Section 1850.405 - Arbitration Between MHPs(a) Under the following arbitration processes the MHP of the beneficiary may be determined to be different than that specified in the MEDS file.(b) Any two or more MHPs may develop an arbitration agreement to provide for determining final responsibility for MHP payment authorization as described in Subchapters 2 and 3, beginning with Sections 1820.100 and 1830.100, respectively, when there is a dispute between the participating MHPs. Each arbitration agreement must: (1) Provide for the selection of an arbitrator.(2) Include timelines for filing and resolution.(3) Include criteria that will serve as a basis for a decision.(4) Specify that decisions reached under the arbitration process will be final.(5) Be signed by all participating MHPs or their designees.(6) Require that all decisions of the arbitrator shall be in writing.(7) Provide that a copy of each decision shall be forwarded to the affected MHPs within 14 calendar days of the decision.(c) In cases where there is a disagreement between MHPs that are not participating in an arbitration process, the arbitration process shall be as follows: (1) Each MHP shall provide the Department with at least one individual available to serve as an arbitrator. The MHP shall confirm or update the available individuals annually. The Department shall provide a listing of the available individuals to the MHPs annually by October 1. The parties to the dispute may agree to a single arbitrator. If the parties to the dispute cannot agree on a single arbitrator, the parties shall each select an arbitrator from the list of available individuals, except that an individual identified by either involved MHP may not be selected. The selected arbitrators shall select a third arbitrator who is not an individual identified by either involved MHP from the listing.(2) The arbitrators' services shall be reimbursed at the hourly rate charge of $150.00, not to exceed a total of ten hours. The parties shall share equally in paying for the arbitrators' services. Payment shall be made directly to the arbitrators unless the arbitrator is an employee of the MHP, in which case payment shall be made to that MHP.(3) The arbitrators' decision as to the MHP of the beneficiary shall be based on a review of the facts in relation to the following criteria:(A) If a beneficiary has moved to a county or acts to establish residency in a county and has a clear intent to reside in the county, the MHP for that county shall be considered the MHP of the beneficiary.(B) If a beneficiary is a Lanterman-Petris-Short or Probate Conservatee, the MHP for the county in which the beneficiary is conserved shall be considered the MHP of the beneficiary.(C) If a beneficiary has been placed in legal custody by a county, the MHP for the county that initiated the legal proceeding shall be considered the MHP of the beneficiary. If a beneficiary is on parole or in a conditional release program and is restricted to a particular area, the MHP for the county that includes the area to which the beneficiary is restricted shall be the MHP of the beneficiary.(D) If a beneficiary has adopted a transient, nomadic lifestyle and has a clear intent to continue this lifestyle, the MHP for the county in which the beneficiary presents for services shall be considered the MHP of the beneficiary.(E) If a beneficiary, because of the beneficiary's mental status, is unable to form or express a clear intent to reside anywhere, the following may be considered evidence that the MHP for the county involved would be the MHP of the beneficiary: 1. The county that originated residential, medical, or psychiatric placement.2. The county in which the beneficiary has current housing.3. The county that has paid general assistance to the beneficiary.4. The county in which the beneficiary has received ongoing community mental health clinical care during the last six months.(F) Where the facts do not clearly meet the criteria, the arbitrators' decision shall be reasonable in light of the facts presented using the criteria in Subsections (a)(3)(A)-(E) as general guidelines.(4) The affected MHPs shall provide relevant documentation to arbitrators no later than 21 calendar days after the arbitrators have been selected.(5) The arbitrators shall decide on the issue no later than 60 calendar days: (A) From the date documentation is received from the affected MHPs, or(B) From 21 calendar days after the arbitrator has been selected, whichever is sooner.(6) The arbitrators shall issue the decision in writing to the affected MHPs within 14 calendar days of the decision.Cal. Code Regs. Tit. 9, § 1850.405
1. New section filed 10-31-97 as an emergency; operative 11-1-97 (Register 97, No. 44). A Certificate of Compliance must be transmitted to OAL by 3-2-98 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 3-2-98 as an emergency; operative 3-2-98 (Register 98, No. 10). A Certificate of Compliance must be transmitted to OAL by 6-30-98 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 6-17-98 as an emergency; operative 6-30-98 (Register 98, No. 25). Pursuant to Chapter 324 (Statutes of 1998) Item 4440-103-0001(4), a Certificate of Compliance must be transmitted to OAL by 7-1-99 or emergency language will be repealed by operation of law on the following day.
4. Editorial correction of HISTORY 3 (Register 98, No. 39).
5. Editorial correction extending Certificate of Compliance date to 7-1-2001 pursuant to Chapter 50 (Statutes of 1999) Item 4440-103-0001(4) (Register 99, No. 33). Notwithstanding any other provision of law, emergency regulations adopted pursuant to Welfare and Institutions Code section 14680 to implement the second phase of mental health managed care as provided in this part shall remain in effect until permanent regulations are adopted, or June 30, 2006, whichever occurs first.
6. Editorial correction of HISTORY 5 (Register 2000, No. 42).
7. Editorial correction of HISTORY 5, new article 4 heading and repealer and new section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20). Note: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 5778 and 14684, Welfare and Institutions Code.
1. New section filed 10-31-97 as an emergency; operative 11-1-97 (Register 97, No. 44). A Certificate of Compliance must be transmitted to OAL by 3-2-98 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 3-2-98 as an emergency; operative 3-2-98 (Register 98, No. 10). A Certificate of Compliance must be transmitted to OAL by 6-30-98 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 6-17-98 as an emergency; operative 6-30-98 (Register 98, No. 25). Pursuant to Chapter 324 (Statutes of 1998) Item 4440-103-0001(4), a Certificate of Compliance must be transmitted to OAL by 7-1-99 or emergency language will be repealed by operation of law on the following day.
4. Editorial correction ofHistory3 (Register 98, No. 39).
5. Editorial correction extending Certificate of Compliance date to 7-1-2001 pursuant to Chapter 50 (Statutes of 1999) Item 4440-103-0001(4) (Register 99, No. 33). Notwithstanding any other provision of law, emergency regulations adopted pursuant to Welfare and Institutions Code section 14680 to implement the second phase of mental health managed care as provided in this part shall remain in effect until permanent regulations are adopted, or June 30, 2006, whichever occurs first.
6. Editorial correction ofHistory5 (Register 2000, No. 42).
7. Editorial correction ofHistory5, new article 4 heading and repealer and new section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).