Statutes
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Welfare & Institutions Code Section 14499.5-14499.6
14499.5. (a) (1) In carrying out the intent of this article the director shall contract for the operation of one local pilot program. Special consideration shall be given to approving a program contracted through county government in Santa Barbara County. (2) Notwithstanding the limitations contained in Section 14490, the director may enter into, or extend, contracts with the local pilot program in Santa Barbara County pursuant to paragraph (1) for periods that do not exceed three years.
(b) The establishment of a pilot program pursuant to this section shall be contingent upon the availability of state and federal funding. The program shall include the following components: (1) Local authority for administration, fiscal management. and delivery of services. but not including eligibility determination. (2) Physician case management. (3) Cost containment through provider incentives and other means.
(c) The program for the pilot project shall include a plan and budget for delivery of services. administration. and evaluation. During the first year of the pilot program, the amount of the state contract shall equal 95 percent of total projected Medi-Cal expenditures for delivery of services and for administration based on fee-for-service conditions in the program county. During the remaining years of the pilot project Medi-Cal expenditures in the program county shall be no more than 100 percent of total projected expenditures for delivery of services and for administration based on any combination of the following paragraphs:
(1) Relevant prior fee-for-service Medi-Cal experience in the program county.
(2) The fee-for-service Medi-Cal experience in comparable counties or groups of counties.
(3) Medi-Cal experience of the pilot project in the program county if, as determined by the department, the scope, level, and duration of, and expenditures for, any services used in setting the rates under this paragraph would be comparable to fee-for-service conditions were they to exist in the program county and would be more actuarially reliable for use in rates setting than data available for use in applying paragraph (1) or (2).
The projected total expenditure shall be determined annually according to an acceptable actuarial process. The data elements used by the department shall be shared with the proposed contractor.
(d) The director shall accept or reject the proposal within 30 days after the date of receipt. If a decision is made to reject the proposal, the director shall set forth the reasons for this decision in writing. Upon approval of the proposal, a contract shall be written within 60 days. After signature by the local contractor. the State Department of Health Services, the Department of General Services, and the Department of Finance shall execute the contract within 60 days.
(e) The director shall seek the necessary state and federal waivers to enable operation of the program. If the federal waivers for delivery of services under this plan are not granted, the department is under no obligation to contract for implementation of the program.
(f) For purposes of Section 1343 of the Health and Safety Code, the Santa Barbara Regional Health Authority shall be considered to be a county-operated pilot program contracting with the State Department of Health Services pursuant to this article, and notwithstanding any other provision of law. during the period that this contract is in effect, the contractor shall be exempt from the provisions of the Knox-Keene Health Care Service Plan Act of 1975, Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code, relative to the services provided to Medi-Cal beneficiaries under the terms and provisions of the pilot program.
(g) Dental services may be included within the services provided in this pilot program.
(h) Any federal demonstration funding for this pilot program shall be made available to the county within 60 days upon notification of the award without the state retaining any portion not previously specified in the grant application as submitted.
i.(1) (A)Commencing January 1, 1996, the California Medical Assistance Commission may negotiate exclusive contracts and rates on behalf of the department with the Santa Barbara Regional Health Authority in the implementation of this section.
(B) Contracts entered under this article may be on a noncompetitive bid basis and shall be exempt from Chapter 2 (commencing with Section 10290) of Part 2 of Division 2 of the Public Contract Code. These contracts shall have no force or effect unless approved by the Department of Finance.
(C) The department shall enter into contracts pursuant to this article and shall be bound by the terms and conditions related to the rates negotiated by the negotiator.
(2) The department shall implement this subdivision to the extent that the following apply:
A. Its implementation does not revise the status of the pilot program as a federal demonstration project.
B. Existing federal waivers apply to the pilot program as revised by this subdivision. or the federal government extends the applicability of the existing federal waivers or authorizes additional federal waivers for the implementation of the program.
(3) The implementation of this subdivision shall not affect the pilot program’s having met any of the requirements of Part 3.5 (commencing with Section 1175) of Division 1 of the Health and Safety Code and this division applicable to the pilot program with respect to the negotiations of contracts and rates by the department.
