reglab/statecodes huggingface dataset:
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 4 - MARKETING, ENROLLMENT AND DISENROLLMENT › Section 56400 - Marketing

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each PCCM plan
					 shall ensure compliance with all statutory, regulatory and contractual
					 provisions relating to member enrollment and marketing activities.
(b) PCCM plan subcontractors shall not enter
					 into any sub-subcontracts for marketing.
(c) Each PCCM plan shall establish an
					 education program that assures that its marketing representatives have
					 sufficient knowledge about the PCCM plan to explain how it operates to
					 prospective and new members.
(d) A
					 PCCM plan or marketing representative shall not adopt or utilize any procedure
					 to identify prospective members who have medical or psychiatric problems, other
					 than those specifically excluded from coverage by the PCCM contract, in order
					 to exclude prospective members from enrollment in the PCCM plan.
(e) Marketing on county premises by PCCM
					 plans is prohibited unless the marketing of prospective members is in
					 accordance with Welfare and Institutions Code sections
					 14016.5
					 and
					 14016.6.
1. New
						section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 7-9-90.
2. New section
						refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed by operation of law on
						11-6-90
3. Request to readopt section on an emergency basis pursuant
						to Government Code section
						11346.1
						granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No.
						6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or
						emergency language will be repealed by operation of law on the following
						day.
4. Certificate of Compliance as to 11-6-90 order transmitted to
						OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5.
						New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No.
						18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or
						emergency language will be repealed by operation of law on the following
						day.
6. Certificate of Compliance as to 3-25-91 order including
						amendment of section transmitted to OAL 7-19-91 and filed 8-19-91 (Register 92,
						No. 1).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14088.16,
						  Welfare and Institutions Code.
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 4 - MARKETING, ENROLLMENT AND DISENROLLMENT › Section 56401 - Door-to-Door Marketing

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 PCCM plans may use door-to-door marketing only when all of the following
					 conditions are met:
(1) The presenter is a
					 marketing representative of the PCCM plan.
(2) Door-to-door marketing is performed only
					 in the service area of the PCCM plan.
(3) The PCCM plan complies with this article
					 and the terms of the PCCM contract.
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 4 - MARKETING, ENROLLMENT AND DISENROLLMENT › Section 56402 - Marketing Representative

