California Welfare and Institutions Code ARTICLE 4.3 - Long-Term Care Integration Pilot Program

Section 14139.05.
The Legislature finds and declares that:(a) Long-term care services in California include an uncoordinated array of categorical programs offering medical, social, and other support services that...
Section 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 long-term care...
Section 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 individual dignity, and...
Section 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...
Section 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...
Section 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:(a) Development of...
Section 14139.21.
The department may accept funding from federal agencies, foundations or other nongovernmental sources and may contract with qualified consultants to assist with the provision of...
Section 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...
Section 14139.23.
Upon the implementation of the pilot program, responsibility for administering the programs integrated within the pilot program shall be transferred to the department, and shall...
Section 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. This article...
Section 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...
Section 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) Establish...
Section 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,...
Section 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 Medi-Cal long-term institutional care,...
Section 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 all...
Section 14139.34.
The administrative action plan may also include any of the following services:(a) Transportation.(b) Home modification.(c) Medical services, including, but not limited to, primary, ancillary, and acute care.(d) Housing and...
Section 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...
Section 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...
Section 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 area...
Section 14139.38.
Participating counties shall continue their financial maintenance of effort for each of the programs integrated within the pilot program under this article. The amount of...
Section 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 shall do all...
Section 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 functionally or cognitively impaired. For purposes...
Section 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...
Section 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 individuals or...
Section 14139.44.
Pilot project sites shall ensure provider reimbursement rates that are adequate to maintain compliance with applicable federal and state requirements.(Added by Stats. 1995, Ch. 875,...
Section 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...
Section 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 amount of...
Section 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 capability to achieve and...
Section 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...
Section 14139.61.
The department may adopt emergency regulations as necessary to implement this article in accordance with the Administrative Procedure Act, Chapter 3.5 (commencing with Section 11340)...
Section 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 waiver reporting...

Last modified: October 22, 2018