101.1. . All Californians, who have been born in, work in, or who have established residency are eligible and covered by the CALTCHA program. No discrimination based on income, race, location, gender identity, sexual orientation, immigration status, seasonal work, disability, pre-existing health conditions, religion, political beliefs, or incarceration or prior incarceration will be allowed under this Act.
101.2. The Secretary of Health and Human Services shall promulgate a rule that provides exact criteria determining residency and eligibility purposes for the CALTCHA program and clear criteria for partial residence and a mechanism for intentional withdrawal from the program. Each individual shall receive a CALTCHA Card with a unique number. An individual's Social Security number shall not be used for purposes of registration under this program.
101.3. Registration: Individuals shall receive a CALTCHA Electronic Smart ID card at birth or by filing a CALTCHA program application, not to exceed 2 pages, from an approved and licensed health care provider or social services agency.
101.4. Residents will be issued the CALTCHA "smart ID card," which will access the patient's most essential medical history with the card, and can be securely downloaded at any medical provider, provided the patient gives their consent to do so. All medical providers in California will receive smart card reader machinery from the CALTCHA program.
101.5. . It is prohibited in this Act for one county's medical providers to receive smart card machinery, while other counties are not provided the same quantity (based on their populations and number of providers) and quality of smart card readers.
101.6. Confidential Electronic Patient Record System (EPRS): The EPRS will collect patient information necessary to conduct health care, quality assurance, and accurate public health reporting. All provider billing shall be performed electronically; the EPRS shall segregate documentation of care provision and billing functions.
101.7.The Secretary shall create a standardized and secure (privacy protected) electronic patient record system according to state and federal laws and regulations and enact regulations to maintain accurate patient identity and ensure a system that streamlines billing and reduces medical errors and bureaucratic fraud waste. All patients may request a copy of all medical information held in the file.
101.8. Presumptive Eligibility: Visitors from other states or foreign countries without a CALTCHA card and individuals who present themselves who may be homeless or otherwise without a CALTCHA card and need essential, urgent, critical, or emergency care for covered services from a participating CALTCHA provider shall be presumed eligible for benefits under this Act. The Secretary shall establish rules for out-of-state and out-of-country reimbursement coverage arrangements or a self-pay mechanism to discourage "medical tourism."
101.9. No person in the state of California will be denied emergency care in hospitals, community clinics, urgent care centers, doctors' offices, or by other licensed health care providers competent and equipped to respond to the presenting problem where capacity exists. No one can be denied emergency medical care.
This system intends to ensure the quality and parity of delivering comprehensive health services for all residents of California to achieve barrier-free and convenient access to outpatient primary and specialty services and hospitals, guided by clinical, demographic, and epidemiological needs.
102.1 General: The following list identifies the comprehensive health care, services, goods, and medically necessary benefits included in inaugural CALTCHA coverage. Available services must include but need not be limited to:
102.1.1. Licensed inpatient and outpatient hospital care
102.1.2. All licensed clinic or licensed health care provider community, individual, home and family care, telemedicine care, and health maintenance counseling
102.1.3. Preventive, immunizations, and primary care
102.1.4. Prenatal, neonatal, postnatal, early childhood, and all pediatric care, including vaccination for preventable conditions
102.1.5. . Life Time Care to establish individualized, cradle-to-grave planning and services, including home, residential, in-home support services, and hospice services. Program funds shall fully support eligible elderly and disabled individuals and their families by providing lifetime care - emphasizing patient autonomy and least restrictive home- and community-based, non-institutional care, while still funding institutional care where appropriate and as determined by patients in alliance with those who care for them.
102.1.6.All Mental health care in full parity with physical health care, including psychiatric and psychological care, social work, and counseling from allied providers
102.1.7. All pharmaceutical therapeutics and complementary non-allopathic medicine modalities as defined by the CALTCHA formulary.
102.1.9. Reproductive and assistive reproductive support services, abortion, and sexual health services, including sexual re/assignment
102.1.10. Emergency care with ambulance services
102.1.11 Substance abuse and addiction services
102.1.12. Transfusion and blood products
102.1.13. Dialysis
102.1.14. Verified regular health care transportation
102.1.15. Inpatient and outpatient rehabilitation and habilitation care (including licensed and non-licensed in-home health care providers)
102.1.16. Assistive and communication technology, orthotic, prosthetic, rehabilitation engineering evaluation and equipment, and all necessary durable medical equipment (DME)
102.1.17. Dental care includes but is not limited to preventive and all medically needed specialty dental care
102.1.18. Hearing and vision evaluation, equipment, and repair
102.1.19. All needed surgical psychosocial corrective and indicated reproductive and recuperative surgery and recuperative care
102.1.20. Podiatry, chiropractic, and targeted medically necessary acupuncture
102.1.21. Medical necessary targeted therapeutic massage and movement care
102.1.22. Social work
102.1.23. Public health nursing
102.1.24. Case management and care coordination
102.1.25. Patient education and health maintenance counseling
102.1.26. Adult daycare
102.1.27. Sanitation engineering for environmental health
102.1.28. Benefits included in public retiree health plans or Taft-Hartley Health Trust Fund plans with no benefit losses for any Californian
102.1.29. Workers compensation, health component coverage
102.1.30. Language and translation services including audio, sign, and braille for individuals with communication differences
102.1.31. Experimental and innovative products, services, and health care (peer-reviewed and demonstrated by the National Institutes of Health, National Center for a Complimentary and Integrative Health) to be safe and effective.
102.1.32. Ancillary health, case management, coordination, navigation, and social services previously covered by county programs, Regional Center for Developmental Disability, Children’s Health Insurance Program (CHIP), Medicaid, Child Health and Disability Prevention (CHDP), etc.
102.1.33. Medicare and Knox-Keene Health Care Service Plan Act benefits
102.1.34. Prison and detention center health and post-incarceration health, mental health, and social services
102.1.35. Disease investigation, contact-tracing, and quarantine interventions
102.1.36. Any additional health care resources and services that may arise from natural disasters, epidemics, and pandemics, as designated by the CALTCHA Board and the Secretary.
102.1.37. The Board may include other benefits on an as-needed basis but may not reduce the benefits stated in this section of the Act.
102.1.38. These services shall be provided based on any CA CALTCHA licensed clinician prescription or direction and will not require prior approval or authorization by any intermediary, consistent with the standards and CALTCHA approved benefits.