This regulation, which became effective in August of 2005, establishes standards for redirecting enrollees to one or more contracting providers when their health plan terminates or does not renew the contract with their provider group or hospital. The regulation applies to transfers of 2,000 or more enrollees. Among other provisions, it requires health plans to file with the Department of Managed Health Care, no later than 75 days before the termination, a detailed transition plan to ensure continuity of care for enrollees. It also requires plans to mail notices of the transfer to affected enrollees at least 60 days prior to the proposed termination date. [Download]
Summaries of select CalWORKs, CalFresh, Health and Housing Regulations
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Independent Medical Review System, 28 C.C.R. §1300.74.30
This regulation, which became effective in September 2005, provides a mechanism for health plan enrollees to challenge their plans’ denials of coverage. The regulation details how applications for Independent Medical Review should be submitted and what supporting materials may be included. It also explains that the IMR process is the exclusive forum for disputes about medical necessity, but allows plans to offer and use their own review process if the situation does not involve medical necessity.
The regulation affords the enrollee six months from receipt of the plan’s written response to the enrollee’s grievance to file the request for IMR. Applications cannot be denied due to lack of supporting documentation, and extensions will be approved if the delay was reasonable under the circumstances. Additionally, the DMHC must advise the enrollee of the most efficient means of completing an IMR application if it lacks necessary information. Additionally, this amended regulation allows Medi-Cal health plan enrollees to file for IMR as long as they have not yet presented the dispute for resolution through the Medi-Cal fair hearing process. Finally, it requires DMHC to notify the enrollee and the plan of the acceptance or rejection of the IMR application within seven calendar days of receipt (48 hours for an expedited review), and mandates that each reviewer issue a thorough written analysis of the decision in plain English. [Download]
HUD PIH Notice 2006-5(HA) – Implementation of the 2006 HUD Appropriations Act (Public Law 109-115); Funding Provisions for the Housing Choice Voucher Program (January 13, 2006)
“This Notice implements the Housing Choice Voucher (HCV) program funding provisions resulting from enactment of the Federal Fiscal Year (FFY) 2006 HUD Appropriations Act … signed into law on November 30, 2005.” Among other things, this Notice describes the method by which HUD will allocate funds for FFY 2006 to public housing authorities (PHAs) consistent with the HUD Appropriations Act. Most important for housing advocates and PHA directors and staff is the provision permitting a PHA to apply to HUD for funds to adjust (increase) its baseline funding allocation. Congress has appropriated $45 million dollars for such adjustments. The adjustments are available only to (1) adjust allocations for Calendar Year 2005 renewal funding that was based on leasing and cost data averaged for the months of May, June and July of 2004 which, due to temporarily low leasing levels during these months did not accurately reflect actual leasing levels and costs for such period; and (2) adjust allocations for PHAs that experienced a significant increase in renewal costs from unforeseen circumstances or portability.
Is that crystal clear? The bottom line is that the application deadline for adjustment funds is close of business (5:00 p.m. EST) January 31, 2006. So, advocates and PHAs in jurisdictions that may be eligible should take note and act quickly. Surprisingly, the application form which is attached to this Notice is short and simple. [Download]
70 Federal Register 77742, et. seq. – Final Rule Eligibility of Students for Assisted Housing Under Section 8 of the U.S. Housing Act of 1937 (December 30, 2005).
This rule implements a new law, enacted as part of HUD’s Fiscal Year (FY) 2006 appropriations (Public Law 109-115, 199 Stat. 2936), that restricts certain students enrolled in institutions of higher education from receiving assistance under Section 8 of the U.S. Housing Act of 1937. Subsection (a) of Section 327 bars Section 8 assistance to any individual who meets all of the following criteria: (1) is enrolled as a student in an institution of higher education, as defined in 20 U.S.C. § 1002; (2) is under 24; (3) is not a veteran; (4) is unmarried; (5) does not have a dependent child; and (6) is not otherwise individually eligible or has parents who, individually or jointly, are not eligible to receive Section 8 assistance.
Subsection(b) provides that, except for a person over the age of 23 with dependent children, for purposes of determining a person’s eligibility for Section 8, any financial assistance (in excess of amounts received for tuition) that a student received under the Higher Education Act of 1965 (20 U.S.C. § 1001), from private sources, or an institution of higher education, shall be counted as income.HUD states that the new law and regulation were enacted to address incidents of college students obtaining federal housing assistance without counting their educational financial assistance as income.
HUD states that the new law and regulation were enacted to address incidents of college students obtaining federal housing assistance without counting their educational financial assistance as income. [Download]Â
ACIN I-02-06 – CalWORKS Domestic Abuse Protocols And Waivers (January 9, 2006)
The long-awaited for, yet not quite what we hoped, DV Q & A. Highlights include specifically mentioning that the MFG rule can be waived, that counties must have written standards for their waivers, and that the waivers must be based on individual need, and that the counties must issue a Notice of Action approving or denying a waiver. (The 90 days doesn’t run for a hearing until such a notice issues.)Â (Download)
ACL 05-38 – The Emergency Assistance Program (December 5, 2005)
An overview of the Foster Care Emergency Assistance (EA) Program, complete with Frequently Asked Questions (FAQs). Ready for the acronyms? EA is funded by TANF, and provides FFP (federal financial participation) for short term aid to children/families in emergency situations. It no longer includes services for probation, but does cover Emergency Shelter Care (ESC).
So, what are some of the FAQ’s? Relatives can qualify for Shelter Care for up to 30 days; it’s limited to once in 12 months/single episode, for up to 12 months (except not the emergency shelter care) to resolved the emergency. An EA application must be taken immediately or no later than 30 calendar days from the date the child is removed from the home or the date the child is determined to be at risk. (Refer to ACL No. 93-64 and ACL No. 94-90), but the beginning date of aid begins on the date the application is signed. A county can place the child in a relative’s home on an emergency basis prior to relative approval of that home and claim emergency shelter care, if the worker has completed an assessment on the home. The age requirements go up to the age of 21, with no requirement of school attendance. [Download]