JurisdictionCaliforniaCode WICWelfare and Institutions Code - WIC
Div. 9.DIVISION 9. PUBLIC SOCIAL SERVICES
Part 3.PART 3. AID AND MEDICAL ASSISTANCE
Ch. 7.CHAPTER 7. Basic Health Care
Art. 6.3.ARTICLE 6.3. Medi-Cal Managed Care Plans
(a)The department may, at its discretion, align relevant terms of its contract with a Medi-Cal behavioral health delivery system with the terms of its contract with a Medi-Cal managed care plan, as defined in subdivision (j) of Section 14184.101, for those requirements that apply to both entities. Requirements that apply to both entities include, but are not limited to, all of the following:
(1)Organization and administration of the plan, including key administrative staffing requirements.
(2)Financial information.
(4)Quality improvement systems.
(5)Utilization management.
(7)Provider compensation arrangements.
(8)Provider oversight and monitoring.
(9)Access and availability of services, including, but not limited to, reporting o
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(a)
The department may, at its discretion, align relevant terms of its contract with a Medi-Cal behavioral health delivery system with the terms of its contract with a Medi-Cal managed care plan, as defined in subdivision (j) of Section 14184.101, for those requirements that apply to both entities. Requirements that apply to both entities include, but are not limited to, all of the following:
(1)
Organization and administration of the plan, including key administrative staffing requirements.
(2)
Financial information.
(3)
Information
systems.
(4)
Quality improvement systems.
(5)
Utilization management.
(6)
Provider network.
(7)
Provider compensation arrangements.
(8)
Provider oversight and monitoring.
(9)
Access and availability of services, including, but not limited to, reporting of waitlists for behavioral health services or attesting to no waitlists.
(10)
Care coordination and data sharing.
(11)
Member services.
(12)
Member grievances and appeals data.
(13)
Reporting requirements.
(14)
Other contractual requirements determined by the department.
(b)
The department shall establish minimum quality metrics to measure and evaluate the quality and efficacy of services and programs covered under Medi-Cal behavioral health delivery systems.
(c)
(1)
Each Medi-Cal behavioral health delivery system shall report annually to the county board of supervisors on utilization, quality, patient care expenditures, and other data as determined by the department.
(2)
The board of supervisors shall annually submit an attestation to the department that the county is meeting its obligations to provide realigned programs and services pursuant to clauses (i), (iv), and (v) of subparagraph (B) of paragraph (16) of subdivision (f) of Section 30025 of the Government Code.
(d)
(1)
Notwithstanding any other state or local law, including, but not limited to, Section 5328 of this code and Sections 11812 and 11845.5 of the Health and Safety Code, the sharing of health, social services, housing, and criminal justice information, records, and other data with and among the department, other state departments, including the State Department of Public Health and the State Department of Social Services, Medi-Cal managed care plans, as
defined in subdivision (j) of Section 14184.101, Medi-Cal behavioral health delivery systems, as defined in subdivision (i) of Section 14184.101, counties, health care providers, social services organizations, care coordination and case management teams, and other authorized provider or plan entities, and contractors of all of those entities, shall be permitted to the extent necessary and consistent with federal law.
(2)
The department shall issue guidance identifying permissible data-sharing arrangements.
(e)
For purposes of this section, the term “Medi-Cal behavioral health delivery system” means an entity or local agency that contracts with the department to provide covered behavioral health Medi-Cal benefits pursuant to Section 14184.400 and Chapter 8.9 (commencing with
Section 14700) or a county Drug Medi-Cal Organized Delivery System pilot authorized under the CalAIM Terms and Conditions and described in Section 14184.401 or authorized under the Medi-Cal 2020 Demonstration Project Act pursuant to Article 5.5 (commencing with Section 14184).
(f)
This section shall be implemented only to the extent that necessary federal approvals have been obtained and federal financial participation is available and not otherwise jeopardized.
(g)
The department shall implement this section no later than January 1, 2027.