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 7 - Payment for Services and Supplies › Section 51510 - Nursing Facility Level A Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Payment to nursing facilities, hospitals,
					 or public institutions providing level A services in accordance with Section
					 51120 shall be as set forth in
					 this section and Section
					 51535. As used in this section,
					 the term "nursing facility level A services" is defined as a nursing facility
					 services provided in accordance with Section
					 51120.
(b) Each provider of nursing facility level A
					 services shall furnish all equipment, drugs, supplies, and services necessary
					 to provide level A services except as provided in subsection (c). Such
					 equipment, supplies, and services are, at a minimum, those which are required
					 by law, including those required by federal Medicaid regulations and state
					 licensing regulations.
(c) Not
					 included in the payment rate and to be billed separately by the provider
					 thereof, subject to the utilization controls and limitations of Medi-Cal
					 regulations covering such services and supplies, are as follows:
1. Allied health services ordered by the
					 attending physician.
2. Alternating
					 pressure mattresses/pads with motor.
3. Atmospheric oxygen concentrators and
					 enrichers and accessories.
4.
					 Blood, plasma and substitutes.
5.
					 Dental services.
6. Durable medical
					 equipment as specified in Section
					 51321(g).
7. Insulin.
8. Intermittent positive pressure breathing
					 equipment.
9. Intravenous trays,
					 tubing and blood infusion sets.
10.
					 Laboratory services.
11. Legend
					 drugs.
12. Liquid oxygen
					 system.
13. MacLaren or Pogon
					 Buggy.
14. Medical supplies as
					 specified in the list established by the Department.
15. Nasal cannula.
16. Osteogenesis stimulator device.
17. Oxygen (except emergency).
18. Parts and labor for repairs of durable
					 medical equipment if originally separately payable or owned by the
					 beneficiary.
19. Physician
					 services.
20. Portable
					 aspirator.
21. Portable gas oxygen
					 system and accessories.
22.
					 Precontoured structures (VASCO-PASS, cut out foam).
23. Prescribed prosthetic and orthotic
					 devices for exclusive use of patient.
24. Reagent testing sets.
25. Therapeutic air/fluid support
					 systems/beds.
26. Traction
					 equipment and accessories.
27.
					 Variable height beds.
28.
					 X-rays.
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 7 - Payment for Services and Supplies › Section 51510.1 - Intermediate Care Services for the Developmentally Disabled

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each provider of intermediate care
					 services for the developmentally disabled shall furnish all equipment, drugs,
					 services and supplies necessary to provide intermediate care services for the
					 developmentally disabled except as provided in subsection (b). Such equipment,
					 drugs, supplies, and services are, at a minimum, those which are required by
					 law, including those required by federal Medicaid regulations and state
					 licensing regulations.
(b) Not
					 included in the payment rate and to be billed separately by the provider
					 thereof, subject to the utilization controls and limitations of Medi-Cal
					 regulations covering such services and supplies, are as follows:
(1) Allied health services ordered by the
					 attending physician.
(2)
					 Alternating pressure mattresses/pads with motor.
(3) Atmospheric oxygen concentrators and
					 enrichers and accessories.
(4)
					 Blood, plasma and substitutes.
(5)
					 Dental services.
(6) Durable
					 medical equipment as specified in Section
					 51321(g).
(7) Insulin.
(8) Intermittent positive pressure breathing
					 equipment.
(9) Intravenous trays,
					 tubing and blood infusion sets.
(10) Laboratory services.
(11) Legend drugs.
(12) Liquid oxygen system.
(13) MacLaren or Pogon Buggy.
(14) Medical supplies as specified in the
					 list established by the Department.
(15) Nasal cannula.
(16) Osteogenesis stimulator
					 device.
(17) Oxygen (except
					 emergency).
(18) Parts and labor
					 for repairs of durable medical equipment if originally separately payable or
					 owned by the beneficiary.
(19)
					 Physician services.
(20) Portable
					 aspirator.
(21) Portable gas oxygen
					 system and accessories.
(22)
					 Precontoured structures (VASCO-PASS, cut out foam).