(j) An independent evaluation of the program shall be conducted, and a report submitted to the Legislature and the director by January 1, 1988. The independent evaluation of the program commissioned by the federal Health Care Financing Administration may fulfill the purposes of this part. This evaluation and report shall include, but is not limited to, the following:
- An assessment of the cost of medical services as compared to the cost of the existing Medi-Cal fee-for-service delivery mode.
- An assessment of utilization levels of specialist and emergency services.
- An assessment of the quality of care.
- Recommendations for future policy on delivery of services.
14499.6. (a) The Santa Barbara Regional Health Authority may arrange with out-of-county Selective Provider Contracting Program hospitals that have negotiated hospital contracts and per diem rates under Article 5.1 (commencing with Section 14165} of Chapter 7, to provide medically justified emergency services or to provide specialized hospital services not available within Santa Barbara County to Medi-Cal beneficiaries who reside in Santa Barbara County. The authority may arrange medically justified inpatient hospital services with out-of-county program hospitals for those beneficiaries whose county of residence for purposes of eligibility determination is Santa Barbara, but who for medical or legal reasons physically reside in a county other than Santa Barbara.
(b) The out-of-county program hospitals shall not charge the authority more than their program negotiated rates when providing hospital services to authority patients under this section, except as provided in subdivision (c).
(c) In cases where an out-of-county program hospital can demonstrate that the cost of the services it is rendering to authority patients was not contemplated in the case mix and acuity assumptions on which the program rates are based, the program hospital and the authority shall negotiate in good faith equitable rates for payment for the provision of hospital services to authority patients. The established program rate shall serve as the base for those negotiations.
d.(1) Notwithstanding any other provision of law, any records maintained by the authority which would enable a determination to be made regarding rates negotiated pursuant to Article 5.1 (commencing with Section 14165) of Chapter 7, shall be exempt from the Public Records Act (Chapter 3.5 (commencing with Section 6250} of Division of Title 1 of the Government Code).
(2) The authority shall establish guidelines to ensure that these rates are maintained as confidential records and that access to these records is restricted.
(3) The authority shall submit the established guidelines to the department for approval.
The following information is sourced from the California Legislative Information website, and can be accessed by clicking here.
HEALTH AND SAFETY CODE – HSC
DIVISION 101. ADMINISTRATION OF PUBLIC HEALTH[100100 – 101997]
(Division 101 added by Stats. 1995, Ch. 415, Sec. 3.)
PART 4. SPECIAL HEALTH AUTHORITIES [101525 – 101881]
( Part 4 added by Stats. 1995, Ch. 415, Sec. 3. )
CHAPTER 3. Santa Barbara County Special Health Care Authority [101675 – 101781]
(Chapter 3 added by Stats. 1995, Ch. 415, Sec. 3.)
ARTICLE 2. Powers of the Authority [101750 – 101781]
(Article 2 added by Stats. 1995, Ch. 415, Sec. 3.)
101750.
The authority is hereby declared to be a body corporate and politic and it shall have power:
(a) To have perpetual succession.
(b) To sue and be sued in the name of the authority in all actions and proceedings in all courts and tribunals of competent jurisdiction.
(c) To adopt a seal and alter it at pleasure.
(d) To take by grant, purchase, gift, devise, or lease, to hold, use and enjoy, and to lease, convey or dispose of, real and personal property of every kind, within or without the boundaries of the authority, necessary or convenient to the full exercise of its powers. The board may lease, mortgage, sell, or otherwise dispose of any real or personal property within or without the boundaries of the authority necessary to the full or convenient exercise of its powers.
(e) To make and enter into contracts with any public agency or person for the purposes of this chapter, including, but not limited to, agreements under Chapter 5 (commencing with Section 6500) of Division 7 of Title 1 of the Government Code. Members of the board shall be disqualified from voting on contracts in which they have a financial interest. Notwithstanding any other provision of law, members shall not be disqualified from continuing to serve as a member of the board and a contract may not be avoided solely because of a member’s financial interest.
