reglab/statecodes huggingface dataset:
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 51000.18 - Provider Identification Number or PIN

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Provider Identification Number or PIN" means the unique
						identification number assigned to a provider to:
(a) Submit electronic claims for
					 reimbursement.
(b) Verify a
					 beneficiary's eligibility.
(c)
					 Determine whether the beneficiary has met his/her share of cost, if
					 applicable.
(d) Complete a
					 Medi-Service reservation or reversal.
(e) Gain access to the provider
					 telecommunications network for check write or claim information, payment
					 history, or to verify procedure codes and rates of reimbursement.
1. New
						section filed 9-28-99 as an emergency; operative 9-28-99 (Register 99, No. 40).
						A Certificate of Compliance must be transmitted to OAL by 3-27-2000 or
						emergency language will be repealed by operation of law on the following day.
						Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
2. New section refiled 11-24-99 as an emergency; operative
						11-24-99 (Register 99, No. 48). A Certificate of Compliance must be transmitted
						to OAL by 5-22-2000 or emergency language will be repealed by operation of law
						on the following day. Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
3. New section refiled 5-5-2000 as an emergency; operative
						5-22-2000 (Register 2000, No. 18). A Certificate of Compliance must be
						transmitted to OAL by 9-19-2000 or emergency language will be repealed by
						operation of law on the following day.
4. New section refiled
						8-28-2000 as an emergency; operative 9-6-2000 (Register 2000, No. 35). A
						Certificate of Compliance must be transmitted to OAL by 1-4-2001 or emergency
						language will be repealed by operation of law on the following
						day.
5. Certificate of Compliance as to 8-28-2000 order, including
						amendment of subsection designators, transmitted to OAL 12-26-2000 and filed
						2-8-2001 (Register 2001, No. 6).
Note: Authority cited: Sections
						  10725
						  and
						  14124.5,
						  Welfare and Institutions Code; and Section
						  78, Chapter 146, Statutes of 1999.
						  Reference: Sections
						  14040
						  and
						  14124.5,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 1 - Application and Enrollment › Section 51000.19 - Provider

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Provider" shall have the same meaning as in Section
						51051.
1. New
						section filed 9-28-99 as an emergency; operative 9-28-99 (Register 99, No. 40).
						A Certificate of Compliance must be transmitted to OAL by 3-27-2000 or
						emergency language will be repealed by operation of law on the following day.
						Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
2. New section refiled 11-24-99 as an emergency; operative
						11-24-99 (Register 99, No. 48). A Certificate of Compliance must be transmitted
						to OAL by 5-22-2000 or emergency language will be repealed by operation of law
						on the following day. Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
3. New section refiled 5-5-2000 as an emergency; operative
						5-22-2000 (Register 2000, No. 18). A Certificate of Compliance must be
						transmitted to OAL by 9-19-2000 or emergency language will be repealed by
						operation of law on the following day.
4. New section refiled
						8-28-2000 as an emergency; operative 9-6-2000 (Register 2000, No. 35). A
						Certificate of Compliance must be transmitted to OAL by 1-4-2001 or emergency
						language will be repealed by operation of law on the following
						day.
5. Certificate of Compliance as to 8-28-2000 order transmitted
						to OAL 12-26-2000 and filed 2-8-2001 (Register 2001, No.
						6).
Note: Authority cited: Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code; and Section
						  78, Chapter 146, Statutes of 1999.
						  Reference: Sections
						  14043
						  and
						  14043.1,
						  Welfare and Institutions Code.
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 51000.20 - Provider Number

