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§ 57332. Maximum Rates of Reimbursement for Non-Residential Services.

17 CA ADC § 57332BARCLAYS OFFICIAL CALIFORNIA CODE OF REGULATIONS

Barclays Official California Code of Regulations Currentness
Title 17. Public Health
Division 2. Health and Welfare Agency - Department of Developmental Services Regulations
Chapter 3. Community Services
Subchapter 7. Nonresidential Service Vendor Rate-Setting Provisions
Article 5. Rates of Reimbursement Based on the Schedule of Maximum Allowances or the Vendor's Usual and Customary Rate
17 CCR § 57332
§ 57332. Maximum Rates of Reimbursement for Non-Residential Services.
(a) The maximum rate of reimbursement for the following services shall be the vendor's usual and customary rate as defined in Section 57210(a)(19) or, if the vendor does not have an established usual and customary rate, a negotiated rate pursuant to Section 57300(e):
(1) Adaptive Skills Trainer - Service Code 605
(2) Adult Day Care - Service Code 855
(3) Art Therapist - Service Code 691
(4) Associate Behavior Analyst - Service Code 613.
(5) Attorney - Service Code 610
(6) Behavior Analyst - Service Code 612
(7) Camping Services - Service Code 850 (Day Camp, Residential Camp, and Traveling Camp)
(8) Child Day Care - Service Code 851
(9) Counseling Services - Service Code 625 (Family Counselors and Social Workers)
(10) Dance Therapist - Service Code 692
(11) Developmental Specialist - Service Code 670
(12) Diaper Service - Service Code 627
(13) Dietary Services - Service Code 720 (Dietician and Nutritionist)
(14) Driver Trainer - Service Code 630
(15) Educational Psychologist - Service Code 672
(16) Homemaker - Service Code 858
(17) Homemaker Service - Service Code 860
(18) Independent Living Specialist - Service Code 635
(19) Interpreter - Service Code 642
(20) Mobility Training Services Agency - Service Code 645
(21) Mobility Training Services Specialist - Service Code 650
(22) Music Therapist - Service Code 693
(23) Psychiatric Technician - Service Code 790
(24) Recreational Therapist - Service Code 694
(25) Retail/Wholesale Stores - Service Code 660
(26) Teacher - Service Code 674
(27) Teacher of Special Education - Service Code 678
(28) Teacher's Aide - Service Code 676
(29) Translator - Service Code 643
(30) Tutor - Service Code 680
(b) The maximum rate of reimbursement for the following medical services shall be in accordance with the Schedule of Maximum Allowances (SMA):
(1) Acute Care Hospitals - Service Code 700
(Acute Care Hospitals and Acute Psychiatric Hospital)
(2) Adult Day Health Center - Service Code 702
(3) Audiology - Service Code 706
(4) Clinical Psychologist - Service Code 785
(5) Day Treatment Centers - Service Code 710
(6) Dentistry - Service Code 715
(7) Durable Medical Equipment Dealer - Service Code 725
(8) Genetic Counselor - Service Code 800
(9) Hearing and Audiology Facilities - Service Code 730
(10) Home Health Agency - Service Code 854
(11) Home Health Aide - Service Code 856
(12) Infant Development Specialist - Service Code 810
(13) Laboratory and Radiology Services - Service Code 735
(14) Nurse Anesthetist - Service Code 741
(15) Occupational Therapy - Service Code 773
(16) Orthoptic Services - Service Code 745
(Orthoptic Technician and Optometrist)
(17) Orthotic and Prosthetic Services - Service Code 750
(Orthotist and Prosthetist)
(18) Other Medical Equipment or Supplies - Service Code 755
(Dispensing Optician, Hearing Aid Dispenser, and Prosthetic and Orthoptic Appliance Factory)
(19) Other Medical Services - Service Code 760
(20) Pharmaceutical Services - Service Code 765
(Pharmacist and Pharmacy)
(21) Physical Therapy - Service Code 772
(22) Physicians or Surgeons - Service Code 775
(23) Psychiatrist - Service Code 780
(24) Respiratory Therapist - Service Code 793
(25) Speech Pathology - Service Code 707
(c) The maximum rate of reimbursement for the following medical services shall be as specified below:
(1) Behavior Management Assistant - Service Code 615
(A) The usual and customary rate, as defined in Section 57210(a)(19), charged for the behavior management assistant services or, if the vendor does not have an established usual and customary rate, a negotiated rate pursuant to Section 57300(e), not to exceed the rate of reimbursement established for the licensed professional with whom the Behavior Management Assistant is registered.
(2) Behavior Management Consultant - Service Code 620
(A) The maximum rate of reimbursement shall be based on the method of reimbursement established, pursuant to Section 57332, for an individual with the same licensed classification.