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) All PCCM plan marketing representatives
					 shall complete the PCCM plan's marketing education program required by Section
					 56400(c) and
					 shall receive a passing score of 90 percent or better, based on a straight
					 percentage method, on the Department's examination for marketing
					 representatives prior to engaging in marketing activities on behalf of any PCCM
					 plan.
(b) A PCCM plan marketing
					 representative shall not provide marketing services on behalf of more than one
					 PCCM plan or prepaid health plan.
(c) A PCCM plan marketing representative
					 shall neither offer nor give any form of compensation or reward to induce or
					 procure enrollment of members.
1. New
						section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 7-9-90.
2. New section
						refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed by operation of law on
						11-6-90.
3. Request to readopt section on an emergency basis
						pursuant to Government Code section
						11346.1
						granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No.
						6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or
						emergency language will be repealed by operation of law on the following
						day.
4. Certificate of Compliance as to 11-6-90 order transmitted to
						OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5.
						New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No.
						18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or
						emergency language will be repealed by operation of law on the following
						day.
6. Certificate of Compliance as to 3-25-91 order including
						amendment of subsection (a) transmitted to OAL 7-19-91 and filed 8-19-91
						(Register 92, No. 1).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14088.16,
						  Welfare and Institutions Code.
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 4 - MARKETING, ENROLLMENT AND DISENROLLMENT › Section 56404 - Marketing Presentation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Marketing presentations shall fully disclose the
						availability of, and restrictions upon the services provided by the PCCM plan.
						Such presentations shall, as a minimum, specify:
(a) The scope, access to, and availability of
					 services.
(b) A description of the
					 PCCM plan restricted Medi-Cal card which will authorize the member to obtain
					 services.
(c) That members shall
					 obtain all PCCM plan covered health care services rendered in nonemergency
					 situations through the PCCM plan's providers.
(d) What emergency services are and that
					 emergency services may be obtained at all times from specified PCCM plan
					 providers or from non-PCCM plan providers, if necessary.
(e) That enrollment is voluntary.
(f) That enrollment is subject to a
					 verification and processing period from 15 to 45 calendar days in
					 length.
(g) The conditions under
					 which disenrollment is possible.
1. New
						section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 7-9-90.
2. New section
						refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed by operation of law on
						11-6-90.
3. Request to readopt section on an emergency basis
						pursuant to Government Code section
						11346.1
						granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No.
						6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or
						emergency language will be repealed by operation of law on the following
						day.
4. Certificate of Compliance as to 11-6-90 order transmitted to
						OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5.
						New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No.
						18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or
						emergency language will be repealed by operation of law on the following
						day.
6. Certificate of Compliance as to 3-25-91 order including
						amendment of subsections (d) and (g) transmitted to OAL 7-19-91 and filed
						8-19-91 (Register 92, No. 1).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14088.16,
						  Welfare and Institutions Code.
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 4 - MARKETING, ENROLLMENT AND DISENROLLMENT › Section 56406 - Misrepresentation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) No marketing
					 representatives or marketing organizations under contract with or employed by
					 any PCCM plan shall in any manner misrepresent themselves, the PCCM plans they
					 represent or the Medi-Cal program to induce enrollment.
(b) Violations of this section shall include,
					 but shall not be limited to false or misleading claims that:
(1) Marketing representatives are employees
					 or representatives of the federal government, state, county or anyone other
					 than the PCCM plan.
(2) The PCCM
					 plan is recommended or endorsed by any government organization or
					 official.
(3) The federal
					 government, state or county recommends that a Medi-Cal beneficiary enroll in a
					 specific PCCM plan.
(4) A Medi-Cal
					 beneficiary will lose benefits under the Medi-Cal program or any other health
					 or welfare benefit to which the beneficiary is legally entitled, if the
					 beneficiary does not enroll in a PCCM plan.
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 4 - MARKETING, ENROLLMENT AND DISENROLLMENT › Section 56408 - Penalties for Misrepresentation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Department may impose one or more of the following
						penalties for violations of the provisions of this Article:
(a) Revoke one or more permitted method of
					 marketing.
(b) Refuse to accept new
					 enrollments for a period specified by the Department.
(c) Refuse to accept enrollments submitted by
					 a specific marketing representative or organization.
(d) Withhold, deny or recover all or part of
					 the capitation payment or savings sharing for persons enrolled as a result of
					 the violations.
(e) Require that
					 the PCCM plan personally contact each member enrolled in violation of this
					 Article, explain the nature of the violation and inform the member of the right
					 to disenroll.
(f) Terminate the
					 PCCM contract.
1. New
						section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 7-9-90.
2. New section
						refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed by operation of law on
						11-6-90.
3. Request to readopt section on an emergency basis
						pursuant to Government Code section
						11346.1
						granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No.
						6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or
						emergency language will be repealed by operation of law on the following
						day.
4. Certificate of Compliance as to 11-6-90 order transmitted to
						OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5.
						New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No.
						18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or
						emergency language will be repealed by operation of law on the following
						day.
6. Certificate of Compliance as to 3-25-91 order transmitted to
						OAL 7-19-91 and filed 8-19-91 (Register 92, No.
						1).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14088.16,
						  Welfare and Institutions Code.
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 4 - MARKETING, ENROLLMENT AND DISENROLLMENT › Section 56420 - Member Enrollment

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 A Medi-Cal beneficiary is enrolled upon completion of all of the following
					 events:
(1) The voluntary signing and dating
					 of a designation form by the Medi-Cal beneficiary.
(2) Departmental validation of the
					 beneficiary's designation form.
(3)
					 Departmental verification of the beneficiary's Medi-Cal eligibility.
(4) Addition of the beneficiary's name to the
					 approved list of members, furnished by the Department to the PCCM plan, which
					 is effective at the first of any given month.
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 4 - MARKETING, ENROLLMENT AND DISENROLLMENT › Section 56424 - Designation Form Processing

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 PCCM plans shall submit all completed designation forms to the Department
					 within 15 calendar days of the date the PCCM plan receives the completed
					 designation form.
(b) Unless
					 otherwise provided in writing by the Department, each PCCM plan shall accept
					 designation forms from eligible Medi-Cal beneficiaries to the enrollment
					 maximums specified in the PCCM contract.
(c) Each PCCM plan shall accept designation
					 forms regardless of the prospective member's race, creed, color, religion, age,
					 sex, national origin, ancestry, marital status, sexual orientation, physical or
					 mental handicap, and without reference to pre-existing medical conditions other
					 than those specifically excluded from coverage by the PCCM contract.
1. New
						section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 7-9-90.
2. New section
						refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed by operation of law on
						11-6-90.
3. Request to readopt section on an emergency basis
						pursuant to Government Code section
						11346.1
						granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No.
						6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or
						emergency language will be repealed by operation of law on the following
						day.
4. Certificate of Compliance as to 11-6-90 order transmitted to
						OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5.
						New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No.
						18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or
						emergency language will be repealed by operation of law on the following
						day.
6. Certificate of Compliance as to 3-25-91 order including
						amendment of subsection (b) transmitted to OAL 7-19-91 and filed 8-19-91
						(Register 92, No. 1).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14088.16
						  and
						  14088.3,
						  Welfare and Institutions Code.
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 4 - MARKETING, ENROLLMENT AND DISENROLLMENT › Section 56426 - Term of Membership