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Provider Number" means the unique identification number
						used by an applicant or provider to obtain reimbursement from the Medi-Cal
						program. For purposes of substance use disorder clinics, the term "provider
						number" shall mean the national provider identifier (NPI)
						number.
1. New
						section filed 9-28-99 as an emergency; operative 9-28-99 (Register 99, No. 40).
						A Certificate of Compliance must be transmitted to OAL by 3-27-2000 or
						emergency language will be repealed by operation of law on the following day.
						Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
2. New section refiled 11-24-99 as an emergency; operative
						11-24-99 (Register 99, No. 48). A Certificate of Compliance must be transmitted
						to OAL by 5-22-2000 or emergency language will be repealed by operation of law
						on the following day. Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
3. New section refiled 5-5-2000 as an emergency; operative
						5-22-2000 (Register 2000, No. 18). A Certificate of Compliance must be
						transmitted to OAL by 9-19-2000 or emergency language will be repealed by
						operation of law on the following day.
4. New section refiled
						8-28-2000 as an emergency; operative 9-6-2000 (Register 2000, No. 35). A
						Certificate of Compliance must be transmitted to OAL by 1-4-2001 or emergency
						language will be repealed by operation of law on the following
						day.
5. Certificate of Compliance as to 8-28-2000 order transmitted
						to OAL 12-26-2000 and filed 2-8-2001 (Register 2001, No. 6).
6.
						Change without regulatory effect amending section and NOTE filed 1-23-2009
						pursuant to section
						100, title 1, California Code of
						Regulations (Register 2009, No. 4).
7. Amendment of section and NOTE
						filed 8-17-2015 as a deemed emergency exempt from OAL review pursuant to
						Welfare and Institutions Code section
						14043.75;
						operative 8-17-2015 (Register
						2015,
						No. 34). A Certificate of Compliance must be transmitted to OAL by 2-16-2016 or
						emergency language will be repealed by operation of law on the following
						day.
8. Certificate of Compliance as to 8-17-2015 order transmitted
						to OAL 12-30-2015 and filed 2-11-2016 (Register 2016, No.
						7).
Note: Authority cited: Section
						  20, Health and Safety Code;
						  Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14043.26
						  and
						  14043.45,
						  Welfare and Institutions Code.
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 51000.20.1 - Provider Transferor

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 "Provider Transferor" means a provider that joins a transferee applicant to its
					 Medi-Cal provider agreement, including its rights to use the provider number
					 for that location when any of the following events occur;
(1) A change of ownership as defined in
					 Section 51000.6.
(2) A sale or transfer of 50 percent or more
					 of the assets owned by the corporation at the location for which a provider
					 number was issued.
(3) A cumulative
					 change in the person(s) with an ownership or control interest of 50 percent or
					 more since the information provided in the last complete application package
					 that was approved for enrollment.
(4) When a new Taxpayer Identification Number
					 is issued by the Internal Revenue Service (IRS).
(5) When the Board of Pharmacy requires a new
					 site permit, pursuant to Chapter 9 (commencing with Section
					 4000) Division 2 of the Business
					 and Professions Code.
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 51000.20.9 - Rendering Practitioner. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 9-29-2004 as an emergency; operative 10-7-2004 (Register 2004,
						No. 41). A Certificate of Compliance must be transmitted to OAL by 2-4-2005 or
						emergency language will be repealed by operation of law on the following day.
						Deemed emergency exempt from OAL pursuant to Welfare and Institutions Code
						section
						14043.75.
2.
						New section refiled 1-27-2005 as an emergency; operative 2-5-2005 (Register
						2005, No. 4). A Certificate of Compliance must be transmitted to OAL by
						6-6-2005 or emergency language will be repealed by operation of law on the
						following day. Deemed emergency exempt from OAL review pursuant to Welfare and
						Institutions Code section
						14043.75.
3.
						New section refiled 6-2-2005 as an emergency; operative 6-7-2005 (Register
						2005, No. 22). A Certificate of Compliance must be transmitted to OAL by
						10-5-2005 or emergency language will be repealed by operation of law on the
						following day. Deemed emergency exempt from OAL review pursuant to Welfare and
						Institutions Code section
						14043.75.
4.
						Certificate of Compliance as to 6-2-2005 order, including repealer of section,
						transmitted to OAL 9-29-2005 and filed 11-10-2005 (Register 2005, No.
						45).
Note: Authority cited: Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  2505,
						  2746,
						  2834
						  and
						  3500,
						  Business and Professions Code; Section
						  100185.5,
						  Health and Safety Code; and Sections
						  14043.1,
						  14043.26
						  and
						  14043.47,
						  Welfare and Institutions Code.
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 51000.21 - Rendering Provider