(3) In-Home Respite Worker - Service Code 864
(A) Effective January 1, 2008, the maximum rate of reimbursement for in-home respite workers shall not exceed $10.71 per consumer per hour, including fringe benefits, except:
1. When the family member has more than one consumer residing with them who has been authorized by the regional center to receive in-home respite services, the maximum level of payment shall be determined pursuant to Section 58140 of these regulations.
(4) Licensed Vocational Nurse - Service Code 742
(A) The rate of reimbursement shall be in accordance with the Schedule of Maximum Allowances (SMA) for the Home and Community- Based Services, In-Home Medical Care Waiver Program.
(5) Nurse's Aide or Assistant - Service Code 743
(A) The rate of reimbursement shall be in accordance with the Schedule of Maximum Allowances (SMA) for the Home and Community-Based Services, In-Home Medical Care Waiver Program.
(6) Out-of-Home Respite Services - Service Code 868
(A) Day care homes providing out-of-home respite services shall be reimbursed in accordance with the vendor's usual and customary rate, as defined in Section 57210(a)(19) or, if the vendor does not have an established usual and customary rate, a negotiated rate pursuant to Section 57300(e).
(B) Licensed residential facilities providing out-of-home respite services, for whom the Department of Social Services or the Department of Health Services has established a rate, shall be reimbursed in accordance with the rate of reimbursement as established by the appropriate Department.
(C) Licensed residential facilities providing out-of-home respite services, for whom the Department of Social Services has not established a rate, shall be reimbursed at 1/21 of the monthly rate established by the regional center for the facility's service level as approved pursuant to Title 17, California Code of Regulations, Section 56005.
(7) Out-of-State Manufacturer or Distributor - Service Code 655
(A) Out-of-State Manufacturers or Distributors supplying products that are reimbursable under the Medi-Cal program shall be reimbursed in accordance with the Schedule of Maximum Allowances (SMA).
(B) Out-of-State Manufacturers or Distributors supplying products that are not reimbursable under the Medi-Cal program shall be reimbursed according to the vendor's usual and customary rate.
(8) Registered Nurse - Service Code 744.
(A) The rate of reimbursement shall be in accordance with the Schedule of Maximum Allowances (SMA) for the Home and Community-Based Services, In-Home Medical Care Waiver Program.
(9) Respite Facility - Service Code 869
(A) Vendors classified as a respite facility shall be reimbursed as follows:
1. Either 1/21 of the established monthly rate for the facility's service level as approved pursuant to Title 17, California Code of Regulations, Section 56005; or
2. The agreed-upon level of payment for a service contract negotiated pursuant to Section 57540(b) through (f).
a. Effective January 1, 2008, the level of payment shall not exceed $10.71 per consumer per hour, including fringe benefits, authorized by the Department for an In-Home Respite Worker, Service Code 864, for the same units of service.
(10) Genetic Counselor - Service Code 800
Genetic counselors to whom the SMA does not apply shall be reimbursed in accordance with the vendor's usual and customary rate, as defined in Section 57210(a)(19) or, if the vendor does not have an established usual and customary rate, a negotiated rate pursuant to Section 57300(e).
(11) Infant Development Specialist - Service Code 810
Infant development specialists to whom the SMA does not apply shall be reimbursed in accordance with the vendor's usual and customary rate, as defined in Section 57210(a)(19) or, if the vendor does not have an established usual and customary rate, a negotiated rate pursuant to Section 57300(e).
(12) Behavior Management Technician (Paraprofessional) - Service Code 616
Regional centers shall contract for Behavior Management Technician (Paraprofessional) services at no more than 75 percent of the regional center's median hourly rate for Behavior Management Assistant - Service Code 615, or the statewide median rate for Behavior Management Assistant - Service Code 615, whichever is lower.
Note: Authority cited: Sections 4690 and 4686.3, Welfare and Institutions Code. Reference: Sections 4648(a), 4690 and 4691.6, Welfare and Institutions Code.
HISTORY
1. New section filed as an emergency 6-17-93; operative 6-17-93. Submitted to OAL for printing only pursuant to SB485 (Chapter 722, Statutes of 1992) Section 147(a) (Register 93, No. 26).
2. New subsections (a)(4), (a)(11)(A)-(D) and (a)(12) and subsection redesignation filed 6-20-94 as an emergency; operative 6-20-94. Submitted to OAL for printing only pursuant to Chapter 722, Statutes of 1992, Section 147 (Register 94, No. 25).