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Except as provided in section
						56440, membership shall continue
						indefinitely after enrollment. Membership shall be contingent upon the member's
						retention of Medi-Cal eligibility as well as eligibility for enrollment in the
						PCCM plan under the terms of the PCCM contract.
1. New
						section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 7-9-90.
2. New section
						refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed by operation of law on
						11-6-90.
3. Request to readopt section on an emergency basis
						pursuant to Government Code section
						11346.1
						granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No.
						6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or
						emergency language will be repealed by operation of law on the following
						day.
4. Certificate of Compliance as to 11-6-90 order transmitted to
						OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5.
						New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No.
						18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or
						emergency language will be repealed by operation of law on the following
						day.
6. Certificate of Compliance as to 3-25-91 order transmitted to
						OAL 7-19-91 and filed 8-19-91 (Register 92, No.
						1).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14088.16,
						  Welfare and Institutions Code.
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 4 - MARKETING, ENROLLMENT AND DISENROLLMENT › Section 56440 - Disenrollment of Members

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A
					 request for disenrollment by a PCCM plan member shall be submitted to the
					 Department by the PCCM plan within five working days after either the date the
					 member submits a signed disenrollment request directly to the PCCM plan or the
					 postmark date for disenrollment requests sent by U.S. mail.
(b) Disenrollment of members for the
					 following reasons shall be processed by the Department:
(1) The member's eligibility as a Medi-Cal
					 beneficiary for enrollment in the PCCM plan is terminated.
(2) The enrollment is in violation of
					 sections 56400,
					 56402,
					 56404, or
					 56406.
(3) Change of a member's place of residence
					 outside the PCCM plan's service area.
(4) The member requests
					 disenrollment.
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 4 - MARKETING, ENROLLMENT AND DISENROLLMENT › Section 56442 - Disenrollment Requests

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Members desiring disenrollment shall make written
						requests to the PCCM plan.
1. New
						section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 7-9-90.
2. New section
						refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed by operation of law on
						11-6-90.
3. Request to readopt section on an emergency basis
						pursuant to Government Code section
						11346.1
						granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No.
						6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or
						emergency language will be repealed by operation of law on the following
						day.
4. Certificate of Compliance as to 11-6-90 order transmitted to
						OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5.
						New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No.
						18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or
						emergency language will be repealed by operation of law on the following
						day.
6. Certificate of Compliance as to 3-25-91 order transmitted to
						OAL 7-19-91 and filed 8-19-91 (Register 92, No.
						1).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14088.16
						  and
						  14088.5,
						  Welfare and Institutions Code.
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 4 - MARKETING, ENROLLMENT AND DISENROLLMENT › Section 56450 - Information to Prospective Members. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 7-9-90.
2. New section
						refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed by operation of law on
						11-6-90.
3. Request to readopt section on an emergency basis
						pursuant to Government Code section
						11346.1
						granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No.
						6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or
						emergency language will be repealed by operation of law on the following
						day.
4. Certificate of Compliance as to 11-6-90 order transmitted to
						OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5.
						New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No.
						18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or
						emergency language will be repealed by operation of law on the following
						day.
6. Repealed by operation of Government Code section
						11346.1(g)
						(Register 92, No. 1).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14088.16
						  and
						  14088.5,
						  Welfare and Institutions Code.
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 4 - MARKETING, ENROLLMENT AND DISENROLLMENT › Section 56456 - Notification of Changes in Services. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 7-9-90.
2. New section
						refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed by operation of law on
						11-6-90.
3. Request to readopt section on an emergency basis
						pursuant to Government Code section
						11346.1
						granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No.
						6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or
						emergency language will be repealed by operation of law on the following
						day.
4. Certificate of Compliance as to 11-6-90 order transmitted to
						OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5.
						New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No.
						18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or
						emergency language will be repealed by operation of law on the following
						day.
6. Repealed by operation of Government Code section
						11346.1(g)
						(Register 92, No. 1).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14088.16,
						  Welfare and Institutions Code.
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 5 - APPLICATION AND PROPOSAL › Section 56500 - Application and Proposal Information

