(a) The State Department of Developmental Services and the State Department of Health Care Services shall coordinate the transition of health care services for Medi-Cal eligible consumers who are transitioning from a developmental center into the community.
(b) In order to meet the unique medical health needs of consumers who will be transitioning from a developmental center into the community, whose individual program plans document the need for coordinated medical and specialty care, and who are Medi-Cal eligible, the State Department of Health Care Services shall issue transition requirements including referral practices, service authorization practices, coordination of case management services, education and training services, and the management and sharing of medical records, to applicable Medi-Cal managed care health plans and monitor compliance. These transition requirements shall include, but are not limited to, processes for individuals assigned to a Medi-Cal managed care plan which promote coordination of care during and following the transition, identification of providers prior to a transition occurring, and the continuation of medically necessary covered services. These processes shall be described in a transition plan which will be shared with stakeholders prior to being finalized. The final transition plan shall be submitted to the Joint Legislative Budget Committee no later than December 31, 2016.
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the State Department of Health Care Services may implement, interpret, or make specific this section, in whole or in part, by means of all-county letters, plan letters, plan or provider bulletins, policy letters, or other similar instructions, without taking regulatory action.
(d) The State Department of Health Care Services shall implement this section only to the extent that any necessary federal approvals are obtained and federal financial participation is available.
(Added by Stats. 2016, Ch. 26, Sec. 6. (AB 1606) Effective June 27, 2016.)
Last modified: October 25, 2018