200.1 The Board shall establish six (6) distinct budget accounts and an additional annual Reserve Account; these six accounts comprise the CALTCHA Trust Fund, which shall be independent of California’s General Fund. (Global, Provider Reimbursement, Capital Construction and Decentralization, System Transition & Development, Public Health System, and a Reserve Fund)
200.1.1 Each Account shall be monitored by a distinct committee of the Board
200.2. The Global Operations Budget Account shall be annually negotiated, contracted, and distributed quarterly to each participating hospital, clinic, or other institutional provider, in amounts based on each facilities’ prior year operating budget (including professional and non-professional salaries and wages), projected changes in utilization, and an added Cost Of Living Adjustment (COLA). Global budgets reflect (1) projected changes in volume and type of items and services to be furnished in the upcoming quarter, (2) wages for employees, (3) the provider’s maximum capacity, (4) needs and costs for consumables provided, (5) education and prevention programs, (6) quality improvement and correction of maldistribution of resources, and (7) other factors determined to be appropriate by the CALTCHA Board. Such payments shall be considered as payment in full for all items and services provided under this Act, whether inpatient or outpatient, by such institutional provider for each quarter. Global Operations Budget funds may not be used for capital expenses.
200.2.1 Institutional providers include, but are not limited to, hospitals, community clinics, trauma, and urgent care centers, mental health hospitals, rehabilitation and habilitation clinics, and hospice systems.
200.2.2 All public, postsecondary health science schools’ (University of California, California State University, and community college) operations shall be funded by the Global Operations Budget account.
200.2.3 Provider Reimbursement Budget Account shall reimburse health professionals, using negotiated collective bargaining fee-for-service rates (FFS) or “fee for time” (FFT) model for individual and group practice physicians, advanced practice nurses, dentists, therapists, psychologists, pharmacists, social workers, and all other licensed health care personnel.
200.2.4 All unlicensed and support staff within a globally budgeted health institution shall be paid from the Global Budget account.
200.3. Provider Reimbursement Budget Account shall reimburse health professionals, using negotiated collective bargaining fee-for-service rates (FFS) or “fee for time” (FFT) model for individual and group practice physicians, advanced practice nurses, dentists, therapists, psychologists, pharmacists, social workers, and all other licensed health care personnel.
200.3.1Reimbursement levels for licensed clinicians shall be negotiated based on customary, reasonable, and faires rates to assure an adequate and accessible supply of health care services.
200.3.2 The Board shall address disparities and deficiencies in care within underserved urban, suburban, and rural populations by paying enhanced provider fees for services rendered in relevant geographic areas.
200.4. A Capital Construction, Maintenance, and Expansion Budget Account shall fund capital investments to meet the needs of cities, communities, and neighborhoods for buildings and equipment necessary to provide high-quality, equitably-distributed care and to improve all health outcomes. The capital expenditures budget shall be used for:
200.4.1. The construction, renovation, decentralization, and transition of health facilities to maximize local access and equitable coverage related to population needs and prioritize underserved rural and urban areas.
200.4.2. All major equipment and building investments shall be based on local budgeted three (3) year plan priorities submitted by Local Health Officers and the annually reprioritized allocations by the Board.
200.4.3 Hospitals, lifetime care systems, rehabilitation clinics, habilitation services, and other health care providers must have the requisite number of mobility, transfer lift, and communication interface equipment in order for all care personnel to avoid trauma or injuries from addressing the needs and moving patients without the aid of such assistive equipment.
200.4.4. 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.
200.5. The System Transition and Development Budget Account shall fund the effort to transition to, and then maintain, decision-making decentralization, democratization, and innovation, including relevant new workforce costs. This account shall provide the resources to establish and administratively support the Neighborhood Health Assemblies detailed in CALTCHA. This account shall also cover costs to:
200.5.1. Retire all outstanding medical services and health care debt of every California resident within five (5) years of the implementation date of CALTCHA. Health care providers will be compensated over a fifteen (15) year period, based on the fiscal strength of the Trust Fund Budget. Debt retirement shall include expunging medical reported debt on all credit reports. Further, no health care, medical debtcollecting, or billing entity shall be allowed to garnish wages from any individual‘s bank accounts, impose liens or attachment on personal property, tax returns, or any other financial assets seized in relation to medical debts immediately upon passage of this Act.
200.5.2 Adequately staff, fund, and resource the CALTCHA Board, State and Local Professional and Technical Advisory Committees, Neighborhood Liaison Offices, Neighborhood Health Assemblies, and mandated program regulatory task forces.
200.5.3 Develop and maintain quality assurance structures and innovations mandated in CALTCHA that target and end negative health outcomes associated with service system “deserts,” systemic racism, wealth-determined service disparities, and professional workforce deficiencies.
200.5.4 Fund on-the-job training and expansion of the neighborhood health workforce, coordinated with the relevant curriculum for job expansion through the public, post-secondary education system.
200.5.5 Fund essential mass media and public education communications to build community awareness of CALTCHA systems implementation and function.
200.6 Public Health System Budget Account: This account shall provide the CA Department of Public Health resources and each (61) local health department and associated Local Public Health Liaison Office staff.
200.6.1 Fund permanent full-time Local Health Officers, their staffs, their operations, and the establishment of public health laboratories in each county.
200.6.2 Fund local staff, advisory bodies, stipends, contract service costs for new public health system administrative bodies and functions.
200.6.3 Fund all In-Home Support Service (IHSS) to fulfill the Life Time Care individual planning and implementation model in consultation with IHSS workers’ professional associations. The existing IHSS budget for CA shall become a component of the CALTCHA Trust Fund and exclusively be used for its statutory purpose.
200.6.4 4 Fund and implement public health professional development and training needed to build effective and culturally sensitive public health leadership
200.6.5 County Supplemental Funding: After the CALTCHA Trust Fund appropriates annual Count program budgets, individual County Health Offices may petition the Board for additional funds from this account. Such requests should originate from the process of local health assessments and should be targeted to address socioeconomic health disparities, environmental sources of negative health outcomes, and any identified lack of parity between physical and mental health services. Funds may augment community health clinics, migrant health clinics, and other needed health services.
200.7 The Reserve Fund Account. The Secretary of HHS and the Board shall establish a Reserve Fund Account within the Trust Fund to ensure the stability and security of CALTCHA mandated services, rights, and structures for at least a single year prior to the program’s operational launch. Adequacy of this reserve shall be reassessed, and the reserve adjusted every three years.
200.8 The CALTCHA Trust Fund shall not be mixed with the state’s General Fund or other state Funds for any reason or purpose; nor shall money from the CALTCHA Trust Fund be appropriated for any purpose other than those specified in this Act.
200.9Additional Funding Sources: These may include disbursements from FEMA and Non-Government Organizations (NGO) sources as well as bequeathals from personal estates or private donations.