(f) To appoint and employ an executive director and other employees as may be necessary, including legal counsel, fix their compensation and define their powers and duties. The board shall prescribe the amounts and forms of fidelity bonds of its officers and employees. The cost of these bonds shall be borne by the authority. The authority may also contract for the services of an independent contractor.
(g) To incur indebtedness not exceeding revenue in any year.
(h) To purchase supplies, equipment, materials, property, or services.
(i) To establish policies relating to its purposes.
(j) To acquire or contract to acquire, rights-of-way, easements, privileges, or property of every kind within or without the service area of the authority, and construct, equip, maintain, and operate any and all works or improvements within or without the boundaries of the authority necessary, convenient, or proper to carry out any of the provisions, objects or purposes of this chapter, and to complete, extend, add to, repair, or otherwise improve any works or improvements acquired by it.
(k) To make contracts and enter into stipulations of any nature upon the terms and conditions that the board finds are for the best interest of the authority for the full exercise of the powers granted in this chapter.
(l) To accept gifts, contributions, grants, or loans from any public agency or person for the purposes of this chapter. The authority may do any and all things necessary in order to avail itself of the gifts, contributions, grants, or loans, and cooperate under any federal or state legislation in effect on March 25, 1982, or enacted after that date.
(m) To manage its moneys and to provide depository and auditing services pursuant to either of the methods applicable to special districts as set forth in the Government Code.
(n) To negotiate with service providers rates, charges, fees and rents, and to establish classifications of health care systems operated by the authority. Members of the board who are county officers and employees may vote to approve arrangements and agreements between the authority and the county as a service provider and these directors shall not thus be disqualified solely for the reason that they are employed by the county.
(o) To develop and implement health care delivery systems to promote quality care and cost efficiency and to provide appeal and grievance procedures available to both providers and consumers.
(p) To provide health care delivery systems for any or all of the following:
(1) For all persons who are eligible to receive medical benefits under the Medi-Cal Act, as set forth in Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code, in the service area through waiver, pilot project, or otherwise.
(2) For all persons in the service area who are eligible to receive medical benefits under both Titles XVIII and XIX of the federal Social Security Act.
(3) For all persons in the service area who are eligible to receive medical benefits under Title XVIII of the federal Social Security Act.
(4) For all persons in the service area who are eligible to receive medical benefits under publicly supported programs if the authority, and participating providers acting pursuant to subcontracts with the authority, agree to hold harmless the beneficiaries of the publicly supported programs if the contract between the sponsoring government agency and the authority does not ensure sufficient funding to cover program benefits.
(q) To insure against any accident or destruction of its health care system or any part thereof. It may insure against loss of revenues from any cause. The authority may also provide insurance as provided in Part 6 (commencing with Section 989) of Division 3.6 of Title 1 of the Government Code.
(r) To exercise powers that are expressly granted and powers that are reasonably implied from express powers and necessary to carry out the purposes of this chapter.
(s) To do any and all things necessary to carry out the purposes of this chapter.
(t) With respect to services provided outside the county, the authority may only provide those services to the extent that the services are authorized by resolution of the board of supervisors of the county in which the services are to be provided.
(Amended by Stats. 2007, Ch. 266, Sec. 9. Effective January 1, 2008.)
101750.5.
Notwithstanding subdivision (f) of Section 14499.5 of the Welfare and Institutions Code, for the purposes of Division 3.6 (commencing with Section 810) of Title 1 of the Government Code, the authority shall be considered a public entity separate from the county or counties and shall file the statement required by Section 53051 of the Government Code.
(Added by Stats. 2004, Ch. 228, Sec. 3.9. Effective August 16, 2004.)
101755.
Notwithstanding any other provision of law, the state or any state agency may enter into contracts with the authority for the authority to obtain or arrange for health care under the authority’s health care systems, for all persons who are eligible to receive medical benefits under the Medi-Cal Act, as set forth in Section 14000 et seq., of the Welfare and Institutions Code, and to enter into contracts for the provision of health care services to subscribers in the Healthy Families Program, in its service area through waiver, pilot project, or otherwise.
