28 CA ADC § 1300.43.14
28 CCR s 1300.43.14
Cal. Admin. Code tit. 28, s 1300.43.14
CALIFORNIA CODE OF REGULATIONS
TITLE 28. MANAGED HEALTH CARE
DIVISION 1. THE DEPARTMENT OF MANAGED HEALTH CARE
CHAPTER 2. HEALTH CARE SERVICE PLANS
ARTICLE 1. EXEMPTIONS
This database is current through 06/09/06, Register 2006, No. 23.
s 1300.43.14. Employee Assistance Programs.
(a) A health care service plan which, pursuant to a contract with an
employer, labor union or licensing board within the Department of Consumer
Affairs, consults with employees, members of their families or licensees
of such board to identify their health, mental health, alcohol and
substance abuse problems and refer them to health care providers and other
community resources for counseling, therapy or treatment, is exempt from
the provisions of the Act (other than Sections 1360, 1360.1, 1368 and
1381, relating to advertising, client grievance procedures and the
inspection of records by the Director) if the plan complies with each of
the following provisions, and the contracts of a licensed health care
service plan are exempt from the provisions of the Act if they comply with
each of the following provisions:
(1) The plan has filed a notice with the Director as provided in
subsection (c) within the preceding 24 months.
(2) The purpose of the contract, insofar as it relates to the provision of
services to clients is either
(A) to maintain or improve employee efficiency through identification and
referrals for counseling, treatment or therapy, in connection with
personal problems affecting employee performance and the contract does not
provide for counseling, treatment or therapy with respect to health,
mental health, alcohol or substance abuse problems or
(B) to identify alcohol and substance abuse problems or mental health or
health problems of DCA licensees and refer them to appropriate health care
providers or organizations for treatment, and the plan does not provide
for counseling, treatment or therapy with respect to health, mental
health, alcohol or substance abuse problems.
(3) No client or member of his or her family, directly or indirectly shall
pay any prepaid or periodic charge under the contract or pay any
copayment, fee or other charge for any service rendered under the contract
in connection with a health, mental health, alcohol or substance abuse
problem. The payment of regular union dues by an employee, a license fee
by a DCA licensee, or of a benefit payment by an employer on behalf of an
employee and members of the employee's family which does not affect the
employee's compensation or other benefits is not a "prepaid or periodic
charge" for the purpose of this subsection.
(4) If such plan, its employees or contracting consultants, or an
affiliate of any of the foregoing, has a financial interest in referrals
made under the contract in connection with a health, mental health,
alcohol or substance abuse problem, such person prior to making any such
referral shall disclose to the contracting employer, union or state
licensing agency and to the person who is referred, the existence of such
financial interest; provided that neither the plan nor its employees shall
receive any payment, fee or commission directly or indirectly from any
person to whom an employee, licensee or family member is referred for
counseling, treatment or therapy. The disclosure requirement to the
employer may be a single blanket disclosure provided it identifies the
providers to which referrals will be made and identifies the financial
interest involved.
(5) The number of sessions with any client under the contract shall not
exceed 3 within any six month period.
(6) Except as otherwise provided in Division 2 (commencing with Section
500) of the Business and Professions Code, the plan shall maintain a
record for a period of not less than two years of each session with a
client concerning a health, mental health, alcohol or substance abuse
problem, and each consultation excluded from the definition of "session."
The record shall include the name of or identifier for the client, the
date and purpose of the session and the outcome if any, including the name
of the provider to which the client was referred. The employee assistance
program contracts and the records specified pursuant to subparagraph (6)
shall be available for inspection by the Director as provided in Section
1381 of the Act.
(7) The plan and the personnel, facilities and equipment of the plan,
including that employed under contract, shall be licensed or certified
when required by applicable law and persons engaged in identification and
referral who are not licensed under Division 2 of the Business and
Professions Code shall be certified by any of the following organizations:
(A) Any organization accredited by the National Commission for
Accreditation of Alcohol/Drug Abuse Counselors' Credentialing Bodies, Inc.
(B) Alcoholism Council of California.
(C) California Association of Alcoholism and Drug Abuse Counselors.
(D) Association of Labor-Management Administrators and Consultants on
Alcoholism.
(8) Unless the plan is licensed under the Act, no prepaid fees shall be
collected more than 45 days in advance.
(b) For the purposes of this section the following definitions apply:
(1) "Client" means the employee, the employee's family member, the DCA
licensee or other person eligible for the services provided under the plan
contract.
(2) "DCA licensee" means a licensee of the Department of Consumer Affairs.
(3) "Session" means any in-person or telephone consultation with the
client in connection with the client's health, mental health, alcohol or
substance abuse problems, excluding a consultation that occurs in an acute
emergency situation, a consultation after referral for motivation or
re-referral or a consultation due to a management, state licensing agency
or union request for information or assessment regarding work performance
issues.
(c) The notice specified in subsection (a)(1) shall be in the following
form and contain the information specified below:
DEPARTMENT OF MANAGED HEALTH CARE STATE OF CALIFORNIA NOTICE OF EMPLOYEE
ASSISTANCE PROGRAM EXEMPTION RULE 1300.43.14, KNOX-KEENE HEALTH CARE
SERVICE PLAN ACT ( ) Original Notice ( ) Amendment to Notice Dated
__________
The person/entity named in Item 1 below files this notice/amended notice
claiming the exemption pursuant to Rule 1300.43.14 under the Knox-Keene
Health Care Service Plan Act:
1. Legal name of person or entity filing this notice: __________
2. Address of principal office, and if different, mailing address:
__________ __________
3. Fictitious names used in connection with the operation of employee
assistance programs (if none, so specify): __________
4. Identify each location at which the plan maintains records subject to
inspection by the Director under Rule 1300.43.14(a)(6) (if space is
insufficient, continue on separate sheet): __________ __________
__________
5. Name, title, address and telephone number of representative who may be
contacted concerning this notice:
6. The person/entity filing this notice declares hereby that it is in
compliance with the provisions of Rule 1300.43.14, and undertakes to amend
this notice within 30 calendar days of any material change in the
information specified in its current notice as filed with the Director of
the Department of Managed HealthCare.
Date of Notice __________ (Name of Person/Entity Filing Notice) __________
__________ (Signature of Authorized Officer) __________ (Printed Name and
Title of Signatory) Verification:
I certify (or declare) under penalty of perjury under the laws of the
State of California that I have read this Notice and its attachments
thereto and know the contents thereof and that the statements therein are
true and correct. Executed at ____________________ on ____________ (City
and State) (Date) __________ (Signature)
Note: Authority cited: Section 1344, Health and Safety Code. Reference:
Section 1343, Health and Safety Code.
HISTORY
1. New section filed 6-12-87; operative 6-12-87 (Register 87, No. 28).
2. Change without regulatory effect amending section filed 4-4-2000
pursuant
to section 100, title 1, California Code of Regulations (Register 2000,
No. 14).
3. Change without regulatory effect amending subsections (a)-(a)(1),
(a)(6)
and (c) filed 7-18-2000 pursuant to
section 100, title 1, California Code ofRegulations (Register 2000, No.
29).
4. Change without regulatory effect amending subsection (c) -form filed
11-21-
2002 pursuant to section 100, title 1, California Code of Regulations
(Register 2002, No. 47).
28 CA ADC s 1300.43.14
END OF DOCUMENT
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