California Code of Regulations › Title 9 - Rehabilitative and Developmental Services › Division 1 - Department of Mental Health › Chapter 11 - Medi-Cal Specialty Mental Health Services › Subchapter 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services › Article 1 - Fiscal Provisions › Section 1830.105 - Provider Rate Setting Standards and Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Except as
					 approved by the Department pursuant to Section
					 1810.438, the MHP shall reimburse
					 organizational providers that provide services to beneficiaries of the MHP in
					 accordance with Section
					 1840.105.
(b) The MHP shall reimburse individual and group
					 providers that contract with the MHP in accordance with the terms of the
					 contract.
(c) The MHP shall reimburse
					 individual or group providers that provide services to beneficiaries of the MHP and
					 that do not have a contract with the MHP at the rates established by the Medi-Cal
					 program in Title 22, Division 3, Subdivision
					 1, Chapter 3, Article 7, unless a
					 different rate is agreed to between the MHP and the provider, except as provided in
					 Subsection (d).
(d) The MHP shall
					 reimburse individual or group providers that provide psychiatric inpatient hospital
					 professional services to a beneficiary of the MHP with an emergency medical
					 condition and that do not have a contract with the MHP at the rates established by
					 the Medi-Cal program in Title 22, Division 3, Subdivision
					 1, Chapter 3, Article 7.
(e) Individual and group providers shall bill the
					 MHP the provider's usual and customary charges for the specialty mental health
					 service rendered to the beneficiary. The rate paid by the MHP to individual and
					 group providers less third party liability and beneficiary share of cost shall be
					 considered payment in full for the specialty mental health services provided to the
					 beneficiary.
(f) Organizational
					 providers shall bill the MHP in accordance with the cost settlement requirements
					 described in Section
					 1840.105 that apply to the
					 provider.
(g) The MHP shall not be
					 responsible to reimburse providers who deliver Medicare covered services to a
					 beneficiary for any Medicare coinsurance and deductible payments due to the provider
					 from the Medi-Cal program pursuant to Title 42, United States Code, Section
					 1396 a(a)(n), unless the provider is an
					 organizational provider contracting with or otherwise authorized by the MHP of the
					 beneficiary.
1. New article
						1 (sections 1830.105-1830.115) and section filed
						10-31-97 as an emergency; operative 11-1-97 (Register 97, No. 44). A Certificate of
						Compliance must be transmitted to OAL by 3-2-98 or emergency language will be
						repealed by operation of law on the following day.
2. New article 1
						(sections 1830.105-1830.115) and section refiled
						3-2-98 as an emergency; operative 3-2-98 (Register 98, No. 10). A Certificate of
						Compliance must be transmitted to OAL by 6-30-98 or emergency language will be
						repealed by operation of law on the following day.
3. New article 1
						(sections 1830.105-1830.115) and section refiled
						6-17-98 as an emergency; operative 6-30-98 (Register 98, No. 25). Pursuant to
						Chapter 324 (Statutes of 1998) Item 4440-103-0001(4), a Certificate of Compliance
						must be transmitted to OAL by 7-1-99 or emergency language will be repealed by
						operation of law on the following day.
4. Editorial correction of HISTORY
						3 (Register 98, No. 39).
5. Editorial correction extending Certificate of
						Compliance date to 7-1-2001 pursuant to Chapter 50 (Statutes of 1999) Item
						4440-103-0001(4) (Register 99, No. 33). Notwithstanding any other provision of law,
						emergency regulations adopted pursuant to Welfare and Institutions Code section
						14680
						to implement the second phase of mental health managed care as provided in this part
						shall remain in effect until permanent regulations are adopted, or June 30, 2006,
						whichever occurs first.
6. Editorial correction of HISTORY 5 (Register
						2000, No. 42).
7. Editorial correction of HISTORY 5 and repealer and new
						section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).
Note: Authority cited: Section
						  14680,
						  Welfare and Institutions Code. Reference: Sections
						  5777,
						  5778
						  and
						  14684,
						  Welfare and Institutions Code; and Title 42, United States Code, Section
						  1396 a(a)(n).