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each applicant for a PCCM contract shall
					 submit to the Department an application containing, but not limited to, the
					 following information:
(1) A statement as to
					 the optional services that will be selected in addition to the mandatory
					 services required of PCCM plans.
(2) A brief description of any existing
					 health care delivery system including information covering the scope and
					 availability of services currently provided to Medi-Cal beneficiaries by the
					 applicant.
(3) A description of the
					 proposed PCCM plan health care delivery system. If the services are a duplicate
					 of those described in (2), a signed statement declaring that the health care
					 delivery system will be the same will satisfy this requirement.
(4) A U.S. Postal Zip Code map with the
					 proposed service area outlined in red.
(5) A separate list of all service area Zip
					 codes in numerical order.
(6) A
					 general area map of the service area that has all service sites distinctly
					 identified and clearly listed on a legend.
(7) An array of the Medi-Cal population in
					 the service area by PCCM plan eligible Medi-Cal Aid categories.
(8) A breakdown of the applicant's current
					 patient population by private pay, insurance and Medi-Cal.
(9) A history of any experience the applicant
					 has in providing care to patients through medical systems such as preferred
					 provider organizations, industrial practice, prepaid health plans, PCCM plans,
					 or any structured medical care delivery system that would demonstrate the
					 ability to function as a PCCM plan.
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 5 - APPLICATION AND PROPOSAL › Section 56502 - PCCM Contract Selection Criteria

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Department in exercising its
					 discretion to enter into PCCM contracts shall evaluate applications,
					 considering the following:
(a) Provider
					 models that are able to offer the broadest base or reach particular segments of
					 the Medi-Cal population, such as rural areas and Medicare/Medi-Cal
					 beneficiaries. These provider models include, but are not limited to:
(1) Primary care clinics with
					 specialists.
(2) Primary care
					 clinics.
(3) Hospital based
					 clinics.
(4) Group
					 practices.
(5) Individual primary
					 care physicians.
(6) Other models
					 which offer potential for contracting, which shall be considered by the
					 Department on an individual basis.
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 5 - APPLICATION AND PROPOSAL › Section 56505 - Contract Term. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 7-9-90.
2. New section
						refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed by operation of law on
						11-6-90.
3. Request to readopt section on an emergency basis
						pursuant to Government Code section
						11346.1
						granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No.
						6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or
						emergency language will be repealed by operation of law on the following
						day.
4. Certificate of Compliance as to 11-6-90 order transmitted to
						OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5.
						New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No.
						18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or
						emergency language will be repealed by operation of law on the following
						day.
6. Repealed by operation of Government Code section
						11346.1(g)
						(Register 92, No. 1).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14088.16,
						  Welfare and Institutions Code.
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 5 - APPLICATION AND PROPOSAL › Section 56506 - Contract Renewals. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 7-9-90.
2. New section
						refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed by operation of law on
						11-6-90.
3. Request to readopt section on an emergency basis
						pursuant to Government Code section
						11346.1
						granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No.
						6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or
						emergency language will be repealed by operation of law on the following
						day.
4. Certificate of Compliance as to 11-6-90 order transmitted to
						OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5.
						New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No.
						18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or
						emergency language will be repealed by operation of law on the following
						day.
6. Repealed by operation of Government Code section
						11346.1(g)
						(Register 92, No. 1).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14088.16,
						  Welfare and Institutions Code.
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 5 - APPLICATION AND PROPOSAL › Section 56508 - Mergers, Reorganizations or Assumptions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A PCCM plan shall submit proposals for
					 mergers, reorganizations or assumptions to the Department for review.
(b) The Department may approve PCCM plan
					 proposals relating to mergers, reorganizations or assumptions if, in addition
					 to satisfying the requirements of section
					 14088 et seq., Welfare and
					 Institutions Code as applicable, the following conditions are satisfied:
(1) The surviving organization meets the
					 requirements of section
					 56500.
(2) The surviving organization provides
					 written assurance that it will comply with all PCCM contract requirements and
					 all applicable state and federal laws and regulations.
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 5 - APPLICATION AND PROPOSAL › Section 56520 - Public Notice