(23) Prescribed prosthetic and orthotic
					 devices for exclusive use of patient.
(24) Reagent testing sets.
(25) Therapeutic air/fluid support
					 systems/beds.
(26) Traction
					 equipment and accessories.
(27)
					 Variable height beds.
(28)
					 X-rays.
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 7 - Payment for Services and Supplies › Section 51510.2 - Intermediate Care Services for the Developmentally Disabled-Habilitative

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Daily
					 Reimbursement Rate--Intermediate care facilities meeting licensing and Medi-Cal
					 standards and criteria for providing services to the developmentally
					 disabled-habilitative as contained or referred to in Sections
					 51164.1 through
					 51343.1 and Sections
					 76801 through
					 76962, Divisions 3 and 5 of Title
					 22, California Code of Regulations, shall be entitled to payment according to
					 the following daily rates. Payment for service includes the Quality Assurance
					 Fee pursuant to Health and Safety Code Section
					 1324.2.
Total Licensed Beds
Effective Rate
								Year
4-6
7-15
2004-05
$163.45
$163.18
2005-06
$174.96
$190.26
2006-07
$174.96
$190.26
(1) Each
					 provider of intermediate care, developmentally disabled/habilitative services
					 shall furnish:
(A) Services of the facility's
					 direct care staff in accordance with Section
					 76872 of Title 22 of California
					 Code of Regulations.
(B) Services
					 of the facility's interdisciplinary professional staff/team and qualified
					 mental retardation professional staff as follows:
1. Case conference review of client's
					 developmental needs;
2. Joint
					 development of individual service plans;
3. In-service training of direct care staff
					 and follow-up to ensure proper implementation of individual service
					 plan.
4. Advising on the need for
					 provision of various types of intervention or specialized equipment beyond the
					 capabilities of the facility or staff;
(C) Administrative services in accordance
					 with Sections
					 76907 through
					 76931 of Title 22 of California
					 Code of Regulations.
(D) Health
					 support, food and nutritional and pharmaceutical services as required in
					 Sections 76874 through
					 76906 of Title 22 of California
					 Code of Regulations.
(E)
					 Transportation services when necessary for round trips to attending physicians
					 in accordance with Section
					 51343.1(f), (g),
					 and (
l
).
(F)
					 Social services required in 42 Code of Federal Regulations, Sections
					 442.494 and
					 442.495.
(G) All services, drugs, equipment and
					 supplies required to provide intermediate care, developmentally
					 disabled/habilitative services except as provided in subsection (b). Such
					 equipment, drugs, supplies, and services are, at a minimum, those which are
					 required by law, including those required by federal Medicaid regulations and
					 state licensing regulations.
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 7 - Payment for Services and Supplies › Section 51510.3 - Intermediate Care Services for the Developmentally Disabled-Nursing

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Daily
					 Reimbursement Rate--Intermediate care facilities meeting licensing and Medi-Cal
					 standards and criteria for providing services to the developmentally
					 disabled-nursing as contained or referred to in Sections
					 51164.2 through
					 51343.2, Division 3, and Sections
					 73800 through
					 73956, Division 5, Title 22,
					 California Code of Regulations, shall be entitled to payment according to the
					 following daily rates. Payment for service includes the Quality Assurance Fee
					 pursuant to Health and Safety Code Section
					 1324.2.
Total Licensed Beds
Effective Rate
								Year
4-6
7-15
2004-05
$200.28
$177.60
2005-06
$203.18
$202.61
2006-07
$212.55
$217.66
(1) Each
					 provider of intermediate care, developmentally disabled-nursing services shall
					 furnish:
(A) Services of the facility's direct
					 care staff in accordance with Section
					 73873, Title 22, California Code
					 of Regulations.
(B) Services of the
					 facility's interdisciplinary professional staff/team and qualified mental
					 retardation professional as follows:
1. Case
					 conference review of beneficiary's medical/nursing and developmental
					 needs.
2. Joint development of
					 individual service plans.
3.
					 In-service training of direct care staff and follow-up to ensure proper
					 implementation of individual service plans.
