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General Authority.

This contract is entered into in accordance with the provisions of Part 2.5 (commencing with Section 5775) of Division 5 of the Welfare and Institutions (W&I) Code. Part 2.5 (commencing with Section 5775) of Division 5 of the W&I Code directs the California Department of Mental Health to implement and administer Managed Mental Health Care for Medi-Cal eligible residents of this state; and «Contractor_Name» agrees to operate the Mental Health Plan (MHP) for «County» County. No provision of this contract is intended to obviate or waive any requirements of applicable law or regulation, in particular, the provisions noted above. In the event a provision of this contract is open to varying interpretations, the contract provision shall be interpreted in a manner that is consistent with applicable law and regulation.


  1. Successor.

Effective July 1, 2012, the Department of Health Care Services (DHCS) shall assume the contract obligations specified in this contract on behalf of the state.  On and after July 1, 2012, all references to the “Department” shall refer to DHCS.  It is the intent of the parties that this contract remain in effect only until the earlier of the date that DHCS and the MHP execute a successor MHP contract or December 31, 2012.





  1. Definitions.

The definitions contained in Title 9, Section 1810, shall apply in this contract.




  1. “Beneficiary” means a Medi-Cal recipient who is currently receiving services from the Contractor.

B. "Contractor" means (fill in County Name).


C. "Covered Mental Health Services" means mental health services, medication support services, day treatment intensive, day rehabilitation, crisis intervention, crisis stabilization, adult residential treatment services, crisis residential services, psychiatric health facility services, and targeted case management as defined in Title 9, CCR, Section 1810.247, to the extent described in Title 9, CCR, Section 1810.345, and in California’s Medicaid State Plan Sections Supplement 3 to Attachment 3.1-A, Supplement 2 to Attachment 3.1-B and Supplement 1 to Attachment 3.1-A. Covered mental health services also includes, psychiatric inpatient hospital services as defined in Title 9, CCR, Section 1810.238, and Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Supplemental Specialty Mental Health Services as defined in 1810.215. Psychiatric nursing facility services are not included.
D. "Department" means the California Department of Mental Health through June 30, 2012. On and after July 1, 2012, “Department” means the California Department of Health Care Services (DHCS).
E. "DHCS" means the California Department of Health Care Services.
F. “Director” means the Director of the California Department of Mental Health through June 30, 2012. On and after July 1, 2012, “Director” means the Director of DHCS.
G. "HHS" means the United States Department of Health and Human Services.


      1. “MCO” means Managed Care Organization.




      1. “PAHP” means Prepaid Ambulatory Health Plan as defined in Title 42, Code of Federal Regulations (CFR), Section 438.2.




      1. “PIHP” means Prepaid Inpatient Health Plan as described in Title 42 CFR Section 438.2. A PIHP is an entity that:




        1. Provides medical services to beneficiaries under contract with the Department, and on the basis of prepaid capitation payments, or other payment arrangement that does not use state plan rates;




        1. Provides, arranges for, or otherwise has responsibility for the provision of any inpatient hospital or institutional services for its beneficiaries; and




        1. Does not have a comprehensive risk contract.

K. "Subcontract" means an agreement entered into by the Contractor with any of the following:




  1. A provider of specialty mental health services who agrees to furnish covered services to beneficiaries.




  1. Any other organization or person who agrees to perform any administrative function or service for the Contractor specifically related to securing or fulfilling the Contractor's obligations to the Department under the terms of this contract.



  1. State and Federal Law Governing this Contract.





  1. Contractor agrees to comply with all applicable federal and state law, particularly the statutes and regulations incorporated by reference below, in its provision of services as the Mental Health Plan. The Department will endeavor to notify Contractor of any changes to these statutes and regulations. Contractor agrees to comply with any changes to these statutes and regulations that may occur during the contract period, but either the Department or Contractor may request consultation and discussion of such changes, including whether contract amendments may be necessary.




  1. Federal Law:




  1. Title 42, United States Code;




  1. Title 42, Code of Federal Regulations (CFR), to the extent that these requirements are applicable;




  1. Title 42, CFR; Part 438 – Managed Care, limited to those provisions that apply to Prepaid Inpatient Health Plans (PIHP);




  1. Title 45, CFR, Parts 160 and 164, Subparts A and E, to the extent that these requirements are applicable;




  1. Title VI of the Civil Rights Act of 1964;




  1. Title IX of the Education Amendments of 1972;




  1. Age Discrimination Act of 1975;




  1. Rehabilitation Act of 1973;




  1. Titles II and III of the Americans with Disabilities Act;




  1. Deficit Reduction Act of 2005;




  1. Balanced Budget Act of 1997.

C. State Law:




  1. Division 5, W&I Code;




  1. Part 2 (commencing with Section 5718, Chapter 3, W&I Code;




  1. Part 2.5 (commencing with Section 5775), Chapter 4, Division 5, W&I Code;




  1. Article 5 (Sections 14680-14685), Chapter 8.8, Division 9, W&I Code;




  1. Title 9, CCR, Chapter 11 (commencing with Section 1810.100) – Medi-Cal Specialty Mental Health Services.


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