§ 51185. Targeted Case Management Services Program Definitions.

(a) “Encounter” means a face-to-face contact or a significant telephone contact in lieu of a face-to-face contact when environmental considerations preclude a face-to-face encounter, for the purpose of rendering one or more targeted case management service components by a case manager. For the target populations specified in Section 50262.7(a)(3)(B), (C) or (D), the encounter may be with persons acting on behalf of the Medi-Cal beneficiary.

(b) “High-risk persons” means those persons who have failed to take advantage of necessary health care services, or do not comply with their medical regimen or who need coordination of multiple medical, social and other services due to the existence of an unstable medical condition in need of stabilization, substance abuse or because they are victims of abuse, neglect, or violence, including, but not limited to, the following individuals:

(1) Women, infants, children and young adults to age 21.

(2) Pregnant women.

(3) Persons with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome.

(4) Persons with reportable communicable disease.

(5) Persons who are technology dependent. Solely for the purposes of the Targeted Case Management Services program, “technology dependent persons” means those persons who use a medical technology, embodied in a medical device, that compensates for the loss of normal use of a vital body function and require skilled nursing care to avert death or further disability.

(6) Persons with multiple diagnoses who require services from multiple health/social service providers.

(7) Persons who are medically fragile. Solely for the purposes of the Targeted Case Management Services program, “medically fragile persons” means those persons who require ongoing or intermittent medical supervision without which their health status would deteriorate to an acute episode.

(c) “Host county” means the local governmental agency that has been designated by all local governmental agencies participating in the targeted case management program, to be the administrative and fiscal intermediary between the department and all participating local governmental agencies.

(d) “Local Governmental Agency” means a county or chartered city.

(e) “Skilled Professional Medical Personnel” means a physician, dentist, or nurse, or other specialized personnel who has completed a 2-year or longer program leading to an academic degree or certification in a medically-related profession and who performs duties and responsibilities requiring professional medical knowledge and skills, and who is in an employer-employee relationship with the local governmental agency.

(f) “Year”, “current year” or “fiscal year” means the period July 1 through June 30.

HISTORY

1. New section filed 7-1-96; operative 7-1-96. Submitted to OAL for printing only pursuant to Section 6, Chapter 305, Statutes of 1995 (Register 96, No. 27).

2. New section refiled 10-29-96 as an emergency; operative 10-29-96 (Register 96, No. 44). Submitted to OAL for printing only pursuant to Section 6, Chapter 305, Statutes of 1995. A Certificate of Compliance must be transmitted to OAL by 2-26-97 or emergency language will be repealed by operation of law on the following day.

3. Editorial correction of History 2 (Register 97, No. 15).

4. Repealed by operation of Government Code section 11346.1(g) (Register 97, No. 15).

5. New section filed 4-10-97; operative 4-10-97 pursuant to Government Code section 11343.4(d) (Register 97, No. 15).

Note

Note: Authority cited: Sections 10725, 14105, 14124.5 and 14132.44, Welfare and Institutions Code. Reference: Section 14132.44, Welfare and Institutions Code.