2010 California Code
Welfare and Institutions Code
Chapter 4. Rural Health Services

16930.  (a) (1) There is in the County Health Services Fund, created
pursuant to Section 16803, the Rural Health Services Account.
   (2) For purposes of this chapter, "account" means the account
created by paragraph (1).
   (b) All money appropriated for the purposes of this chapter shall
be deposited in the account.
   (c) The department shall administer moneys deposited in the
account on an accrual basis, and notwithstanding any other provision
of law, except as provided in this chapter, those moneys shall not be
transferred to any other fund or account except for purposes of
investment, as provided in Article 4 (commencing with Section 16470)
of Chapter 3 of Part 2 of Division 4 of Title 2 of the Government
Code.



16931.  (a) Funds appropriated for the purposes of this chapter
shall be used to enhance and maintain rural health services provided
by counties, hospitals, physicians, and other providers of services
to patients who cannot afford to pay for those services, and for whom
payment will not be made through any private coverage or by any
program funded in whole or in part by the federal government.
   (b) The requirements of Sections 16804.1 and 16818 apply to
services supported by funds appropriated for the purposes of this
chapter.
   (c) Except as specifically provided in this chapter, the authority
of each county established pursuant to Section 16817 shall remain
unaffected.


16931.5.  The county may reimburse for emergency services provided
by a physician in a standby emergency room in a hospital specified in
Section 124840 of the Health and Safety Code.



16932.  The department shall allocate money derived from the
Hospital Services Account in the fund to each county that is eligible
to participate in the CMSP pursuant to Section 16809 in the
following manner:
   (a) The combined total of hospital uncompensated care costs for
all county and noncounty hospitals in each county that is eligible to
participate in the CMSP pursuant to Section 16809 shall be
calculated by using the definitions, procedures, and data elements
specified in Section 16945.
   (b) (1) The office shall determine each county's 1989-90 fiscal
year share by using the 1988 calendar year data, as adjusted by the
office, existing on the statewide file on September 1, 1989.
   (2) The office shall determine each county's share for the fiscal
years after the 1989-90 fiscal year by using the data from the
quarterly reports for the calendar year preceding the fiscal year, as
adjusted by the office and existing on the statewide file on April
15 immediately preceding the fiscal year.
   (3) The office shall determine each county's share based on that
county's total hospital uncompensated care costs, divided by the
total hospital uncompensated care costs for all counties that are
eligible to participate in the CMSP pursuant to Section 16809, and by
multiplying that product by the amount appropriated from the
Hospital Services Account in the fund for purposes of this chapter.
   (4) The amounts calculated pursuant to paragraphs (2) and (3)
shall be each county's allocation from the total amount available for
allocation to the counties under this chapter.
   (c) The amounts calculated pursuant to paragraph (4) of
subdivision (b) shall be divided and allocated in accordance with
Section 16946. Sections 16946, 16947, 16948, and 16949 shall be
applicable to counties and hospitals receiving these funds.



16933.  (a) The department shall distribute those moneys
appropriated from the Physician Services Account and the Unallocated
Account in the fund to counties that are eligible to participate in
the CMSP pursuant to Section 16809 on the basis of the percentages
obtained by dividing the population of each county that is eligible
to participate in the CMSP pursuant to Section 16809 by the total
population of all counties that are eligible to participate in the
CMSP pursuant to Section 16809, as reported in the most recent annual
Department of Finance Research Unit report E-1.
   (b) Each county shall use moneys allocated from the Unallocated
Account in the fund pursuant to, and for the purposes specified in,
Article 4 (commencing with Section 16960) of Chapter 5, and to expand
emergency medical transportation services.
   (c) Counties shall use moneys allocated from the Physician
Services Account in the fund the following ways to provide medically
necessary emergency, obstetric, or pediatric services, or all of
them, to patients who cannot afford to pay for those services, and
for whom payment will not be made through any private coverage or by
any program funded in whole or in part by the federal government:
   (1) Establishment and administration of a Physician Services
Account in the county emergency medical services fund in accordance
with Article 3.5 (commencing with Section 16951) of Chapter 5.
   (2) Contracting with the department for the administration of all
Physician Services Account moneys specified in this subdivision
pursuant to subdivision (c) of Section 16952.
   (3) The reimbursement or support of services, either directly or
by contract, which are provided by physicians or groups of
physicians.
   (d) Moneys allocated from the Physician Services Account in the
fund shall be used to provide reimbursement for services provided on
or after July 1, 1989.


16933.1.  Any physician who receives funds pursuant to subdivision
(c) of Section 16933 shall comply with the requirements of
subdivision (d) of Section 16955.