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Rendering provider" means an individual provider who
						renders healthcare services, or provides goods, supplies, or merchandise, as a
						member of a provider group and uses the group provider number to bill the
						Medi-Cal program.
1. New
						section filed 9-28-99 as an emergency; operative 9-28-99 (Register 99, No. 40).
						A Certificate of Compliance must be transmitted to OAL by 3-27-2000 or
						emergency language will be repealed by operation of law on the following day.
						Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
2. New section refiled 11-24-99 as an emergency; operative
						11-24-99 (Register 99, No. 48). A Certificate of Compliance must be transmitted
						to OAL by 5-22-2000 or emergency language will be repealed by operation of law
						on the following day. Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
3. New section refiled 5-5-2000 as an emergency; operative
						5-22-2000 (Register 2000, No. 18). A Certificate of Compliance must be
						transmitted to OAL by 9-19-2000 or emergency language will be repealed by
						operation of law on the following day.
4. New section refiled
						8-28-2000 as an emergency; operative 9-6-2000 (Register 2000, No. 35). A
						Certificate of Compliance must be transmitted to OAL by 1-4-2001 or emergency
						language will be repealed by operation of law on the following
						day.
5. Certificate of Compliance as to 8-28-2000 order transmitted
						to OAL 12-26-2000 and filed 2-8-2001 (Register 2001, No.
						6).
Note: Authority cited: Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code; and Section
						  78, Chapter 146, Statutes of 1999.
						  Reference: Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 1 - Application and Enrollment › Section 51000.22 - Rendering Provider Number

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Rendering provider number" means the unique
						identification number assigned to a rendering provider to identify the
						rendering provider on claims submitted by a provider group under a group
						provider number.
1. New
						section filed 9-28-99 as an emergency; operative 9-28-99 (Register 99, No. 40).
						A Certificate of Compliance must be transmitted to OAL by 3-27-2000 or
						emergency language will be repealed by operation of law on the following day.
						Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
2. New section refiled 11-24-99 as an emergency; operative
						11-24-99 (Register 99, No. 48). A Certificate of Compliance must be transmitted
						to OAL by 5-22-2000 or emergency language will be repealed by operation of law
						on the following day. Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
3. New section refiled 5-5-2000 as an emergency; operative
						5-22-2000 (Register 2000, No. 18). A Certificate of Compliance must be
						transmitted to OAL by 9-19-2000 or emergency language will be repealed by
						operation of law on the following day.
4. New section refiled
						8-28-2000 as an emergency; operative 9-6-2000 (Register 2000, No. 35). A
						Certificate of Compliance must be transmitted to OAL by 1-4-2001 or emergency
						language will be repealed by operation of law on the following
						day.
5. Certificate of Compliance as to 8-28-2000 order, including
						amendment of NOTE, transmitted to OAL 12-26-2000 and filed 2-8-2001 (Register
						2001, No. 6).
Note: Authority cited: Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code; and Section
						  78, Chapter 146, Statutes of 1999.
						  Reference: Section
						  14043.45,
						  Welfare and Institutions Code.
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 51000.23 - Significant Business Transaction

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Significant business transaction" means any business
						transaction or series of transactions that involve health care services, goods,
						supplies, or merchandise related to the provision of services to Medi-Cal
						beneficiaries that, during any one fiscal year, exceed the lesser of $25,000 or
						5 percent of an applicant's or provider's total operating
						expenses.
1. New
						section filed 9-28-99 as an emergency; operative 9-28-99 (Register 99, No. 40).
						A Certificate of Compliance must be transmitted to OAL by 3-27-2000 or
						emergency language will be repealed by operation of law on the following day.
						Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
2. New section refiled 11-24-99 as an emergency; operative
						11-24-99 (Register 99, No. 48). A Certificate of Compliance must be transmitted
						to OAL by 5-22-2000 or emergency language will be repealed by operation of law
						on the following day. Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
3. New section refiled 5-5-2000 as an emergency; operative
						5-22-2000 (Register 2000, No. 18). A Certificate of Compliance must be
						transmitted to OAL by 9-19-2000 or emergency language will be repealed by
						operation of law on the following day.
4. New section refiled
						8-28-2000 as an emergency; operative 9-6-2000 (Register 2000, No. 35). A
						Certificate of Compliance must be transmitted to OAL by 1-4-2001 or emergency
						language will be repealed by operation of law on the following
						day.
5. Certificate of Compliance as to 8-28-2000 order, including
						amendment of section, transmitted to OAL 12-26-2000 and filed 2-8-2001
						(Register 2001, No. 6).
Note: Authority cited: Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code; and Section
						  78, Chapter 146, Statutes of 1999.
						  Reference: Section
						  14043.2,
						  Welfare and Institutions Code; 42, U.S.C., Sections
						  1320 a-3, 1320a-7, 1396a(a)(38),
						  1396b(i)(2); and 42, Code of Federal Regulations, Part
						  455.
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 51000.24 - Subcontractor

