SECTIONS 124010-124015 - California Statutes

HEALTH AND SAFETY CODE

SECTION 124010-124015

124010. (a) It is the intent of the Legislature to establish
demonstration projects to assist medically fragile infants, children,
and adolescents.
(b) It is further the intent of the Legislature that these
demonstration projects serve as models for methods of providing
primary care services and coordination of health care for medically
fragile infants, children, and adolescents.
(c) The Legislature finds and declares that the use of care
management services under these demonstration projects will lead to
savings in medical costs through reduced emergency room visits,
hospital admissions, and other medical indicators and measures.

124011. There is hereby established demonstration projects to
provide a medical home and coordination of care model in order to
reduce avoidable health problems of chronically, seriously ill
infants, children, and adolescents. The demonstration projects may
operate for a period of up to three years. Existing demonstration
projects may be extended for up to two years, if outcome data display
effectiveness as determined by the State Department of Health
Services.

124012. The department shall award funding appropriated for
purposes of this article, on a competitive basis, to any nonprofit
children's hospitals, as defined in Section 10727 of the Welfare and
Institutions Code, and other hospitals that operate at least 10
special care centers, as certified by the California Childrens'
Services Program.

124013. The demonstration projects shall provide care management
services to children enrolled in the demonstration projects pursuant
to proposals accepted by the department.
Demonstration projects shall meet all of the following
requirements:
(a) Establish and function as a medical home to a population of
infants, children, and adolescents whose medical conditions requires
multidisciplinary and multispecialty care.
(b) Provide care coordination between primary care and specialty
health care providers and community agencies for project enrollees.
(c) Provide, or arrange for the provision of, health care services
to maintain optimal health status. These services may include, but
need not be limited to, physician office or home visits, psychosocial
counseling, and medical nutrition evaluation and counseling.
(d) Establish a relationship with an enrollee's parent or guardian
in order to enhance the understanding of the child's condition and
the parent or guardian's participation in the enrollee's medical
treatment plan and decisionmaking.
(e) Maximize the use of third-party reimbursement for the services
provided to the population enrolled in the project.

124014. In order to most effectively assist children enrolled in
the demonstration project, the demonstration project may employ the
use of clinic visits, home visits, school visits, inpatient visits,
and multidisciplinary conferences, as well as other innovative care
management techniques.

124015. (a) The hospital receiving funding under this article shall
submit a report to the department that evaluates the demonstration
project and includes measures of medical costs and improved health
outcomes of enrollees.
(b) The report shall address the following outcome measures as
identified in the hospital's demonstration project submitted to the
department for approval.
(c) The report required by subdivision (a) shall include a
determination as to whether the demonstration project is deemed to be
successful. Unless other outcome measures are used pursuant to
subdivision (d), the demonstration project shall be deemed to be
successful if all of the following have occurred:
(1) The average number of school days missed is decreased by 50
percent.
(2) The average number of emergency room visits is decreased by 50
percent.
(3) The average number of hospitalizations and hospital days is
decreased by 50 percent.
(4) The number of children with up-to-date immunizations is
increased by 50 percent.
(d) The demonstration project may use other outcome measures in
lieu of those identified in subdivision (c), if deemed appropriate by
the department, to measure success.
(e) The determinations made pursuant to this subdivision shall be
based on a comparison of the preprogram utilization rates, which is
data collected one year prior to enrollment in the program, with the
utilization rates one year after enrollment.