16934.  (a) As a condition of receiving funds under this chapter, a
county shall provide, or arrange and pay for, medically necessary
followup treatment, including necessary followup dental services and
prescription drugs, for any condition detected as part of a child
health and disability prevention screen for a child eligible for
services under Section 104395 of the Health and Safety Code, if the
child was screened by the county, or upon referral by a child health
and disability prevention program provider. This section shall not
apply to any child eligible to receive care with no share of cost
under the Medi-Cal program or who is covered by another publicly
funded program or for whom these services are covered or will be paid
by any other responsible party. A county may require that hospitals
that contract with the county pursuant to paragraph (2) of
subdivision (b) of Section 16946, physicians who contract with the
county pursuant to paragraph (3) of subdivision (c) of Section 16933
or dentists or any provider that contracts with the county pursuant
to subdivision (b) of Section 16933 and receives funds appropriated
for the purposes of this chapter to participate in complying with
this section. A county shall not require that hospitals receiving an
allocation pursuant to paragraph (1) of subdivision (b) of Section
16946 or physicians who receive payment from a physician services
account established pursuant to paragraph (1) of subdivision (c) of
Section 16933 participate in complying with this section.
   (b) Dental services provided pursuant to this section shall be at
least equal in scope and frequency to dental services available to
Medi-Cal eligible children of the same age.
   (c) Counties shall implement this section in consultation and
coordination with their child health and disability prevention
programs.



16934.2.  (a) For the 1989-90 fiscal year, a county shall not have
the option to contract with the department for payment for treatment
of children required pursuant to Section 16934. However, a county may
elect to limit its liability for payment of that treatment to 15
percent of the amount the county actually received under this chapter
for the 1989-90 fiscal year. Any county which elects to establish a
15 percent reserve shall notify the department within 45 days of the
effective date of this section of its intention. A county electing to
limit its liability pursuant to this section shall reserve 15
percent of the amount it received, if the county contracts with the
department for administration of its physician services account
pursuant to Section 16935. If the county does not contract with the
department to administer its physician services account, the county's
liability shall be 15 percent of the total allocation it received
under this chapter. Payment for service provided between July 1, 1989
and June 30, 1990, pursuant to Section 16934 which exceeds the
amount reserved shall be the responsibility of the state, provided
that the county provides documentation that it established a 15
percent reserve and met its applicable 15 percent obligation for
services provided pursuant to Section 16934. The state shall recoup
any funds remaining in the 15 percent reserve which were not expended
and shall use the funds to pay for treatment services required under
Section 16934 in future years.
   (1) A county which elects not to establish a 15 percent reserve
pursuant to subdivision (a), or fails to notify the department of its
intention to participate, shall retain full liability for the
payment of treatment of children required pursuant to Section 16934.
   (2) In addition to contractual and other arrangements with
providers, the county, or the department under this subdivision,
pursuant to the obligation under Section 16934, may refer a child in
need of inpatient care to children's hospitals which have received
funding under Chapter 6 (commencing with Section 16996), if the child
meets the hospital's specific criteria for inpatient care. The
county or the department shall be under no obligation to reimburse
the children's hospital for these services.
   (b) For the 1989-90 fiscal year, the department shall establish a
separate Rural Health Services Reinsurance Account within the County
Health Services Fund. For purposes of this chapter "reinsurance
account" means the account established pursuant to this section.
   (1) Moneys appropriated by the Legislature to establish the
reinsurance account shall be deposited in the reinsurance account.
   (2) Moneys deposited into the reinsurance account shall be used to
pay for services provided pursuant to Section 16934 in those
counties which have expended their 15 percent reserves established
pursuant to subdivision (a).
   (3) Any moneys remaining in the reinsurance account after June 30,
1990, which have not been expended or encumbered shall be
transferred to the CHDP Treatment Account established pursuant to
subdivision (b) of Section 16934.5.



