Cal. Code Regs. Tit. 22, § 51516 - Reimbursement for Short-Doyle/Medi-Cal Services
(a) The federal Medicaid share of
reimbursement for Short-Doyle Medi-Cal mental health services shall be based on
the lowest of the following.
(1) The
provider's usual and customary charge to the general public for the same or
similar services, unless the provider is a nominal charge provider pursuant to
Medicare rules at 42 CFR
413.13.
(2) The provider's reasonable and allowable
cost of rendering the services, based on year-end cost reports and Medicare
principles of reimbursement pursuant to 42 CFR Part 413 and as described in
HCFA Publication 15-1, for providers not contracting on a negotiated rate
basis.
(3) The negotiated rates as
approved by the Department of Mental Health for Short-Doyle/Medi-Cal providers
contracting on a negotiated rate basis pursuant to section
5705.2
of the Welfare and Institutions Code.
(4) The following maximum allowances are
effective for fiscal year 1998-1999:
Service Function | Maximum Allowance |
Hospital inpatient services, per day.......................... | ..........................$724.16 |
Psychiatric Health Facilities, per day.......................... | ..........................414.13 |
Adult crisis residential services, per day.......................... | ..........................233.53 |
Adult residential services, per day.......................... | ..........................113.89 |
Day treatment intensive, half day.......................... | ..........................110.51 |
Day treatment intensive, full day.......................... | ..........................155.22 |
Day rehabilitative services, half day.......................... | ..........................64.47 |
Day rehabilitative services, full day.......................... | ..........................100.63 |
Mental health services, per minute.......................... | ..........................1.99 |
Medication support services, per minute.......................... | ..........................3.70 |
Crisis intervention services, per minute.......................... | ..........................2.98 |
Crisis stabilization - emergency room, per hour.......................... | ..........................72.50 |
Crisis stabilization - urgent care, per hour.......................... | ..........................72.50 |
Case management, brokerage, per minute.......................... | ..........................1.55 |
(b) Negotiated rates, as defined in section
5705.2
of the Welfare and Institutions Code, shall be established by the standard
service function categories and reimbursement principles delineated in (a)(4)
above. Reimbursement based on negotiated rates shall be subject to
retrospective cost settlement which shares equally with the federal government
the portion of the federal reimbursement that exceeds actual costs in the
aggregate by legal entity. In no case will payments exceed the established
maximum allowances.
Notes
2. Certificate of Compliance transmitted to OAL 12-1-89 and filed 1-2-90 (Register 90, No. 2).
3. Amendment filed 12-10-90 as an emergency; operative 12-10-90 (Register 91, No. 6). A Certificate of Compliance must be transmitted to OAL by 4-9-91 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 12-10-90 order transmitted to OAL 4-8-91 and filed 5-8-91 (Register 91, No. 24).
5. Amendment filed 6-17-92 as an emergency; operative 6-17-92 (Register 92, No. 25). A Certificate of Compliance must be transmitted to OAL 10-15-92 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 6-17-92 order including amendment of NOTE transmitted to OAL 10-7-92 and filed 11-17-92 (Register 92, No. 47).
7. Amendment of subsections (a)(4), (c)(3) and NOTE filed 10-5-93 as an emergency; operative 10-5-93 (Register 93, No. 41). A Certificate of Compliance must be transmitted to OAL by 2-2-94 or emergency language will be repealed by operation of law on the following day.
8. Certificate of Compliance as to 10-5-93 order transmitted to OAL 2-2-94 and filed 3-15-94 (Register 94, No. 11).
9. Amendment of section and NOTE filed 10-2-95 as an emergency; operative 10-2-95 (Register 95, No. 40). A Certificate of Compliance must be transmitted to OAL by 1-30-96 or emergency language will be repealed by operation of law on the following day.
10. Amendment of subsection (a)(4) and NOTE filed 11-3-95 as an emergency; operative 11-3-95 (Register 95, No. 44). A Certificate of Compliance must be transmitted to OAL by 3-2-96 or emergency language will be repealed by operation of law on the following day.
11. Repealer of subsections (c)-(d) filed 12-14-95 as an emergency; operative 12-14-95 (Register 95, No. 50). A Certificate of Compliance must be transmitted to OAL by 4-12-96 or emergency language will be repealed by operation of law on the following day.
12. Certificate of Compliance as to 10-2-95 order transmitted to OAL 1-26-96 and filed 3-7-96 (Register 96, No. 10).
13. Certificate of Compliance as to 11-3-95 order transmitted to OAL 2-22-96 and filed 3-19-96 (Register 96, No. 12).
14. Reinstatement of subsections as they existed prior to emergency amendment filed 12-14-95 by operation of Government Code section 11346.1 (Register 96, No. 16).
15. Repealer of subsections (c) and (d) filed 4-16-96 as an emergency; operative 4-16-96 (Register 96, No. 16). A Certificate of Compliance must be transmitted to OAL by 8-14-96 or emergency language will be repealed by operation of law on the following day.
16. Certificate of Compliance as to 4-16-96 order transmitted to OAL 8-13-96 and filed 9-25-96 (Register 96, No. 39).
17. Amendment of subsection (a)(4) and NOTE filed 2-3-97 as an emergency; operative 2-3-97 (Register 97, No. 6). A Certificate of Compliance must be transmitted to OAL by 6-3-97 or emergency language will be repealed by operation of law on the following day.
