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. (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. (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. (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. (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.

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.

History

1. Amendment filed 8-7-89; operative 8-7-89 as an emergency (Register 89, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 12-5-89. For prior history, see Register 89, No. 1.

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).