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Subcontractor" means an individual, agency, or
						organization:
(a) To which an
					 applicant or provider has contracted or delegated some of its management
					 functions or responsibilities of providing healthcare services, equipment or
					 supplies to its patients.
(b) With
					 whom an applicant or provider has entered into a contract, agreement, purchase
					 order, lease, or leases of real property, to obtain space, supplies, equipment,
					 or services provided under the Medi-Cal Program.
1. New
						section filed 9-28-99 as an emergency; operative 9-28-99 (Register 99, No. 40).
						A Certificate of Compliance must be transmitted to OAL by 3-27-2000 or
						emergency language will be repealed by operation of law on the following day.
						Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
2. New section refiled 11-24-99 as an emergency; operative
						11-24-99 (Register 99, No. 48). A Certificate of Compliance must be transmitted
						to OAL by 5-22-2000 or emergency language will be repealed by operation of law
						on the following day. Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
3. New section refiled 5-5-2000 as an emergency; operative
						5-22-2000 (Register 2000, No. 18). A Certificate of Compliance must be
						transmitted to OAL by 9-19-2000 or emergency language will be repealed by
						operation of law on the following day.
4. New section refiled
						8-28-2000 as an emergency; operative 9-6-2000 (Register 2000, No. 35). A
						Certificate of Compliance must be transmitted to OAL by 1-4-2001 or emergency
						language will be repealed by operation of law on the following
						day.
5. Certificate of Compliance as to 8-28-2000 order transmitted
						to OAL 12-26-2000 and filed 2-8-2001 (Register 2001, No.
						6).
Note: Authority cited: Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code; and Section
						  78, Chapter 146, Statutes of 1999.
						  Reference: Section
						  14043.2,
						  Welfare and Institutions Code; 42, U.S.C., Sections
						  1320 a-3, 1320a-7, 1396a(a)(38),
						  1396b(i)(2); and 42, Code of Federal Regulations, Part
						  455.
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 51000.24.1 - Successor Liability with Joint and Several Liability

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Successor Liability with Joint and Several Liability"
						means a provider transferor joins a transferee applicant to its Medi-Cal
						provider agreement, including its rights to use the provider number issued for
						that location.
1. New
						section filed 11-10-2005; operative 11-10-2005 pursuant to Government Code
						section
						11343.4
						(Register
						2005,
						No. 45).
2. Change without regulatory effect amending section and
						NOTE filed 1-23-2009 pursuant to section
						100, title 1, California Code of
						Regulations (Register 2009, No. 4).
Note: Authority cited: Section
						  20, Health and Safety Code; and
						  Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14043.25,
						  14043.26
						  and
						  14043.45,
						  Welfare and Institutions Code; and 42 Code of Federal Regulations, Part
						  489.
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 51000.24.3 - Substance Use Disorder Clinic

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Substance Use Disorder Clinic" means a location that
						provides substance use disorder treatment services pursuant to Article 3.2, of
						Chapter 7, Part 3, Division 9, of the Welfare and Institutions Code. A
						substance use disorder clinic includes perinatal residential substance use
						disorder services programs.
1. New
						section filed 8-17-2015 as a deemed emergency exempt from OAL review pursuant
						to Welfare and Institutions Code section
						14043.75;
						operative 8-17-2015 (Register
						2015,
						No. 34). A Certificate of Compliance must be transmitted to OAL by 2-16-2016 or
						emergency language will be repealed by operation of law on the following
						day.
2. Certificate of Compliance as to 8-17-2015 order transmitted
						to OAL 12-30-2015 and filed 2-11-2016 (Register 2016, No.
						7).
Note: Authority cited: Section
						  20, Health and Safety Code;
						  Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14021,
						  14021.3,
						  14021.5,
						  14021.6,
						  14021.33,
						  14043.7,
						  14053,
						  14107,
						  14124.1,
						  14124.2,
						  14124.24,
						  14124.25,
						  14131,
						  14132.21,
						  14132.905,
						  14133
						  and
						  14133.1,
						  Welfare and Institutions Code.
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 51000.24.4 - Substance Use Disorder Medical Director

