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 56452 - Information to New Members

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Each PCCM plan shall provide to members, in writing,
						within seven days after the effective date of enrollment:
(a) The effective date of enrollment and the
					 term of enrollment.
(b) A
					 description of all available services and an explanation of any service
					 limitations, exclusions from coverage, or charges for services when
					 applicable.
(c) An explanation of
					 the procedure for obtaining services.
(d) The name, telephone number and service
					 site address of the primary care physician chosen by or otherwise made
					 available to the member.
(e) An
					 explanation of and the procedure for obtaining health service rendered in
					 emergency circumstances occurring outside the PCCM plan's service
					 area.
(f) The causes for which a
					 member will lose entitlement to receive services from the PCCM plan.
(g) The procedure for processing and
					 resolving any grievance by members. This information shall include the title,
					 address, and telephone number of a person responsible for resolving grievances
					 or initiating the grievance procedure and shall include an explanation of the
					 member's right to request a fair hearing under Welfare and Institutions Code
					 Section
					 10950,
					 et seq., for unresolved grievances and to request a fair hearing without going
					 through the PCCM plan's grievance procedures when a health care service
					 requested by the member or a provider has not been provided.
(h) Disenrollment procedures, including an
					 explanation of the member's right to disenroll without cause, and a
					 disenrollment form.
(i) An
					 explanation of the appropriate use of health care services and the
					 contributions the member can make toward the maintenance of the member's own
					 health.
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						emergency language will be repealed on 7-9-90.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).
7. New section filed 10-17-95; operative
						11-16-95 (Register 95, No. 42).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  10950,
						  14088.16,
						  14088.5,
						  14406
						  and
						  14450,
						  Welfare and Institutions Code.