(Amended by Stats. 2005, Ch. 29, Sec. 4. Effective January 1, 2006.)
101760.
Notwithstanding any other provision of this chapter, the board of supervisors of the county in which the appellant resides may review major administrative decisions of the authority, excluding those involving personnel matters, upon appeal by the affected person and upon a majority vote of that board of supervisors. That board of supervisors may either approve, modify, reflect, or repeal these decisions. The action of the board of supervisors
supported programs if the contract between the sponsoring government agency and the authority does not ensure sufficient funding to cover program benefits.
(q) To insure against any accident or destruction of its health care system or any part thereof. It may insure against loss of revenues from any cause. The authority may also provide insurance as provided in Part 6 (commencing with Section 989) of Division 3.6 of Title 1 of the Government Code.
(r) To exercise powers that are expressly granted and powers that are reasonably implied from express powers and necessary to carry out the purposes of this chapter.
(s) To do any and all things necessary to carry out the purposes of this chapter.
(t) With respect to services provided outside the county, the authority may only provide those services to the extent that the services are authorized by resolution of the board of supervisors of the county in which the services are to be provided.
(Amended by Stats. 2007, Ch. 266, Sec. 9. Effective January 1, 2008.)
101750.5.
Notwithstanding subdivision (f) of Section 14499.5 of the Welfare and Institutions Code, for the purposes of Division 3.6 (commencing with Section 810) of Title 1 of the Government Code, the authority shall be considered a public entity separate from the county or counties and shall file the statement required by Section 53051 of the Government Code.
(Added by Stats. 2004, Ch. 228, Sec. 3.9. Effective August 16, 2004.)
101755.
Notwithstanding any other provision of law, the state or any state agency may enter into contracts with the authority for the authority to obtain or arrange for health care under the authority’s health care systems, for all persons who are eligible to receive medical benefits under the Medi-Cal Act, as set forth in Section 14000 et seq., of the Welfare and Institutions Code, and to enter into contracts for the provision of health care services to subscribers in the Healthy Families Program, in its service area through waiver, pilot project, or otherwise.
(Amended by Stats. 2005, Ch. 29, Sec. 4. Effective January 1, 2006.)
101760.
Notwithstanding any other provision of this chapter, the board of supervisors of the county in which the appellant resides may review major administrative decisions of the authority, excluding those involving personnel matters, upon appeal by the affected person and upon a majority vote of that board of supervisors. That board of supervisors may either approve, modify, reflect, or repeal these decisions. The action of the board of supervisors
supported programs if the contract between the sponsoring government agency and the authority does not ensure sufficient funding to cover program benefits.
(q) To insure against any accident or destruction of its health care system or any part thereof. It may insure against loss of revenues from any cause. The authority may also provide insurance as provided in Part 6 (commencing with Section 989) of Division 3.6 of Title 1 of the Government Code.
(r) To exercise powers that are expressly granted and powers that are reasonably implied from express powers and necessary to carry out the purposes of this chapter.
(s) To do any and all things necessary to carry out the purposes of this chapter.
(t) With respect to services provided outside the county, the authority may only provide those services to the extent that the services are authorized by resolution of the board of supervisors of the county in which the services are to be provided.
(Amended by Stats. 2007, Ch. 266, Sec. 9. Effective January 1, 2008.)
101750.5.
Notwithstanding subdivision (f) of Section 14499.5 of the Welfare and Institutions Code, for the purposes of Division 3.6 (commencing with Section 810) of Title 1 of the Government Code, the authority shall be considered a public entity separate from the county or counties and shall file the statement required by Section 53051 of the Government Code.
(Added by Stats. 2004, Ch. 228, Sec. 3.9. Effective August 16, 2004.)
101755.
Notwithstanding any other provision of law, the state or any state agency may enter into contracts with the authority for the authority to obtain or arrange for health care under the authority’s health care systems, for all persons who are eligible to receive medical benefits under the Medi-Cal Act, as set forth in Section 14000 et seq., of the Welfare and Institutions Code, and to enter into contracts for the provision of health care services to subscribers in the Healthy Families Program, in its service area through waiver, pilot project, or otherwise.
