2005 California Welfare and Institutions Code Sections 14570-14577 Article 4. Administration

14570.  (a) The department shall adopt all necessary rules and
regulations providing for quality of care and payment for services
rendered under this chapter pursuant to Chapter 7 (commencing with
Section 14000).  All regulations heretofore adopted by the department
pursuant to this chapter, and that are in effect immediately
preceding the operative date of the amendment of this section enacted
by the Legislature during the 1977-78 Regular Session, shall remain
in effect and shall be fully enforceable unless and until readopted,
amended, or repealed by the director.
   (b) The director shall establish a distinct organizational entity
within the department that shall have primary responsibility for the
Adult Day Health Care Medi-Cal program.  This entity shall coordinate
and direct all departmental activities required by this chapter.
14571.  The department, in consultation with the California
Association for Adult Day Services, shall develop a rate methodology.
  The methodology shall take into consideration all allowable costs
associated with providing adult day health care services.  Once a
methodology has been approved by the department, it shall be the
basis of future annual rate reviews.
   Payment shall be for services provided in accordance with an
approved individual plan of care.  Billing shall be submitted
directly to the department.  Additionally, the department shall
establish a reasonable rate of reimbursement for the initial
assessment.
   Nothing in this section shall preclude the department from
entering into specific prospective budgeting and reimbursement
agreements with providers.
14572.  No Medi-Cal reimbursement shall be made for a service
rendered by an adult day health care provider which does not have a
license as an adult day health care center or which does not have
currently effective Medi-Cal certification pursuant to this chapter.
14573.  (a) Initial Medi-Cal certification for adult day health care
providers shall expire 12 months from the date of issuance.  The
director shall specify any date he or she determines is reasonably
necessary because of the record of the applicant and to carry out the
purposes of this chapter, but not more than 24 months from the date
of issuance, when renewal of the certification shall expire.  The
certification may be extended for periods of not more than 60 days if
the department determines it to be necessary.
   (b) Before certification renewal the provider shall submit with
the application for renewal a report according to department
specifications that includes an analysis of income and expenditures,
continued demonstrated community need, services, participant
statistics and outcome, and adherence to policies and procedures.
   (c) Prior to approving renewal of Medi-Cal certification, the
California Department of Aging shall conduct a financial review and
onsite medical and management reviews.  The reviews shall be
conducted by a team of persons with appropriate technical skills.
The management review shall be performed by the entity responsible
for directing and coordinating the program, as specified in the
interagency agreement entered into pursuant to Section 1572 of the
Health and Safety Code.
   (d) Where the director determines that the public interests would
be served thereby, a public hearing may be held on any renewal
application subject to this section.  The findings of the
departmental program and licensing reviews and the provider's annual
evaluation report shall be presented at the hearing.
14574.  (a) The director shall terminate the Medi-Cal certification
of any adult day health care provider at any time if he or she finds
the provider is not in compliance with standards prescribed by this
chapter or Chapter 7 (commencing with Section 14000) or regulations
adopted pursuant to these chapters.  The director shall give
reasonable notice of his or her intention to terminate the
certification to the provider and participants in the center.  The
notice shall state the effective date of, and the reason for, the
termination.
   (b) The denial, suspension, or termination of certification shall
be considered grounds for denial, suspension, or revocation of the
license.
   (c) The California Department of Aging and the department shall
coordinate proceedings to deny an application for certification, to
terminate or suspend certification, or to revoke or suspend licensure
to the extent appropriate to ensure consistency and uniformity.
   (d) The provider shall have the right to appeal the department's
decision made pursuant to Section 14123.
   (e) This section is not applicable to denials of initial
certification made pursuant to a moratorium imposed in accordance
with Section 14043.46 of the Welfare and Institutions Code.
14574.1.  (a) Every adult day health care center shall be
periodically inspected and evaluated for quality of care by a
representative or representatives designated by the director, unless
otherwise specified in the interagency agreement entered into
pursuant to Section 1572 of the Health and Safety Code.  Inspections
shall be conducted prior to the expiration of certification, but at
least every two years, and as often as necessary to ensure the
quality of care being provided.  As resources permit, an inspection
may be conducted prior to, as well as within, the first 90 days of
operation.