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Substance Use Disorder Medical Director" means a
						physician who is licensed by the Medical Board of California or the Osteopathic
						Medical Board of California and who meets requirements set forth in Sections
						51000.70 and
						51341.1(b)(28).
1. New
						section filed 8-17-2015 as a deemed emergency exempt from OAL review pursuant
						to Welfare and Institutions Code section
						14043.75;
						operative 8-17-2015 (Register
						2015,
						No. 34). A Certificate of Compliance must be transmitted to OAL by 2-16-2016 or
						emergency language will be repealed by operation of law on the following
						day.
2. Certificate of Compliance as to 8-17-2015 order transmitted
						to OAL 12-30-2015 and filed 2-11-2016 (Register 2016, No.
						7).
Note: Authority cited: Section
						  20, Health and Safety Code;
						  Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14021,
						  14021.3,
						  14021.5,
						  14021.6,
						  14021.33,
						  14021.51,
						  14043.7,
						  14107,
						  14124.1,
						  14124.2,
						  14124.24,
						  14124.25,
						  14131,
						  14133
						  and
						  14133.1,
						  Welfare and Institutions Code.
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 51000.24.4.1 - Substance Use Disorder Nonphysician Medical Practitioner

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Substance use disorder nonphysician medical
						practitioner" means an individual that provides medically necessary, clinical
						services prescribed for beneficiaries admitted, registered, or accepted for
						care by the substance use disorder clinic and is either:
(a) A registered nurse practitioner;
					 or
(b) A physician
					 assistant.
1. New
						section filed 8-17-2015 as a deemed emergency exempt from OAL review pursuant
						to Welfare and Institutions Code section
						14043.75;
						operative 8-17-2015 (Register
						2015,
						No. 34). A Certificate of Compliance must be transmitted to OAL by 2-16-2016 or
						emergency language will be repealed by operation of law on the following
						day.
2. Certificate of Compliance as to 8-17-2015 order transmitted
						to OAL 12-30-2015 and filed 2-11-2016 (Register 2016, No.
						7).
Note: Authority cited: Section
						  20, Health and Safety Code;
						  Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14021,
						  14021.3,
						  14021.5,
						  14021.6,
						  14021.33,
						  14021.51,
						  14043.7,
						  14107,
						  14124.1,
						  14124.2,
						  14124.24,
						  14124.25,
						  14131,
						  14133
						  and
						  14133.1,
						  Welfare and Institutions Code.
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 51000.24.5 - Substance Use Disorder Treatment Professional

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Substance Use Disorder Treatment Professional" means an
						individual that provides clinical services prescribed for beneficiaries
						admitted, registered, or accepted for care by the substance use disorder clinic
						and is either:
(a) An intern
					 registered with the California Board of Behavioral Sciences or with the Board
					 of Psychology; or
(b) An alcohol
					 and other drug (AOD) counselor that is registered or certified pursuant to
					 California Code of Regulations, Title 9, Section
					 13035.
1. New
						section filed 8-17-2015 as a deemed emergency exempt from OAL review pursuant
						to Welfare and Institutions Code section
						14043.75;
						operative 8-17-2015 (Register
						2015,
						No. 34). A Certificate of Compliance must be transmitted to OAL by 2-16-2016 or
						emergency language will be repealed by operation of law on the following
						day.
2. Certificate of Compliance as to 8-17-2015 order transmitted
						to OAL 12-30-2015 and filed 2-11-2016 (Register 2016, No.
						7).
Note: Authority cited: Section
						  20, Health and Safety Code;
						  Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14021,
						  14021.3,
						  14021.5,
						  14021.6,
						  14021.33,
						  14021.51,
						  14043.7,
						  14107,
						  14124.1,
						  14124.2,
						  14124.24,
						  14124.25,
						  14131,
						  14133
						  and
						  14133.1,
						  Welfare and Institutions Code.
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 51000.24.8 - Substance Use Disorder Treatment Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Substance Use Disorder Treatment Services" means
						reimbursable services provided to beneficiaries pursuant to Section
						51341.1.
1. New
						section filed 8-17-2015 as a deemed emergency exempt from OAL review pursuant
						to Welfare and Institutions Code section
						14043.75;
						operative 8-17-2015 (Register
						2015,
						No. 34). A Certificate of Compliance must be transmitted to OAL by 2-16-2016 or
						emergency language will be repealed by operation of law on the following
						day.
2. Certificate of Compliance as to 8-17-2015 order transmitted
						to OAL 12-30-2015 and filed 2-11-2016 (Register 2016, No.
						7).
Note: Authority cited: Section
						  20, Health and Safety Code;
						  Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14021,
						  14021.3,
						  14021.5,
						  14021.6,
						  14021.33,
						  14043.7,
						  14053,
						  14107,
						  14124.1,
						  14124.2,
						  14124.24,
						  14124.25,
						  14131,
						  14132.21,
						  14132.905,
						  14133
						  and
						  14133.1,
						  Welfare and Institutions Code.
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 51000.25 - Supplier