16934.5.  (a) For the 1990-91 fiscal year and subsequent fiscal
years, each county that is eligible to participate in the CMSP
pursuant to Section 16809 may enter into a contract with the
department in which the department agrees to assume the
responsibility to pay for the cost of treatment service provided on
or after July 1, 1990, to children pursuant to Section 16934. If a
county that is eligible to participate in the CMSP pursuant to
Section 16809 does not apply for or rescinds its application for
funds under this chapter, the department may use all or part of that
county's allocation, as calculated pursuant to paragraph (3), to pay
for the costs of treatment services to children pursuant to Section
16934.
   (1) Each county intending to contract with the department shall
submit to the department a notice of intent to contract adopted by
the board of supervisors no later than June 1, 1990. For each fiscal
year thereafter a notice adopted by the board of supervisors shall be
submitted no later than April 1 of the fiscal year preceding the
fiscal year for which the agreement will be in effect, in accordance
with procedures established by the department. As a condition of
contracting with the department, the department may establish uniform
standards, forms, and procedures for the processing and payment of
claims for treatment services.
   (2) (A) Each county contracting with the department pursuant to
this subdivision for the 1991-92 fiscal year that has previously
contracted with the department pursuant to this section shall agree
that the department shall retain 10 percent of the allocation it
would otherwise have received under this chapter. The department
shall transfer amounts retained on a monthly basis to the CHDP
Treatment Account established in subdivision (b).
   (B) Any county that contracts with the department pursuant to this
subdivision during the 1991-92 fiscal year that has not previously
contracted with the department pursuant to this section shall agree
that the department shall retain 20 percent of the allocation the
county would otherwise have received under this chapter for that
portion of the year for which it contracts under this section.
   (3) In future fiscal years the percentage retained by the
department may be adjusted to reflect actual payments, projected
expenditures, funds appropriated by the Legislature for treatment
services, and the overall status of the account established in
subdivision (b).
   (b) Beginning with the 1990-91 fiscal year, the department shall
establish a separate Child Health and Disability Prevention Treatment
Account. For purposes of this chapter "CHDP Treatment Account" means
the account established pursuant to this subdivision.
   (1) The following funds shall be deposited into the CHDP Treatment
Account:
   (A) Funds appropriated by the Legislature to fund the reinsurance
account established in subdivision (b) of Section 16934.2 which are
not expended or encumbered for that purpose.
   (B) Any funds recouped from those counties electing to establish a
15 percent reserve pursuant to subdivision (a) of Section 16934.2.
   (C) Funds retained by the department pursuant to subdivision (a).
   (D) Interest earnings on funds.
   (E) Any additional funds appropriated by the Legislature.
   (2) Funds deposited in the CHDP Treatment Account shall be
administered on an accrual basis and notwithstanding any other
provision of law, except as provided in this chapter, shall not be
transferred to any other fund or account except for purposes of
investment as provided in Article 4 (commencing with Section 16470)
of Chapter 3 of Part 2 of Division 4 of Title 2 of the Government
Code.
   (3) Moneys deposited into the account shall constitute a risk pool
which shall be used for any or all of the following purposes:
   (A) Payment for services provided pursuant to Section 16934 in
counties which have contracted with the department pursuant to
subdivision (a).
   (B) State administrative costs, including any costs associated
with a contract for processing claims.
   (C) If the projected expenditure of funds from the CHDP Treatment
Account for any fiscal year exceeds available revenues, the
department may adjust payments for the remainder of the fiscal year
to providers on a pro rata basis in order to ensure that expenditures
do not exceed available revenues.



16934.7.  (a) For the 1990-91 fiscal year and each fiscal year
thereafter, each county entering into a contract with the department
pursuant to Section 16934.5, in which the department assumed the
responsibility of payment for the treatment of children pursuant to
Section 16934, shall have the option to contract with the department
to administer the distribution and monitoring of funds allocated from
the Hospital Services Account in the fund pursuant to subdivision
(b) of Section 16946.
   (b) Any county which does not elect to contract with the
department pursuant to Section 16934.5 for payment for the treatment
of children pursuant to Section 16934 may contract with the
department to administer that portion of its funds allocated to the
county from the Hospital Services Account in the fund pursuant to
paragraph (1) of subdivision (b) of Section 16946, but shall not
contract with the department to administer that portion of its funds
allocated to the county from the Hospital Services Account in the
fund pursuant to paragraph (2) of subdivision (b) of Section 16946.
   (c) (1) Any county intending to contract with the department
pursuant to subdivision (a) or (b) shall submit to the department a
notice of intent to contract by resolution adopted by the board of
supervisors or authorized persons within 45 days after the effective
date of the act adding this section.
   (2) For each fiscal year following the submission of the notice of
intent to contract pursuant to paragraph (1), the county board of
supervisors shall submit a notice adopted by the board of supervisors
to the department, in accordance with procedures established by the
department, no later than April 1 of the fiscal year preceding the
fiscal year for which the intended agreement will be in effect.
   (d) (1) Each county contracting with the department pursuant to
subdivision (a) or (b) shall agree that the department shall retain
that portion of the county's allocation pursuant to subdivision (b)
or paragraph (1) of subdivision (b) of Section 16946, whichever is
applicable.
   (2) The department may use up to 10 percent of the amount of funds
retained pursuant to paragraph (1) for purposes of administration of
this section.
   (e) As a condition of any contract entered into pursuant to this
section, the department shall act on behalf of the county and shall
assume all program responsibilities for distribution and monitoring
funds pursuant to subdivision (b) or paragraph (1) of subdivision (b)
of Section 16946, whichever is applicable. The department may
exercise discretion in the administration of funds pursuant to
paragraph (2) of subdivision (b) of Section 16946 and shall also
implement subdivisions (d), (e), (f), and (g) of Section 16946 with
regard to those funds.


