Cal. Code Regs. Tit. 28, § 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:
| () 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
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 Health Care.
| Date of Notice | ___________________________ | |
| (Name of Person/Entity Filing Notice) | ||
| ___________________________ | ___________________________ | |
| (Signature of Authorized
|
||
| ___________________________ | ||
| (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 ____________________(City and State) on __________(Date)
| ___________________________ | |
| (Signature) |
Notes
2. Change without regulatory effect amending section filed 4-4-2000 pursuant to section 100, title 1, California
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
4. Change without regulatory effect amending subsection (c)--form filed 11-21-2002 pursuant to section 100, title 1, California
Note: Authority cited: Section 1344, Health and Safety
2. Change without regulatory effect amending section filed 4-4-2000 pursuant to section 100, title 1, California
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
4. Change without regulatory effect amending subsection (c) -form filed 11-21-2002 pursuant to section 100, title 1, California
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