4. Advising on the need for provision of
					 various types of intervention beyond the capabilities of the direct care staff
					 and specialized equipment beyond the resources of the
					 facility.
(C)
					 Administrative services in accordance with Sections
					 73908 through
					 73932, Title 22, California Code
					 of Regulations.
(D) Health support,
					 food and nutritional, and pharmaceutical services as required in Sections
					 73875 through
					 73907, Title 22, California Code
					 of Regulations.
(E) Transportation
					 services when necessary for round trips to attending physicians in accordance
					 with Section
					 51343.2(i), (j) and
					 (o), Title 22, California Code of
					 Regulations.
(F) Social services
					 required in Section
					 73856(c), Title
					 22, California Code of Regulations.
(G) All services, drugs, equipment and
					 supplies required to provide intermediate care, developmentally
					 disabled-nursing services except as provided in subsection (b). Such equipment,
					 drugs, supplies, and services are, at a minimum, those which are required by
					 law, including those required by federal Medicaid regulations and state
					 licensing regulations.
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 7 - Payment for Services and Supplies › Section 51511.1 - Special Program Services for the Mentally Disordered

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Supplemental payment for special program
					 services for the mentally disordered shall be limited to the amounts specified
					 in (b).
(b) Skilled nursing
					 facilities and intermediate care facilities meeting the standards and criteria
					 established for special program services to the mentally disordered as defined
					 in Sections
					 72443 through
					 72475 or Section
					 73417 through
					 73423, Division 5, Title 22,
					 California Administrative Code, shall be entitled to a supplemental payment of
					 $5.72 per patient day.
1.
						Amendment of subsection (b) filed 1-31-85 as an emergency; designated effective
						2-1-85 (Register 85, No. 12). A Certificate of Compliance must be transmitted
						to OAL within 120 days or emergency language will be repealed on 6-1-85. For
						prior history, see Register 83, No. 1.
2. Certificate of Compliance
						as to 1-31-85 order transmitted to OAL 5-23-85 and filed 6-24-85 (Register 85,
						No. 25).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14105
						  and
						  14132,
						  Welfare and Institutions Code; Items 426-106-001 and 890, Budget Act of 1981;
						  Item 4260-101-001, Budget Act of
						  1982.
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 7 - Payment for Services and Supplies › Section 51511.2 - Uniform Accounting and Cost Reporting System for Skilled Nursing Facilities and Intermediate Care Facilities

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For fiscal years commencing on or after
					 January 1, 1977, all skilled nursing and intermediate care facilities
					 participating in the Medi-Cal program shall maintain a uniform accounting
					 system as specified by the California Health Facilities Commission pursuant to
					 Part 1.7, Division 1, Health and Safety Code.
(b) Annual cost reports shall be submitted to
					 the Department of Benefit Payments by each facility no later than three months
					 after the close of the facility's fiscal year. The report shall be submitted in
					 the format prescribed by the State.
(c) Each facility shall maintain, for a
					 period of three years following the submission of annual cost reports,
					 financial and statistical records of the period covered by such cost reports,
					 which are accurate and in sufficient detail to substantiate the cost data
					 reported. These records shall be made available to State or federal
					 representatives upon request.
1. New
						section filed 5-20-77; effective thirtieth day thereafter (Register 77, No.
						21).
Note: Authority cited: Sections
						  14105,
						  14106
						  and
						  14161,
						  Welfare and Institutions Code. Reference: Sections
						  14105,
						  14106
						  and
						  14161,
						  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 7 - Payment for Services and Supplies › Section 51511.5 - Nursing Facility Services - Subacute Care Reimbursement

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
(1) For the 2003-04, 2004-05, and 2005-06
					 rate years, the prospective rate of reimbursement, which shall be the
					 all-inclusive per diem rates of reimbursement for subacute services as defined
					 in Section
					 51335.5(a), shall
					 be the lesser of the facility's costs as projected by the Department or the
					 rate based on the class median rates continued from the prior year, as set
					 forth below:
Type of
								Licensure
Type of Patient
Class Median- Based Rate Per Rate Year
2004-05
2005-06
2006-07
Hospital-based
Ventilator
								dependent
$580.07
$614.11
$704.88
Freestanding
Ventilator
								dependent
$409.72
Hospital-based
Non-ventilator
								dependent
$553.15
$584.97
$674.05
Freestanding
Non-ventilator
								dependent
$381.45
For freestanding adult subacute facilities only, payment
						for service includes the Quality Assurance Fee pursuant to Health and Safety
						Code Section
						1324.21.