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Supplier" means any manufacturer, principal labeler,
						wholesaler and any other primary supplier from which an applicant or provider
						purchases services, goods, supplies, or merchandise, used in carrying out its
						responsibilities under Medi-Cal.
1. New
						section filed 9-28-99 as an emergency; operative 9-28-99 (Register 99, No. 40).
						A Certificate of Compliance must be transmitted to OAL by 3-27-2000 or
						emergency language will be repealed by operation of law on the following day.
						Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
2. New section refiled 11-24-99 as an emergency; operative
						11-24-99 (Register 99, No. 48). A Certificate of Compliance must be transmitted
						to OAL by 5-22-2000 or emergency language will be repealed by operation of law
						on the following day. Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
3. New section refiled 5-5-2000 as an emergency; operative
						5-22-2000 (Register 2000, No. 18). A Certificate of Compliance must be
						transmitted to OAL by 9-19-2000 or emergency language will be repealed by
						operation of law on the following day.
4. New section refiled
						8-28-2000 as an emergency; operative 9-6-2000 (Register 2000, No. 35). A
						Certificate of Compliance must be transmitted to OAL by 1-4-2001 or emergency
						language will be repealed by operation of law on the following
						day.
5. Certificate of Compliance as to 8-28-2000 order transmitted
						to OAL 12-26-2000 and filed 2-8-2001 (Register 2001, No.
						6).
Note: Authority cited: Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code; and Section
						  78, Chapter 146, Statutes of 1999.
						  Reference: Section
						  14043.2,
						  Welfare and Institutions Code; 42, U.S.C., Sections
						  1320 a-3, 1320a-7, 1396a(a)(38),
						  1396b(i)(2); and 42, Code of Federal Regulations, Part
						  455.
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 51000.25.1 - Suspend

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Suspend" includes a deactivation, and means health care
						services, goods, supplies, or merchandise provided, directly or indirectly, to
						a Medi-Cal beneficiary shall not be reimbursed under the Medi-Cal program until
						the provider is reinstated by the Department.
1. New
						section filed 11-10-2005; operative 11-10-2005 pursuant to Government Code
						section
						11343.4
						(Register 2005, No. 45).
Note: Authority cited: Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14043.2,
						  14043.36,
						  14043.37
						  and
						  14043.7,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 1 - Application and Enrollment › Section 51000.25.2 - Transferee Applicant

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 "Transferee Applicant" means an individual or entity that joins a provider
					 transferors' Medi-Cal provider agreement including the use of the provider
					 number issued for that location when any of the following events occur:
(1) A change of ownership as defined in
					 Section 51000.6.
(2) A sale or transfer of 50 percent or more
					 of the assets owned by the corporation at the location for which a provider
					 number was issued.
(3) A cumulative
					 change in the person(s) with an ownership or control interest of 50 percent or
					 more since the information provided in the last complete application package
					 that was approved for enrollment.
(4) When a new Taxpayer Identification Number
					 is issued by the Internal Revenue Service (IRS).
(5) When the Board of Pharmacy requires a new
					 site permit, pursuant to Chapter 9 (commencing with Section
					 4000) Division 2 of the Business
					 and Professions Code.
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 51000.26 - Wholly Owned Supplier