3. Certificate of Compliance as to 6-17-93 order transmitted to OAL 6-20-94 and filed 8-2-94 (Register 94, No. 31).
4. Certificate of Compliance as to 6-20-94 order transmitted to OAL 2-20-96 and filed 3-29-96 (Register 96, No. 13).
5. Change without regulatory effect amending section, including incorporation and amendment of former section 57333, filed 1-17-97 pursuant to section 100, title 1, California Code of Regulations (Register 97, No. 3).
6. Change without regulatory effect amending subsections (c)(3)(A) and (c)(9)(A)2.a. filed 3-6-97 pursuant to section 100, title 1, California Code of Regulations (Register 97, No. 10).
7. Editorial correction of subsection (a)(3) (Register 97, No. 21).
8. Change without regulatory effect amending subsections (c)(3)(A) and (c)(9)(A)2.a. filed 1-15-99 pursuant to section 100, title 1, California Code of Regulations (Register 99, No. 3).
9. Amendment of subsections (a), (c)(1)(A), (c)(6)(A) and (c)(10)-(11) filed 4-25-2000; operative 5-25-2000 (Register 2000, No. 17).
10. Amendment of subsections (c)(3)(A), (c)(6)(A) and (c)(9)(A)2.a. and amendment of Note filed 3-14-2001 as an emergency; operative 3-14-2001 (Register 2001, No. 11). A Certificate of Compliance must be transmitted to OAL by 7-12-2001 or emergency language will be repealed by operation of law on the following day.
11. New subsection (a)(5) and subsection renumbering filed 5-3-2001; operative 6-2-2001 (Register 2001, No. 18).
12. Amendment of subsections (c)(3)(A), (c)(6)(A) and (c)(9)(A)2.a. and amendment of Note refiled 7-12-2001 as an emergency, including further amendment of Note; operative 7-12-2001 (Register 2001, No. 28). A Certificate of Compliance must be transmitted to OAL by 11-9-2001 or emergency language will be repealed by operation of law on the following day.
13. Reinstatement of section as it existed prior to 7-12-2001 emergency amendment by operation of Government Code section 11346.1(f) (Register 2001, No. 47).
14. Amendment of subsections (c)(3)(A), (c)(6)(A) and (c)(9)(A)2.a. and amendment of Note filed 11-19-2001 as an emergency; operative 11-19-2001 (Register 2001, No. 47). A Certificate of Compliance must be transmitted to OAL by 3-19-2002 or emergency language will be repealed by operation of law on the following day.
15. Certificate of Compliance as to 11-19-2001 order transmitted to OAL 3-15-2002 and filed 3-27-2002 (Register 2002, No. 13).
16. Amendment of subsections (c)(3)(A) and (c)(9)(A)2.a. and amendment of Note filed 8-29-2002 as an emergency; operative 8-29-2002 (Register 2002, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-27-2002 or emergency language will be repealed by operation of law on the following day.
17. Amendment of subsections (c)(3)(A) and (c)(9)(A)2.a. and amendment of Note refiled 12-19-2002 as an emergency; operative 12-27-2002 (Register 2002, No. 51). A Certificate of Compliance must be transmitted to OAL by 4-28-2003 or emergency language will be repealed by operation of law on the following day.
18. Certificate of Compliance as to 12-19-2002 order transmitted to OAL 4-25-2003 and filed 6-5-2003 (Register 2003, No. 23).
19. New subsection (a)(4) and subsection renumbering filed 4-29-2004; operative 5-29-2004 (Register 2004, No. 18).
20. Change without regulatory effect amending subsections (c)(3)(A) and (c)(9)(A)2.a. and amending Note filed 10-4-2006 pursuant to section 100, title 1, California Code of Regulations (Register 2006, No. 40).
21. Amendment of subsections (c)(3)(A) and (c)(9)(A)2. filed 11-16-2007; operative 11-16-2007 pursuant to Government Code section 11343.4 (Register 2007, No. 46).
22. Amendment of subsections (c)(3)(A) and (c)(9)(A)2.a. filed 7-14-2008; operative 7-14-2008 pursuant to Government Code section 11343.4 (Register 2008, No. 29).
23. New subsection (c)(12) and amendment of Note filed 9-19-2011 as an emergency; operative 9-19-2011 (Register 2011, No. 38). A Certificate of Compliance must be transmitted to OAL by 9-19-2013 pursuant to Welfare and Institutions Code section 4686.3 or emergency language will be repealed by operation of law on the following day.
24. Certificate of Compliance as to 9-19-2011 order, including nonsubstantive amendments to subsection (c)(12), transmitted to OAL 9-16-2013 and filed 10-28-2013 (Register 2013, No. 44).
This database is current through 6/17/22 Register 2022, No. 24
17 CCR § 57332, 17 CA ADC § 57332
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