(2)
(A) For
					 each effective rate year, a facility that experienced a reduction in projected
					 facility costs, which would result in a reduced subacute reimbursement rate for
					 the effective rate year pursuant to subsection (a)(1), shall have its subacute
					 prospective reimbursement rate for the effective rate year set at its prior
					 year's rate.
(B) Subacute
					 facilities that do not have historical costs shall receive an interim
					 reimbursement rate. This interim rate shall be based on the subacute facility's
					 projection of their total patient days and costs, as approved by the
					 Department. When actual subacute audit report data becomes available, interim
					 rates shall be retroactively adjusted to the subacute facility's final
					 prospective rate. Final rates may be less than the interim rate, in which case
					 the Department shall recover any overpayment. Only subacute facilities
					 participating in the program as of June 1st shall be in included in the rate
					 study.
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 7 - Payment for Services and Supplies › Section 51511.6 - Nursing Facility Services - Pediatric Subacute Care Reimbursement

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The per diem
					 rates of reimbursement for pediatric subacute services as described in Section
					 51335.6(a) shall
					 be as follows:
Licensure
Type of
								Patient
Rate of
Reimbursement
Effective Rate
								Year
2004-05
2005-06
2006-07
Hospital-based
Ventilator
								Dependent
$719.71
$762.95
$785.01
Hospital-based
Non-ventilator
								Dependent
$660.52
$700.10
$720.20
Freestanding
Ventilator
								Dependent
$673.08
$713.10
$733.52
Freestanding
Non-ventilator
								Dependent
$613.89
$650.25
$668.71
(b) The per diem rate of reimbursement for
					 supplemental rehabilitation therapy services shall be as described below:
Effective Rate
								Year
Per Diem Rate
2004-05
$43.13
2005-06
$46.05
2006-07
$47.46
This rate shall include payment for physical therapy,
						occupational therapy and speech therapy services provided in accordance with
						Section 51215.10(i) through
						(m).
(c) The per diem rate of reimbursement for
					 ventilator weaning services shall be as described below:
Effective Rate
								Year
Per Diem Rate
2004-05
$40.21
2005-06
$42.94
2006-07
$44.25
This rate shall include respiratory care practitioner and
						nursing care services provided in accordance with Section
						51215.11.
(d) Payment to nursing facilities with
					 pediatric subacute units for patients on bedhold receiving acute services shall
					 be in accordance with Section
					 51535.1(d).
(e) The provisions of Section
					 51511 shall apply to pediatric
					 subacute units except for Section
					 51511(a). Section
					 51511(c) shall
					 apply to pediatric subacute units except as provided for in
					 51511.6(f).
(f) The pediatric
					 subacute per diem rate includes the following:
(1) Equipment and supplies necessary for
					 continuous intravenous therapy;
(2)
					 Oxygen and all equipment necessary for administration including positive
					 pressure apparatus;
(3)
					 Ventilators, including calibration and maintenance;
(4) Registered Dietician consultant
					 services;
(5) Respiratory therapy
					 services;
(6) Physical,
					 occupational and speech therapy services, as specified in Section
					 51215.10(h);
(7) Developmental services;
(8) Service Coordinator activities;
					 and
(9) Portable imaging services
					 provided by freestanding 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 7 - Payment for Services and Supplies › Section 51512 - Certified Outpatient Rehabilitation Centers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Reimbursement for services rendered by certified
						outpatient rehabilitation centers is limited to the maximum allowances and
						other provisions contained in Section
						51509.
1. New
						section filed 1-22-71; designated effective 3-1-71 (Register 71, No.
						4).