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
					 Department shall publish a public notice of its intent to enter into a PCCM
					 contract at least 60 calendar days prior to entering into an initial PCCM
					 contract.
(b) The public notice
					 shall appear in at least two major newspapers of general distribution in the
					 service area of the proposed PCCM plan.
1. New
						section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 7-9-90.
2. New section
						refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed by operation of law on
						11-6-90.
3. Request to readopt section on an emergency basis
						pursuant to Government Code section
						11346.1
						granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No.
						6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or
						emergency language will be repealed by operation of law on the following
						day.
4. Certificate of Compliance as to 11-6-90 order transmitted to
						OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).
5.
						New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No.
						18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or
						emergency language will be repealed by operation of law on the following
						day.
6. Certificate of Compliance as to 3-25-91 order including
						amendment of subsection (b) transmitted to OAL 7-19-91 and filed 8-19-91
						(Register 92, No. 1).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14088.16,
						  Welfare and Institutions Code.
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 6 - CONFLICT OF INTEREST › Section 56600 - Conflict of Interest

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
					 Department shall terminate a PCCM contract, if the Department determines that a
					 state officer or state employee:
(1) Provides
					 legal or management services to a PCCM plan,
(2) Has financial interest in the PCCM
					 contract or PCCM plan,
(3) Has any
					 separate contract with the PCCM plan, or
(4) Is involved in the procurement of a
					 contract or subcontract for any PCCM plan.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 7 - CONSTRUCTION/RENOVATION REIMBURSEMENT PROGRAM › Article 1 - DEFINITIONS › Section 57000 - Capital Expenditure Project

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) "Capital expenditure project" means a
					 project for expenditures which, under generally accepted accounting principles,
					 are not properly chargeable as expenses of operation and maintenance and are
					 related to the acquisition, construction, renovation, improvement,
					 modernization, expansion, or replacement of a plant, buildings, and equipment
					 with respect to which the expenditure is made, including, but not limited to
					 the following if included in revenue bond debt service:
(1) Studies, surveys, designs, plans, working
					 drawings, and specifications bid preparation, inspection, and material
					 testing;
(2) Site preparation,
					 including demolishing or razing structures, hazardous waste removal, and
					 grading and paving;
(3) Off-site
					 construction and improvements required by the onsite project including the
					 expansion of utilities, access roads, parking structures, bus stops, bus
					 turnouts, bus shelters, and landscaping;
(4) Permit and license fees;
(5) Architectural, legal, accounting,
					 contract administration cost and appraisal fees;
(6) Costs incurred for borrowing funds
					 including capitalized interest; and
(7) Construction costs.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 7 - CONSTRUCTION/RENOVATION REIMBURSEMENT PROGRAM › Article 1 - DEFINITIONS › Section 57003 - Debt Service

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Debt service" means principal and interest paid to
						holders of revenue bonds issued for the purpose of financing capital
						expenditure projects. Debt service may also include but is not limited to other
						debt service costs such as credit enhancement, debt service reserve funds,
						trustee fees, liquidity letters of credit, bond counsel or other costs of bond
						funding which may or may not be capitalized and reflected in the principal
						portion of debt service.
1. New
						section filed 10-5-89 as an emergency; operative 10-5-89 (Register 89, No. 41).
						A Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 2-2-90.
2. New section filed
						2-9-90 as an emergency; operative 2-6-90 (Register 90, No. 11). A Certificate
						of Compliance must be transmitted to OAL within 120 days or emergency language
						will be repealed on 6-6-90.
3. Certificate of Compliance as to
						2-6-90 order including amendments transmitted to OAL 6-5-90 and filed 6-22-90
						(Register 90, No. 34).
Note: Authority cited: Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14085.5,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 7 - CONSTRUCTION/RENOVATION REIMBURSEMENT PROGRAM › Article 1 - DEFINITIONS › Section 57006 - Disproportionate Share Hospital

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Disproportionate share hospital" means a hospital which
						serves a disproportionate number of low income patients as specified in the
						Medicaid State Plan Attachment 4.19-A., pages 18-29.
1. New
						section filed 10-5-89 as an emergency; operative 10-5-89 (Register 89, No. 41).
						A Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 2-2-90.
2. New section filed
						2-9-90 as an emergency; operative 2-6-90 (Register 90, No. 11). A Certificate
						of Compliance must be transmitted to OAL within 120 days or emergency language
						will be repealed on 6-6-90.
3. Certificate of Compliance as to
						2-6-90 order including amendments transmitted to OAL 6-5-90 and filed 6-22-90
						(Register 90, No. 34).
Note: Authority cited: Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14085.5,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 7 - CONSTRUCTION/RENOVATION REIMBURSEMENT PROGRAM › Article 1 - DEFINITIONS › Section 57009 - Final Plans

