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 2 - DEFINITIONS › Section 56101.1 - Actuarial Method

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Actuarial method means any reasonable and adequate method
						of determining prospective per capita rates of payment for PCCM plan members
						that is based on actual expenditures for fee-for-service Medi-Cal beneficiaries
						and recent comparable data from each PCCM plan and other prepaid populations.
						This data may include:
(a) Experience
					 data to determine the expected costs of services and other requirements for
					 which the rates will serve as payment.
(b) Experience data to determine the expected
					 utilization of each service and other requirements for which the rates will
					 serve as payment by the aid category, age and sex of the Medi-Cal
					 members.
(c) Projected inflation in
					 the costs of the services and other requirements during the period to be
					 covered by the rates.
(d) Costs of
					 any new services or requirements that will be required during the year for
					 which the rates are determined but were not required during the previous
					 year.
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						emergency language will be repealed on 7-9-90.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						emergency language will be repealed by operation of law on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						emergency language will be repealed by operation of law on the following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 first paragraph 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 2 - DEFINITIONS › Section 56102 - Affiliate

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Affiliate means an organization or person that, directly
						or indirectly through one or more intermediaries, controls, is controlled by,
						or is under common control with, a PCCM plan and that provides services to or
						receives services from a 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: Section
						  14088.16,
						  Welfare and Institutions Code. [The next page is
						  553.]
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 2 - DEFINITIONS › Section 56114 - Disenrollment

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Disenrollment means the process by which a member's
						entitlement to receive services from a PCCM plan is
						terminated.
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 2 - DEFINITIONS › Section 56115 - Door-to-Door Marketing

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Door-to-door marketing means the use of a marketing
						presentation at the residence of an individual who has not requested a
						presentation.
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 2 - DEFINITIONS › Section 56115.5 - Effective Date of Enrollment

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Effective date of enrollment means the first day of the
						first month in which a Medi-Cal beneficiary's name appears on the approved list
						of members furnished to the PCCM plan by the Department as a result of the
						completion of a designation form for enrollment in 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: 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 2 - DEFINITIONS › Section 56116 - Enrollment

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Enrollment means the process by which a Medi-Cal
						beneficiary becomes a member of a 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. 34). 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 2 - DEFINITIONS › Section 56116.5 - Experience Data

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Experience data means historical cost and utilization
						data from the Medi-Cal fee-for-service program, prepaid health plans, PCCM
						plans or other prepaid populations which is sufficient to enable accurate
						statistical analysis and comparison.
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 2 - DEFINITIONS › Section 56117 - Facility

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Facility means any location which is:
(a) Owned, leased, used or operated directly
					 or indirectly by or for the benefit of a PCCM plan or its affiliates for
					 purposes related to a PCCM contract, or
(b) Maintained by a provider for the
					 provision of services on behalf of a 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 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 2 - DEFINITIONS › Section 56118 - Marketing

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Marketing means:
(a) Any activity conducted by, or on behalf
					 of, a PCCM plan in which information regarding the services offered is
					 disseminated in order to persuade Medi-Cal beneficiaries to enroll, or accept a
					 designation form for enrollment, in that PCCM plan, or
(b) Any presentation made by, or on behalf
					 of, a PCCM plan to any individual or organization for the purpose of enrolling
					 beneficiaries.
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,
						  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 2 - DEFINITIONS › Section 56120 - Marketing Representative

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Marketing representative means any person engaged in
						marketing activities on behalf of a PCCM plan, pursuant to Article 4 of this
						Chapter.
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
						  14088.3,
						  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 2 - DEFINITIONS › Section 56122 - Member

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Member means any Medi-Cal beneficiary who has enrolled in
						a PCCM plan pursuant to section
						56420.
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,
						  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 2 - DEFINITIONS › Section 56124 - Optional Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Optional services means any Medi-Cal covered service
						included in the PCCM contract as a capitated service which the Department does
						not require the PCCM plan to provide under capitation.
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 2 - DEFINITIONS › Section 56130 - PCCM Contract