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Wholly owned supplier" means a supplier whose total
						ownership interest is held by an applicant or provider or by a person, persons,
						or other entity with an ownership or control interest in an applicant or
						provider.
1. New
						section filed 9-28-99 as an emergency; operative 9-28-99 (Register 99, No. 40).
						A Certificate of Compliance must be transmitted to OAL by 3-27-2000 or
						emergency language will be repealed by operation of law on the following day.
						Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
2. New section refiled 11-24-99 as an emergency; operative
						11-24-99 (Register 99, No. 48). A Certificate of Compliance must be transmitted
						to OAL by 5-22-2000 or emergency language will be repealed by operation of law
						on the following day. Submitted to OAL for printing only pursuant to section
						78, AB 1107 (Chapter 146, Statutes
						of 1999).
3. New section refiled 5-5-2000 as an emergency; operative
						5-22-2000 (Register 2000, No. 18). A Certificate of Compliance must be
						transmitted to OAL by 9-19-2000 or emergency language will be repealed by
						operation of law on the following day.
4. New section refiled
						8-28-2000 as an emergency; operative 9-6-2000 (Register 2000, No. 35). A
						Certificate of Compliance must be transmitted to OAL by 1-4-2001 or emergency
						language will be repealed by operation of law on the following
						day.
5. Certificate of Compliance as to 8-28-2000 order transmitted
						to OAL 12-26-2000 and filed 2-8-2001 (Register 2001, No.
						6).
Note: Authority cited: Sections
						  10725,
						  14043.75
						  and
						  14124.5,
						  Welfare and Institutions Code; and Section
						  78, Chapter 146, Statutes of 1999.
						  Reference: Section
						  14043.2,
						  Welfare and Institutions Code; 42, U.S.C., Sections
						  1320 a-3, 1320a-7, 1396a(a)(38),
						  1396b(i)(2); and 42, Code of Federal Regulations, Part
						  455.
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 51000.30 - Medi-Cal Provider Application for Enrollment, Continued Enrollment, or Enrollment at a New, Additional, or Change in Location

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) As a condition for enrollment, continued
					 enrollment, or enrollment at a new, additional, or change in location, an
					 applicant or provider shall meet the Standards of Participation specified in
					 Chapter 7 (commencing with Section
					 14000) and Chapter 8 (commencing
					 with Section
					 14200) of Part 3 of Division 9 of
					 the Welfare and Institutions Code, and Division 3, Title 22, California Code of
					 Regulations, and either:
(1) Be certified by
					 the Department to participate in the Medi-Cal program and be a:
(A) Clinic licensed by the Department
					 pursuant to Chapter 1 (commencing with Section
					 1200) of Division 2 of the Health
					 and Safety Code, including a clinic, operated by a licensed clinic, that is
					 exempt from licensure pursuant to Section
					 1206(h)
					 of the Health and Safety Code; or
(B) Health facility licensed by the
					 Department pursuant to Chapter 2 (commencing with Section
					 1250) of Division 2 of the Health
					 and Safety Code; or
(C) Adult day
					 health care provider licensed pursuant to Chapter 3.3 (commencing with Section
					 1570) of Division 2 of the Health
					 and Safety Code; or
(D) Home health
					 agency licensed pursuant to Chapter 8 (commencing with Section
					 1725) of Division 2 of the Health
					 and Safety Code; or
(E) Hospice
					 licensed pursuant to Chapter 8.5 (commencing with Section
					 1745) of Division 2 of the Health
					 and Safety Code; or
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 51000.31 - Medi-Cal Provider Group or Rendering Provider Application for Enrollment, Continued Enrollment or Enrollment at a New, Additional or Change in Location

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
					 provider group applicant or provider group shall;
(1) Submit a provider group application
					 package pursuant to Section
					 51000.30(a) through
					 (b) that lists all rendering providers at the
					 business address for which the application package is submitted.
(2) Cease using the provider group number to
					 submit claims whenever the deletion of one or more rendering provider results
					 in less than two remaining rendering providers.
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 51000.32 - Requirements for Successor Liability with Joint and Several Liability

