862 (a) The provisions of this chapter shall be implemented only if all of the following conditions are met: (1) Federal financial participation is available for…
- § 15863 The state shall be held harmless for any federal disallowance resulting from this chapter and any other expenses or liabilities, including, but not limited to,…
- § 15864 This chapter shall become operative on July 1, 2014.
CHAPTER 4. California Major Risk Medical Insurance Program §§ 15870–15895 · 30 sections
ARTICLE 1. General §§ 15870–15872.5 · 3 sections
- § 15870 For the purposes of this chapter, the following terms have the following meanings: (a) “Applicant” means an individual who applies for major risk medical…
- § 15872 The California Major Risk Medical Insurance Program is hereby established within, and shall be administered by, the department.
- § 15872.5 This chapter shall become operative on July 1, 2014.
ARTICLE 2. Powers and Duties §§ 15873–15877 · 3 sections
- § 15873 The department shall have the authority: (a) To establish eligibility criteria, notwithstanding Section 15884, and determine the eligibility of applicants. (b)…
- § 15876 Plan rates for major risk medical benefits approved for the program shall not be excessive, inadequate, or unfairly discriminatory, but shall be adequate to…
- § 15877 (a) The department shall direct the participating health plans to inform all program subscribers of the December 31, 2024, transition of coverage as follows:…
ARTICLE 3. Policies Issued by the Department §§ 15878–15880 · 3 sections
- § 15878 The department may place a lien on compensation or benefits recovered or recoverable by a subscriber from any party or parties responsible for the compensation…
- § 15879 Except as provided in Article 3.5 (commencing with Section 14124.70) of Chapter 7 of Part 3, benefits received under this article or Article 4 (commencing with…
- § 15880 Benefits under this article or Article 4 (commencing with Section 15881) shall be subject to required subscriber copayments and deductibles as the department…
ARTICLE 4. Participating Health Plans §§ 15881–15883 · 3 sections
- § 15881 The department shall provide coverage through participating health plans and may contract for the processing of applications, the enrollment of subscribers,…
- § 15882 The department may provide or purchase stop-loss coverage under which the program and participating health plans share the risk for health plan expenses which…
- § 15883 The department shall withdraw its approval of any participating health benefits plan for noncompliance with program standards, nonpayment of claims, or other…
ARTICLE 5. Subscriber Eligibility and Enrollment §§ 15884–15888.5 · 10 sections
- § 15884 (a) Each resident of the state meeting the eligibility criteria of this section and who is unable to secure adequate private health coverage is eligible to…
- § 15884.5 (a) It shall constitute unfair competition for purposes of Chapter 5 (commencing with Section 17200) of Part 2 of Division 7 of the Business and Professions…
- § 15885 The department may permit the exclusion of coverage or benefits for charges or expenses incurred by a subscriber during the first six months of enrollment in…
- § 15885.5 If more than one participating health plan is offered, the department shall make available to applicants eligible to enroll in the program sufficient…
- § 15886 After the applicant notifies the department in writing of his or her choice of participating health plan, the department shall assist the applicant in…
- § 15886.5 A subscriber may request a change in coverage based upon a change in the family status of any dependent, by filing an application within 30 days after the…
- § 15887 Health coverage secured through the program shall permit a covered dependent of a subscriber to elect to continue the same coverage upon the death of the…
- § 15887.5 A transfer of enrollment from one participating health plan to another may be made by a subscriber at times and under conditions as may be prescribed by the…
- § 15888 If a subscriber is dissatisfied with any action or failure to act which has occurred in connection with a participating plan’s coverage, the subscriber shall…
- § 15888.5 Subscribers and their dependents who become eligible for Medicare Part A and Part B, excluding those on Medicare solely because of end-stage renal disease,…
ARTICLE 6. Plan Rates and Compensation from the Fund §§ 15890–15891.5 · 4 sections
- § 15890 Upon enrollment as a subscriber in the program, the subscriber shall be responsible for payment of the subscriber contribution. Termination of coverage by a…
- § 15890.5 Each health plan contracting with the department pursuant to Article 4 (commencing with Section 15881) shall submit annually to the department rates which it…
- § 15891 (a) The department shall establish program contribution amounts for each category of risk for each participating health plan. The program contribution amounts…
- § 15891.5 A participating health plan may charge subscriber contributions under this article that do not exceed the difference between its plan rate for the category of…
ARTICLE 7. Major Risk Medical Insurance Fund §§ 15893–15895 · 4 sections
- § 15893 (a) There is hereby continued in existence in the State Treasury a special fund known as the Major Risk Medical Insurance Fund that is, notwithstanding Section…
- § 15894 (a) Except as provided in Section 15894.5, the department shall authorize the expenditure of money in the fund to cover program expenses, including program…
- § 15894.5 (a) From money appropriated by the Legislature to the fund, the department may expend sufficient funds to carry out the purposes of this chapter and of Section…
- § 15895 Any moneys remaining in the fund at the end of any fiscal year may be carried forward to the next succeeding fiscal year.