California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 6 - PRIMARY CARE CASE MANAGEMENT PLANS › Article 3 - OPERATIONAL REQUIREMENTS › Section 56250 - Subcontracts

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A provider or
					 management subcontract entered into by a PCCM plan shall become effective upon
					 submission to and approval in writing by the Department. Departmental approval
					 shall be based on compliance with (b) and (c) below.
(b) A PCCM plan that subcontracts for the
					 provision of any health care service to PCCM plan members shall ensure that the
					 subcontractor meets all requirements of Chapters 3 and 6 related to services a
					 PCCM plan is required to perform.
(c) Each subcontract submitted for Department
					 approval pursuant to subdivision (a), shall contain at least the following:
(1) Specification of the services to be
					 provided.
(2) Specification that
					 the subcontract shall be governed by and construed in accordance with all laws,
					 regulations and contractual obligations incumbent upon the PCCM plan.
(3) Specification that the subcontract or
					 subcontract amendments shall become effective only as set forth in subdivision
					 (a).
(4) Specification of the term
					 of the subcontract, including the beginning and ending dates, as well as
					 methods of extension, renegotiation and termination.
(5) Subcontractor's agreement to submit
					 reports as required by the PCCM plan and the Department.
(6) The subcontractor's agreement to make all
					 of its books and records, pertaining to the goods and services furnished under
					 the terms of the subcontract, available for inspection, examination or copying:
(A) By the Department and by the Department
					 of Health and Human Services.
(B)
					 At all reasonable times at the subcontractor's place of business, or at some
					 other mutually agreeable location in California.
(C) In a form maintained in accordance with
					 the general standards applicable to book or record keeping.
(D) For the term required by section
					 56310.
(7) Full disclosure of the method and amount
					 of compensation or other consideration to be received by the subcontractor from
					 the PCCM plan.
(8) Subcontractor's
					 agreement to maintain and make available to the Department, upon request,
					 copies of all sub-subcontracts and to ensure that all sub-subcontracts are in
					 writing and require that the sub-subcontractor:
(A) Make all applicable books and records
					 available at all reasonable times for inspection, examination or copying by the
					 Department and by the Department of Health and Human Services.
(B) Retain all books and records pertaining
					 to its PCCM sub-subcontract in accordance with section
					 56310.
(9) Subcontractor's agreement to notify the
					 Department in the event the agreement with the PCCM plan is amended or
					 terminated. Notice to the Department is considered given when properly
					 addressed and deposited in the United States Postal Service as first-class
					 registered mail, postage attached.
(10) Subcontractor's agreement that
					 assignment or delegation of the subcontract shall be void unless prior written
					 approval is obtained from the Department.
(11) Subcontractor's agreement to hold
					 harmless both the State and PCCM plan members in the event the PCCM plan cannot
					 or will not pay for services performed by the subcontractor pursuant to the
					 subcontract.