(Amended by Stats. 2005, Ch. 29, Sec. 4. Effective January 1, 2006.)
101760.
Notwithstanding any other provision of this chapter, the board of supervisors of the county in which the appellant resides may review major administrative decisions of the authority, excluding those involving personnel matters, upon appeal by the affected person and upon a majority vote of that board of supervisors. That board of supervisors may either approve, modify, reflect, or repeal these decisions. The action of the board of supervisors That board of supervisors may either approve, modify, reflect, or repeal these decisions. The action of the board of supervisors shall be deemed to constitute a final administrative remedy after concurrence by the board of supervisors of the other county. This section shall not be operative until adopted by resolution by the boards of supervisors of both counties.
(Amended by Stats. 2007, Ch. 266, Sec. 10. Effective January 1, 2008.)
101765.
Any licensed provider eligible to receive Medi-Cal reimbursement under law and who enters into a written contract with the authority under terms and conditions approved by the department shall be able to participate in this program as a provider. A written agreement shall not be required if any of the following circumstances apply:
(a) The provider renders any medically necessary emergency health care on a nonroutine basis.
(b) The provider renders services that are duly authorized by the authority, if the services are either seldom used or are rendered outside of the service area.
(Amended by Stats. 2005, Ch. 29, Sec. 5. Effective January 1, 2006.)
101770.
All claims for money or damages against the authority are governed by Part 3 (commencing with Section 900) and Part 4 (commencing with Section 940) of Division 3.6 of Title 1 of the Government Code, except as provided in those parts, or by other statutes or regulations expressly applicable to those parts.
(Added by Stats. 1995, Ch. 415, Sec. 3. Effective January 1, 1996.)
101775.
In the formation of the authority pursuant to this chapter, Chapter 6.6 (commencing with Section 54773) of Part 1 of Division 2 of Title 5 of the Government Code is not applicable.
(Amended by Stats. 2007, Ch. 266, Sec. 11. Effective January 1, 2008.)
101780.
(a) The boards of supervisors of the County of Santa Barbara and the County of San Luis Obispo may, by ordinance or resolution, order the dissolution of the authority by declaring that there is no need for the authority to function in the counties. Both boards of supervisors shall order the dissolution of the authority pursuant to this subdivision in order for the dissolution to become effective. The dissolution shall become effective 180 days after the date of the later adopted resolution or ordinance ordering the dissolution.
(b) As of the effective date of the dissolution of the authority, the authority shall be dissolved, disincorporated and extinguished; its existence shall be terminated and all of its corporate powers shall cease, except for winding up the affairs of the authority.
(c) For the purpose of winding up the affairs of the dissolved authority, the County of Santa Barbara shall be the successor.
(d) Upon the effective date of dissolution, control over all of the moneys or funds, including those on hand, and those due, but uncollected, and all property, real or personal, of the authority shall be vested in the County of Santa Barbara for the purpose of winding up the affairs of the authority.
(e) The powers of the county in winding up the affairs of the authority and the distribution of assets of the authority, shall be in accordance with Chapter 6 (commencing with Section 57450) of Part 5 of Division 3 of Title 5 of the Government Code. The liability of the County of Santa Barbara as successor shall be limited to the assets of the authority.
(Amended by Stats. 2014, Ch. 602, Sec. 1. (AB 2117) Effective January 1, 2015.)
101781.
The Board of Supervisors of either the County of San Luis Obispo or the County of Santa Barbara, or the board of directors of the authority, by ordinance or resolution, may terminate the authority’s operation of a health care system or systems in the County of San Luis Obispo. The termination shall become effective 180 days after the adoption of the ordinance or resolution. If the termination is made by the board of supervisors of either county, the terminating county’s liability to the authority shall be limited to the cost of terminating the authority’s operations in the County of San Luis Obispo, including, but not limited to, the costs of terminating contracts and other obligations for space, services, employment, health care services, required notices to beneficiaries and subscribers, and moving expenses.
(Added by Stats. 2007, Ch. 266, Sec. 13. Effective January 1, 2008.)