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 1 - Application and Enrollment › Section 51000.60 - Established Place of Business Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The applicant or provider shall have an
					 established place of business appropriate and adequate for the services billed
					 or claimed to the Medi-Cal program as relevant to his or her scope of practice
					 or type of business. This section does not apply to an applicant or provider
					 who is subject to Section
					 51000.30(a)(1)(A) -
					 (E).
(b) Failure to have an established place of
					 business at the time of any inspection by the Department for enrollment,
					 continued enrollment, enrollment at a new, additional or change in location, or
					 enrollment pursuant to Section
					 51000.30(b)
					 warrants denial of an application or shall make a provider subject to temporary
					 suspension from the Medi-Cal program, which shall include temporary
					 deactivation of the provider's number and each business address used by the
					 provider to provide services, goods, supplies, or merchandise to Medi-Cal
					 beneficiaries, effective 15 days from the date of notice to the
					 provider.
(c) "Established place of
					 business" means a business address of the provider or applicant that meets all
					 of the following criteria:
(1) Is open and
					 conducting business at the time the application is submitted for participation
					 in the Medi-Cal program;
(2) Has
					 the administrative and fiscal foundation to survive as a going concern. This
					 criterion shall be shown by financial records such as a business plan, bank
					 statements, loan documents, promissory notes, invoices, accounts receivable,
					 business tax records, payroll records and contractual agreements;
(3) Has adequate inventory and staff to meet
					 current and anticipated sales and service requirements for its
					 business;
(4) Operates in
					 compliance with Section
					 51000.30(e);
(5) Has Worker's Compensation insurance as
					 required by state law;
(6) Obtains
					 and maintains, for any individual licensed or certified pursuant to Division 2
					 (commencing with Section
					 500) of the Business and
					 Professions Code, the Osteopathic Initiative Act, or the Chiropractic
					 Initiative Act, Professional Liability insurance coverage in an amount not less
					 than $100,000 per claim, with a minimum annual aggregate of not less than
					 $300,000, from an authorized insurer pursuant to Section
					 700 of the
					 Insurance Code;
(7) Has the
					 necessary equipment, office supplies and facilities available to carry out its
					 business, including storage and retrieval of all documentation as required by
					 Section 51476;
(8) Has the necessary service agreements to
					 process cash and credit card transactions if operating as a retail business, or
					 has the necessary payment mechanisms to process patient billing claims if the
					 applicant or provider is a physician/medical practice; and
(9) Unless the applicant is requesting
					 enrollment or the provider is enrolled pursuant to Welfare and Institutions
					 Code Section
					 14043.15(b)(2)
					 the following criteria also apply;
(A) Is
					 located in a building either owned by the applicant or provider, or the
					 applicant or provider has obtained a signed lease agreement; or if the
					 applicant or provider is a substance use disorder clinic located on space
					 donated at no cost, the applicant or provider has obtained verification from
					 the space owner that it is authorized to use the space to provide substance use
					 disorder services.
(B) Has regular
					 and permanently posted business hours, unless the applicant or provider is a
					 substance use disorder clinic;
(C)
					 Is identifiable as a medical/healthcare provider or business, by permanently
					 attached signage that identifies the name of the provider or business as shown
					 on the application, unless the applicant or provider is a substance use
					 disorder clinic.
(D) Obtains and
					 maintains Liability insurance coverage, that covers premises and operation, in
					 an amount not less than $100,000 per claim, with a minimum annual aggregate of
					 not less than $300,000, from an authorized insurer pursuant to Section
					 700 of the
					 Insurance Code.