18. Certificate of Compliance as to 2-3-97 order transmitted to OAL 5-20-97 and filed 6-30-97 (Register 97, No. 27).
19. Amendment of subsection (a)(4) and NOTE filed 3-3-98 as an emergency; operative 3-3-98 (Register 98, No. 10). A Certificate of Compliance must be transmitted to OAL by 7-1-98 or emergency language will be repealed by operation of law on the following day.
20. Certificate of Compliance as to 3-3-98 order transmitted to OAL 6-1-98 and filed 7-10-98 (Register 98, No. 28).
21. Amendment of subsection (a)(4) and amendment of NOTE filed 8-27-99 as an emergency; operative 8-27-99 (Register 99, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-27-99 or emergency language will be repealed by operation of law on the following day.
22. Certificate of Compliance as to 8-27-99 order transmitted to OAL 11-22-99 and filed 12-22-99 (Register 99, No. 52).
Note: Authority cited: Sections 10725, 14021.3, 14021.5, 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 5705, 5718, 5720 and 5724, Welfare and Institutions Code; and Statutes of 1998, Chapter 324, Item 4260-101-0001.
2. Certificate of Compliance transmitted to OAL 12-1-89 and filed 1-2-90 (Register 90, No. 2).
3. Amendment filed 12-10-90 as an emergency; operative 12-10-90 (Register 91, No. 6). A Certificate of Compliance must be transmitted to OAL by 4-9-91 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 12-10-90 order transmitted to OAL 4-8-91 and filed 5-8-91 (Register 91, No. 24).
5. Amendment filed 6-17-92 as an emergency; operative 6-17-92 (Register 92, No. 25). A Certificate of Compliance must be transmitted to OAL 10-15-92 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 6-17-92 order including amendment of Note transmitted to OAL 10-7-92 and filed 11-17-92 (Register 92, No. 47).
7. Amendment of subsections (a)(4), (c)(3) and Note filed 10-5-93 as an emergency; operative 10-5-93 (Register 93, No. 41). A Certificate of Compliance must be transmitted to OAL by 2-2-94 or emergency language will be repealed by operation of law on the following day.
8. Certificate of Compliance as to 10-5-93 order transmitted to OAL 2-2-94 and filed 3-15-94 (Register 94, No. 11).
9. Amendment of section and Note filed 10-2-95 as an emergency; operative 10-2-95 (Register 95, No. 40). A Certificate of Compliance must be transmitted to OAL by 1-30-96 or emergency language will be repealed by operation of law on the following day.
10. Amendment of subsection (a)(4) and Note filed 11-3-95 as an emergency; operative 11-3-95 (Register 95, No. 44). A Certificate of Compliance must be transmitted to OAL by 3-2-96 or emergency language will be repealed by operation of law on the following day.
11. Repealer of subsections (c)-(d) filed 12-14-95 as an emergency; operative 12-14-95 (Register 95, No. 50). A Certificate of Compliance must be transmitted to OAL by 4-12-96 or emergency language will be repealed by operation of law on the following day.
12. Certificate of Compliance as to 10-2-95 order transmitted to OAL 1-26-96 and filed 3-7-96 (Register 96, No. 10).
13. Certificate of Compliance as to 11-3-95 order transmitted to OAL 2-22-96 and filed 3-19-96 (Register 96, No. 12).
14. Reinstatement of subsections as they existed prior to emergency amendment filed 12-14-95 by operation of Government Code section 11346.1 (Register 96, No. 16).
15. Repealer of subsections (c) and (d) filed 4-16-96 as an emergency; operative 4-16-96 (Register 96, No. 16). A Certificate of Compliance must be transmitted to OAL by 8-14-96 or emergency language will be repealed by operation of law on the following day.
16. Certificate of Compliance as to 4-16-96 order transmitted to OAL 8-13-96 and filed 9-25-96 (Register 96, No. 39).
17. Amendment of subsection (a)(4) and Note filed 2-3-97 as an emergency; operative 2-3-97 (Register 97, No. 6). A Certificate of Compliance must be transmitted to OAL by 6-3-97 or emergency language will be repealed by operation of law on the following day.
18. Certificate of Compliance as to 2-3-97 order transmitted to OAL 5-20-97 and filed 6-30-97 (Register 97, No. 27).
19. Amendment of subsection (a)(4) and Note filed 3-3-98 as an emergency; operative 3-3-98 (Register 98, No. 10). A Certificate of Compliance must be transmitted to OAL by 7-1-98 or emergency language will be repealed by operation of law on the following day.
20. Certificate of Compliance as to 3-3-98 order transmitted to OAL 6-1-98 and filed 7-10-98 (Register 98, No. 28).
21. Amendment of subsection (a)(4) and amendment of Note filed 8-27-99 as an emergency; operative 8-27-99 (Register 99, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-27-99 or emergency language will be repealed by operation of law on the following day.
22. Certificate of Compliance as to 8-27-99 order transmitted to OAL 11-22-99 and filed 12-22-99 (Register 99, No. 52).
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