California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 4 - Scope and Duration of Benefits › Section 51328 - Outpatient Heroin Detoxification Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Routine elective heroin detoxification
					 services are covered, subject to prior authorization, only as an outpatient
					 service. Outpatient services are limited to a maximum period of 21 days.
					 Inpatient hospital services shall be limited to patients with serious medical
					 complications of addiction or to patients with associated medical problems
					 which require inpatient treatment. Hospital admission is subject to the
					 provisions of 51327 (a).
(b) A new
					 course of outpatient heroin detoxification treatment shall not be covered until
					 at least 28 days have elapsed since the completion of an immediately preceding
					 course of treatment. New courses of outpatient heroin detoxification treatment
					 by the same provider which are started in the period between the 29th through
					 the 90th days following completion of an immediately preceding course of
					 treatment shall be reimbursed at the rates listed under Section
					 51533(a) (2) and
					 (3). The daily rate listed under Section
					 51533(a) (1)
					 shall not be billed by the same provider or separately by a physician employee
					 of that provider until 90 days have elapsed. The patient may be considered a
					 new patient for reimbursement purposes after 90 days following the completion
					 of the immediately preceding course of heroin detoxification.
(c) The patient may be considered a new
					 patient for reimbursement purposes by a new provider for heroin detoxification
					 services started in the period between the 29th through the 90th days following
					 completion of an immediately preceding course of heroin detoxification services
					 only if the fact of the preceding course is denied or misrepresented by the
					 patient. Otherwise reimbursement shall be according to Section (b).
1. New
						section filed 6-23-77; effective thirtieth day thereafter (Register 77, No.
						26).
2. Amendment of subsection (a) filed 9-1-82 as an emergency;
						effective upon filing (Register 82, No. 37). A Certificate of Compliance must
						be transmitted to OAL within 120 days or emergency language will be repealed on
						12-30-82.
3. Certificate of Compliance transmitted to OAL 12-28-82
						and withdrawn 1-27-83 (Register 83, No. 5).
4. Amendment of
						subsection (a) refiled 1-27-83 as an emergency; effective upon filing (Register
						83, No. 5). A Certificate of Compliance must be transmitted to OAL within 120
						days or emergency language will be repealed on 5-27-83.
5.
						Certificate of Compliance transmitted to OAL 5-26-83 and filed 6-30-83
						(Register 83, No. 27).
6. Change without regulatory effect of NOTE
						(Register 86, No. 49).
Note: Authority cited: Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code; and Section
						  57(c), Chapter
						  328, Statutes of 1982. Reference: Sections
						  14131,
						  14132,
						  14133
						  and
						  14133.25,
						  Welfare and Institutions Code.