   (b) If, as a result of the inspection, the department or the
California Department of Aging, as specified in the interagency
agreement, determines that the adult day health care center has
serious deficiencies that pose a risk to the health and safety of the
participants, the department or the California Department of Aging,
as specified in the interagency agreement, may immediately take any
of the following actions, including, but not limited to:
   (1) Require a plan of correction, including as requested, a
program plan pursuant to Section 14552.2.
   (2) Limit participant enrollment.
   (3) Prohibit new participant enrollment.
   (c) The provider shall have the right to dispute an action taken
under paragraphs (2) and (3) of subdivision (b).  The department or
the California Department of Aging, as specified in the interagency
agreement, shall accept, consider, and resolve disputes filed
pursuant to this subdivision in a timely manner.  The dispute
resolution process shall be determined by the California Department
of Aging in consultation with the department.
   (d) The director shall ensure that public records accurately
reflect the current status of any potential actions including the
resolution of disputes.
14575.  Each adult day health care provider shall maintain a uniform
accounting and reporting system as developed by the department, in
consultation with the provider.  The department shall implement a
uniform cost accounting system and train providers in this system by
July 1, 1987.  The California Department of Aging, in coordination
with the department may approve an alternative cost accounting system
where the provider demonstrates the ability to report comparable and
reliable data.  The provider shall submit annual cost reports to the
department, unless otherwise specified in an interagency agreement
entered into pursuant to Section 1572 of the Health and Safety Code,
no later than five months after the close of the licensee's fiscal
year.  The report shall be submitted in the format prescribed by the
state.  Each facility shall maintain, for a period of four years
following the submission of annual cost reports, financial and
statistical records of the period covered by the cost reports which
are accurate and in sufficient detail to substantiate the cost data
reported.  These records shall be made available to state or federal
representatives upon request.  The department, unless otherwise
specified in an interagency agreement entered into pursuant to
Section 1572 of the Health and Safety Code, may request a financial
review performed by an independent certified public accountant as
part of the provider's annual cost report.  All certified financial
statements shall be filed with the department within a period no
later than three months after the department's request.  The
department, unless otherwise specified in an interagency agreement
entered into pursuant to Section 1572 of the Health and Safety Code,
may require a limited or complete certified public accountant audit
when the monitoring activities carried out pursuant to Section 14573
reveal significant financial management deficiencies.
14576.  Each adult day health care provider shall furnish to the
department, unless otherwise specified by the interagency agreement
entered into pursuant to Section 1572 of the Health and Safety Code,
all additional information and reports that the department may find
necessary in performing its functions under this chapter.  The
information and reports shall include, but not be limited to, any
statistical information regarding utilization of services, individual
treatment plans and individual service reports, costs of health
care, and administration the department may require.
14577.  All subcontracts for services reimbursable under this
chapter shall be entered into pursuant to regulations of the
department.  All subcontracts shall be in writing, and a copy shall
be transmitted to the department for approval prior to taking effect.
  Each subcontract submitted to the department for approval shall
contain the amount of compensation or other consideration which the
subcontractor will receive under the terms of the subcontract with
the adult day health care provider.  However, this section shall not
apply to employment contracts of salaried employees of an adult day
health care licensee.
   All subcontracts to provide health care benefits, including
emergency services, shall include a specification that services will
be provided to participants to meet the needs of the participants
based upon the plans of care.  All subcontracts to provide any of the
basic services specified in Section 14550 through subcontractors,
shall meet all of the qualifications required by, or pursuant to,
this chapter as appropriate for the services which the subcontractors
are required to perform.
   Each subcontract shall require that the subcontractor make all of
its books and records pertaining to the goods or services furnished
under the terms of the subcontract available for inspection,
examination, or copying by the department during normal working hours
at the subcontractor's principal place of business, or at such other
place in the state as the department shall designate.  Subcontracts
between an adult day health care provider and a subcontractor shall
be public records and shall be kept on file and be available at the
center.  The names of the officers and stockholders of the
subcontractor shall also be kept on file and be available as public
records at the center.