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A provider
					 transferor may elect successor liability with joint and several liability by
					 meeting both of the following conditions:
(1)
					 By letter postmarked no later than five days after the occurrence of any event
					 listed in Section
					 51000.30(b), the
					 provider transferor and the transferee applicant shall submit to the Department
					 the "Successor Liability with Joint and Several Liability Agreement," DHS 6217
					 (11/05), signed and dated by both, which includes the following information:
(A) The legal name of provider transferor
					 which shall be the name currently on file with the Internal Revenue Service
					 (IRS).
(B) Current provider number
					 for the location affected.
(C)
					 Fictitious business name of the provider transferor, if applicable.
(D) The legal name of transferee applicant
					 which shall be the name currently on file with the Internal Revenue Service
					 (IRS).
(E) Current provider
					 number(s) of transferee applicant, if applicable.
(F) Fictitious business name of the
					 transferee applicant, if applicable.
(G) A statement signed and dated by both the
					 provider transferor and the transferee applicant wherein they accept joint and
					 several liability for all debts arising from the Medi-Cal provider agreement
					 applicable to the location for which a provider number was issued by the
					 Department.
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 51000.35 - Disclosure Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 The applicant or provider shall disclose all the information required by 42,
					 Code of Federal Regulations, Sections
					 455.104,
					 455.105 and
					 455.106, on the following forms
					 incorporated by reference herein, using whichever form is applicable, and shall
					 submit the disclosure statement with the application required by Sections
					 51000.30 and
					 51000.40:
(1) "Medi-Cal Disclosure Statement," DHCS
					 6207 (Rev. 2/15); or
(2) "Medi-Cal
					 Rendering Provider Application/Disclosure Statement/Agreement for
					 Physician/Allied/Dental Providers," DHCS 6216 (Rev. 2/15); or
(3) "Drug Medi-Cal Substance Use Disorder
					 Medical Director/Licensed Substance Use Disorder Treatment
					 Professional/Nonphysician Medical Practitioner Application/Agreement/
					 Disclosure Statement," DHCS 6010 (Rev. 12/14).
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 51000.40 - Reporting of Additional or Changed Information to Provider Applications

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A provider,
					 including a provider group, shall report to the Department within 35 days of
					 any addition or change in the information previously submitted in the
					 application package.
(b) A
					 provider, including a provider group, shall complete the form "Medi-Cal
					 Supplemental Changes," DHCS 6209 (Rev. 12/14), incorporated by reference
					 herein, to add or change the following information, or to request the following
					 actions:
(1) "Pay to", unless the provider is
					 a substance use disorder clinic, or "mailing" address.
(2) Business telephone number.
(3) Managing employee.
(4) Pharmacist-in-charge, if the provider is
					 a pharmacy.
(5) Medicare billing
					 number.
(6) Business activities, if
					 the provider currently provides durable medical equipment and/or incontinence
					 medical supplies and:
(A) The change requires
					 the issuance of a new license, permit, or certificate; or
(B) The provider is adding or deleting
					 incontinence medical supplies.
(7) Name under which the provider or provider
					 group is doing business (DBA).
(8)
					 CLIA number.
(9) Deactivation of a
					 provider number.
(10) Re-issuance
					 of a Provider Identification Number (PIN), unless the provider is a substance
					 use disorder clinic.
(11) For
					 provider of medical transportation services:
(A) Vehicle or aircraft
					 information.
(B) Driver or pilot
					 information, or the addition of information on a new driver or pilot.
(C) The days and/or hours of operation of the
					 applicant's or provider's business.
(D) The geographic area(s)
					 served.
(12) A change of
					 less than 50 percent in the person(s) with an ownership or control interest, as
					 defined in Section
					 51000.15, of the provider, or
					 provider group that does not result in a new Taxpayer Identification Number
					 being issued by the IRS. Any cumulative change of 50 percent or more in the
					 person(s) with an ownership or control interest, since the information provided
					 in the last complete application package was approved for enrollment, requires
					 a new application required pursuant to Section
					 51000.30(b)(6).
(13) Specialty Code.
(14) For a substance use disorder clinic the
					 following additional actions:
(A) A change of
					 the substance use disorder medical director or physicians making medical
					 necessity determinations for beneficiaries.
(B) Deletion or addition of service
					 modalities.
(C) A change of any
					 substance use disorder treatment professional or licensed substance use
					 disorder treatment professional providing counseling
					 services.
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 51000.51 - Provisional Provider and Preferred Provisional Provider Status

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Department
					 shall grant provisional provider status for a period of 12 months, or preferred
					 provisional status for a period of 18 months, subject to the provisions of
					 Welfare and Institutions Code Sections
					 14043.26
					 through
					 14043.29,
					 when:
(1) An application for enrollment of a
					 new provider is approved.
(2) An
					 application for continued enrollment of a provider is approved.
(3) An application for enrollment of an
					 additional location, or change of location for a provider is
					 approved.
(4) An application for
					 any change pursuant to Section
					 51000.30(b) is
					 approved.
(5) The Department fails
					 to take any action listed in Section
					 51000.50(e)
					 within 180 days after receiving an application package. The applicant or
					 provider shall be granted provisional provider status, effective on the 181st
					 day.