Section 120915 Of Chapter 4. Acquired Immune Deficiency Syndrome (aids) Early Intervention Projects From California Health And Safety Code >> Division 105. >> Part 4. >> Chapter 4.
120915
. (a) The department shall establish a reimbursement schedule
for all of the services detailed in subdivision (b) of Section
120900. The amounts to be reimbursed for these services shall be
commensurate with the costs of providing these services.
(b) The department shall develop and disseminate guidelines to
assist early intervention projects in identifying appropriate public
and private payers of early intervention services. The guidelines
shall take into account each client's access to, and eligibility for,
private health insurance and public medical assistance. The
guidelines shall include, but not be limited to, the reimbursement
schedule established pursuant to subdivision (a) and the elements
identified in subdivisions (c) to (h), inclusive.
(c) Reimbursement under Sections 120900 to 120920, inclusive,
shall not be made for any services that are available to the client
under a private health insurance program. Early intervention projects
shall inquire of each client as to the client's coverage by a
private health insurance policy. Where a client has a private health
insurance policy, the early intervention project shall bill the
insurer for those services in subdivision (b) of Section 120900 that
are covered by the client's policy.
(d) The department shall develop and implement, or cause to be
implemented by an early intervention project, a uniform sliding fee
schedule for services provided to individuals under Sections 120900
to 120920, inclusive. The schedule shall be based on the client's
ability to pay.
(e) The department may apply for any funds available from the
federal government for the reimbursement of those services to be
provided by early intervention projects, including, but not limited
to, funds available pursuant to Section 2318 of the Public Health
Service Act, as added by Public Law 100-607, that provides for the
development of model protocols for the clinical care of individuals
who are infected with HIV.
(f) To the extent permitted under existing law, the Medi-Cal
program shall provide reimbursement to early intervention projects
for services provided under Sections 120900 to 120920, inclusive,
that are covered under the Medi-Cal program. This subdivision shall
not be construed to confer Medi-Cal eligibility on any person who
does not meet existing Medi-Cal eligibility requirements.
(g) The department shall use federal and state general funds that
are appropriated for the purpose of purchasing HIV-related drug
treatments and related services, to reimburse for covered outpatient
preventative or therapeutic health care services, as defined by the
director, provided that the client is eligible for a federal or state
program that subsidizes the cost of HIV-related drugs and related
services. If Assembly Bill 2251 of the 1989-90 Regular Session is
enacted, the department shall use the provisions in Chapter 6
(commencing with Section 120950) to implement this subdivision.
(h) The department shall use moneys from the General Fund to cover
expenses for early intervention services that are not otherwise
reimbursed, to the extent that moneys from the General Fund are
expressly appropriated to the department for early intervention
services.