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Final plans" means those documents required by the
						Office of Statewide Health Planning and Development (OSHPD) and the Office of
						the State Architect which have been submitted to the OSHPD with Form OSH-FD 121
						entitled "Application for Building Permit" as specified in the California Code
						of Regulations, Title 22, division 7, section
						94037. In order to constitute
						"final plans" the box entitled "final plans" on the Form OSH-FD 121 shall be
						marked.
1. New
						section filed 10-5-89 as an emergency; operative 10-5-89 (Register 89, No. 41).
						A Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 2-2-90.
2. New section filed
						2-9-90 as an emergency; operative 2-6-90 (Register 90, No. 11). A Certificate
						of Compliance must be transmitted to OAL within 120 days or emergency language
						will be repealed on 6-6-90.
3. Certificate of Compliance as to
						2-6-90 order including amendments transmitted to OAL 6-5-90 and filed 6-22-90
						(Register 90, No. 34).
Note: Authority cited: Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14085.5,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 7 - CONSTRUCTION/RENOVATION REIMBURSEMENT PROGRAM › Article 1 - DEFINITIONS › Section 57012 - Fixed Equipment

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Fixed equipment" means equipment that is permanently
						affixed to the structure and which has a useful life determined in accordance
						with guidelines published by the American Hospital Association, entitled
						"Estimated Useful Lives of Depreciable Hospital Assets," 1983 and does not
						include:
(a) movable
					 equipment;
(b) equipment that under
					 generally accepted accounting principles is usually charged as an expense of
					 operation and maintenance;
(c)
					 items of current operating expense, such as food, fuel, pharmaceuticals,
					 dressings, paper, printed forms, and house-cleaning supplies.
1. New
						section filed 10-5-89 as an emergency; operative 10-5-89 (Register 89, No. 41).
						A Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 2-2-90.
2. New section filed
						2-9-90 as an emergency; operative 2-6-90 (Register 90, No. 11). A Certificate
						of Compliance must be transmitted to OAL within 120 days or emergency language
						will be repealed on 6-6-90.
3. Certificate of Compliance as to
						2-6-90 order including amendments transmitted to OAL 6-5-90 and filed 6-22-90
						(Register 90, No. 34).
Note: Authority cited: Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14085.5,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 7 - CONSTRUCTION/RENOVATION REIMBURSEMENT PROGRAM › Article 1 - DEFINITIONS › Section 57015 - New Debt

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"New debt" means funds resulting from the sale of revenue
						bonds used for financing a certified project as specified in section
						57030 of this chapter for which
						final plans are submitted after July 1, 1989 and prior to June 30,
						1994.
1. New
						section filed 10-5-89 as an emergency; operative 10-5-89 (Register 89, No. 41).
						A Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 2-2-90.
2. New section filed
						2-9-90 as an emergency; operative 2-6-90 (Register 90, No. 11). A Certificate
						of Compliance must be transmitted to OAL within 120 days or emergency language
						will be repealed on 6-6-90.
3. Certificate of Compliance as to
						2-6-90 order including amendments transmitted to OAL 6-5-90 and filed 6-22-90
						(Register 90, No. 34).
Note: Authority cited: Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14085.5,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 7 - CONSTRUCTION/RENOVATION REIMBURSEMENT PROGRAM › Article 1 - DEFINITIONS › Section 57018 - Revenue Bond

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Revenue bond" as defined in the California Government
						Code, division 3, Part 7.2, section
						15459(c) means
						any bonds, warrants, notes, leases or installment sale obligations evidenced by
						certificates of participation, or other evidence of indebtedness issued by a
						local agency payable from funds other than the proceeds of ad valorem taxes or
						the proceeds of assessments levied without limitation as to rate or amount by
						the local agency upon property in the local agency.
1. New
						section filed 10-5-89 as an emergency; operative 10-5-89 (Register 89, No. 41).
						A Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 2-2-90.
2. New section filed
						2-9-90 as an emergency; operative 2-6-90 (Register 90, No. 11). A Certificate
						of Compliance must be transmitted to OAL within 120 days or emergency language
						will be repealed on 6-6-90.
3. Certificate of Compliance as to
						2-6-90 order transmitted to OAL 6-5-90 and filed 6-22-90 (Register 90, No.
						34).
Note: Authority cited: Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14085.5,
						  Welfare and Institutions Code; and Section
						  15459(c), Part
						  7.2, Division 3, California Government
						  Code.