16935.  (a) A county that is eligible to participate in the CMSP
pursuant to Section 16809 may elect to have the state administer its
physician services account. Each county that is eligible to
participate in the CMSP pursuant to Section 16809 and that elects to
have the state administer its physician services account shall do all
of the following:
   (1) Enter into a contract with the department to administer its
county physician services account.
   (2) Authorize the department to act on its behalf and to assume
all responsibilities for the distribution and monitoring of funds in
its physician services account pursuant to subdivision (c) of Section
16952.
   (3) Agree to comply with uniform policies, procedures, and program
standards, including, but not limited to, eligibility levels
established mutually by the department and the participating
counties.
   (4) Transfer funds allocated to the county for purposes of the
county physician services account, less any funds retained pursuant
to subdivision (a) of Section 16934.5 to the department under such
conditions as the department may require.
   (b) The department may use funds retained or transferred to it by
the county pursuant to this subdivision for purposes of administering
the county's physician services account in accordance with Sections
16952 to 16958, inclusive.
   (c) For the 1989-90 fiscal year, any county which intends to
contract with the department for the administration of moneys
allocated from the Physician Services Account in the fund pursuant to
subdivision (c) of Section 16952 shall submit, to the department, a
notice of intent to contract which has been adopted by the county
board of supervisors, not later than November 15, 1989.
   (d) For the 1990-91 fiscal year and subsequent fiscal years, any
county which intends to contract with the department for the
administration of moneys allocated from the Physician Services
Account in the fund shall submit to the department a notice of intent
to contract, which has been adopted by the county board of
supervisors, not later than April 1 of the fiscal year preceding the
fiscal year for which the contract will be in effect and in
accordance with procedures established by the department.



16935.5.  The department may administer the distribution and
monitoring of funds allocated from the Hospital Services Account
pursuant to subdivision (b) of Section 16946 and from the Physician
Services Account pursuant to subdivision (c) of Section 16952, less
funds retained by the department for the administration of the
children's treatment program pursuant to Section 16934, for any
county that is eligible to participate in the CMSP pursuant to
Section 16809 that does not apply for, or rescinds its application
for, funds under this chapter. Allocations for a particular county
shall generally be utilized for payments to eligible providers in
that county.



16936.  (a) (1) Any county that requests funds under this chapter
shall submit to the department, for approval by the department, an
application for initial funding and a description of the proposed use
and expenditure of the moneys, as a component of the county health
services plan and budget submitted pursuant to Section 16800. The
department shall review and approve this information for compliance
with this part.
   (2) Beginning in the 1990-91 fiscal year, any county which does
not contract with the department pursuant to subdivision (a) of
Section 16934.5 shall include in the application an estimate of the
costs and funding arrangement for dental services.
   (b) The department shall review each county's application and
proposed use of funds for compliance with this chapter.
   (c) The department shall make initial monthly payments upon
approval of the county's request for funds containing assurances that
the county will comply with this chapter and other applicable
provisions of this part.
   (d) Payments made beyond April 15, 1990, and February 1 of each
subsequent fiscal year, shall be contingent upon the signing of an
agreement between the county board of supervisors and the department.




16937.  (a) Services, associated costs, and sociodemographic
characteristics of persons served by each county under Section 17000
and supported in whole or in part by funds appropriated for purposes
of this chapter shall be incorporated into the information required
pursuant to Section 16915.
   (b) Not later than July 1, 1991, to the extent possible, each
county shall incorporate the data required by Section 16915 in the
reports specified in subdivision (a).



16938.  (a) Each county shall submit a report of expenditures and
other information to the department according to the procedures
established by the department.
   (b) The department shall review the reports submitted pursuant to
subdivision (a) and recoup unspent moneys and expenditures that are
not in compliance with this chapter or the requirements established
by the department.


16939.  As a condition of receiving funds pursuant to this chapter,
each county shall meet the requirements of Articles 6 (commencing
with Section 16980), 7 (commencing with Section 16990) and 10
(commencing with Section 16995) of Chapter 5.