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
PCCM contract means the written agreement entered into
						between a primary care provider as defined in section
						14088(b)(1),
						Welfare and Institutions Code and the Department, and approved by the
						Department of Finance to provide health care services to members under the
						provisions of sections
						14088.16
						and
						14088.17,
						Welfare and Institutions Code.
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: Sections
						  14088,
						  14088.16,
						  14088.17,
						  14088.6
						  and
						  14088.7,
						  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 2 - DEFINITIONS › Section 56133 - Risk Limit

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Risk limit means the per member dollar amount in excess
						of which the Department will reimburse the PCCM plan the cost, based on
						Medi-Cal fee-for-service rates, of capitated services rendered to any
						member.
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 2 - DEFINITIONS › Section 56138 - Service Site

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Service site means the location designated by a PCCM plan
						at which members shall receive health care services.
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 2 - DEFINITIONS › Section 56144 - Subcontract

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Subcontract
					 means an agreement between a PCCM plan and any of the following:
(1) A provider of health care services who
					 agrees to furnish services to PCCM plan members.
(2) A marketing organization.
(3) Any other person or organization who
					 agrees to perform any administrative function or service for the operation of
					 the PCCM plan specifically related to securing or fulfilling its PCCM
					 contractual obligations.
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 2 - DEFINITIONS › Section 56144.5 - Sub-Subcontract

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Sub-subcontract means any agreement, descending from and
						subordinate to a subcontract, which is entered into for the purpose of
						providing any goods or services connected with a PCCM plan's obligations under
						a 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 2 - DEFINITIONS › Section 56146 - Written Approval. [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 2 - DEFINITIONS › Section 56152 - Vendor

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Vendor means any person who provides services or supplies
						to a PCCM plan or subcontractor of a PCCM plan and who does not have a written
						subcontract with the PCCM or its subcontractors.
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 3 - OPERATIONAL REQUIREMENTS › Section 56200 - Organization and Administration

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Each PCCM plan shall have the organizational and
						administrative ability to carry out its contractual obligations.To demonstrate
						this ability, each PCCM plan shall maintain the following:
(a) A license to provide medical
					 care.
(b) An approved Medi-Cal
					 provider number.
(c) A grievance
					 procedure as specified in section
					 56260.
(d) Member and enrollment reporting systems
					 which fulfill the PCCM plan's contractual obligations.
(e) A data-reporting system which provides
					 reports required under the contract to the Department on a timely
					 basis.
(f) Financial records and
					 books of account fully disclosing the disposition of all Medi-Cal program funds
					 received under the PCCM contract. These records and books shall be maintained
					 on the accrual basis and in a uniform accounting system in accordance with
					 generally accepted accounting principles.
(g) A medical director as specified in
					 section 56246.
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 (f) 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
						  14088.2,
						  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 3 - OPERATIONAL REQUIREMENTS › Section 56210 - Scope of Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Each PCCM plan shall provide or arrange for the provision of the full scope of
					 Medi-Cal services set forth in Chapter 3, Article 4, beginning with section
					 51301, and in Chapter 11,
					 beginning with section
					 59998, unless services are
					 specifically excluded under the terms of the PCCM contract.
(b) A PCCM plan may elect to provide services
					 which are not included in section
					 14053,
					 Welfare and Institutions Code at no cost to members.
(c) A PCCM plan shall obtain the prior
					 written approval of the Department if any services are to be provided at a cost
					 to members. Departmental approval shall be based on compliance with State and
					 federal law and regulation and the terms of the PCCM contract. Each member
					 shall be notified of the scope of any non-Medi-Cal covered services offered by
					 the PCCM plan and a full disclosure of any charges:
(1) Prior to the signing of any membership
					 designation form.
(2) Any time the
					 scope of services is changed, and
(3) Immediately prior to rendering services
					 at a cost to members.
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 56212 - Availability of 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 3 - OPERATIONAL REQUIREMENTS › Section 56214 - Pharmaceutical Services and Prescribed Drugs. [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.