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 7 - Payment for Services and Supplies › Section 51513 - Pharmaceutical Services and Prescribed Drugs

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Definitions. The following definitions
					 and definitions pursuant to Welfare and Institutions Code, Section
					 14105.45
					 shall be applicable to this section.
(1)
					 Average Wholesale Price (AWP) means the price for a drug product listed for a
					 standard package in the Department's primary price reference source. The
					 selection of the primary price reference source shall be based upon an
					 evaluation of the various price reference sources available in relation to the
					 following criteria:
(A) Accuracy and
					 currentness of prices.
(B)
					 Comprehensiveness of data base.
(C)
					 Capability to meet the needs of the Department's fiscal intermediary.
The primary price reference source will be the price
						reference source that, in the judgment of the Director, best meets the criteria
						specified above.
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 7 - Payment for Services and Supplies › Section 51513.1 - Average Wholesale Price (AWP). [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1.
						Repealer and new section filed 8-1-73 as an emergency; designated effective
						8-10-73 (Register 73, No. 31). For prior history, see Register 72, No.
						5.
2. Repealer filed 12-6-73 as an emergency; designated effective
						12-6-73 (Register 73, No. 49).
3. Certificate of Compliance filed
						4-3-74 (Register 74, No. 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 7 - Payment for Services and Supplies › Section 51513.2 - Establishment of Maximum Allowable Ingredient Cost. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1.
						Amendment of subsections (e) and (f) filed 2-4-77; effective thirtieth day
						thereafter (Register 77, No. 6). For prior history, see Register 74, No.
						18.
2. Amendment of subsection (e) filed 8-31-79; effective
						thirtieth day thereafter (Register 79, No. 35).
3. New subsection
						(j) filed 10-3-84; effective thirtieth day thereafter (Register 84, No.
						40).
4. Repealer filed 5-22-91 as an emergency pursuant to Statutes
						of 1990, chapter 456, section
						36, p. 1658-1659; operative
						5-22-91 (Register 91, No. 27). A Certificate of Compliance must be transmitted
						to OAL by 9-19-91 or emergency language will be repealed by operation of law on
						the following day.
5. Repealer of section refiled 9-19-91 as an
						emergency; operative 9-20-91 (Register 92, No. 4). A Certificate of Compliance
						must be transmitted to OAL 1-20-92 or emergency language will be repealed on
						the following day.
6. Repealer of section refiled 1-23-92 as an
						emergency; operative 1-17-92 (Register 92, No. 25). A Certificate of Compliance
						must be transmitted to OAL 5-22-92 or emergency language will be repealed by
						operation of law on the following day.
7. Certificate of Compliance
						as to 1-23-92 order transmitted to OAL 5-22-92 and filed 7-6-92 (Register 92,
						No. 28).
8. Editorial correction of printing error in HISTORY 6.
						(Register 92, No. 28).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14053,
						  14105.7,
						  14107,
						  14124.1,
						  14132,
						  14133,
						  and
						  14184,
						  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 7 - Payment for Services and Supplies › Section 51513.3 - Maximum Allowable Ingredient Cost. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1.
						Amendment of subsection (b) filed 9-5-89; operative 10-1-89 (Register 89, No.
						36). For prior history, see Register 88, No. 49.
2. Amendment of
						subsection (b) filed 11-29-89 as an emergency; operative 11-29-89 (Register 89,
						No. 48). A Certificate of Compliance must be transmitted to OAL within 120 days
						or emergency language will be repealed on 3-29-90.
3. Certificate of
						Compliance as to 11-29-89 order deleting Triamterene with hydrochlorothiazide
						capsules transmitted to OAL 3-21-90 and filed 3-22-90 (Register 90, No.
						16).
4. Repealer filed 5-22-91; operative 5-22-91 (Register 91, No.
						27). This repealer is not subject to the Administrative Procedure Act and is
						exempt from review by OAL pursuant to Welfare and Institutions Code section
						14105.45
						(Stats. 1990, ch. 457, section
						17, p. 1670-1671).
5.
						Repealer of section refiled 9-19-91 as an emergency; operative 9-20-91
						(Register 92, No. 4). A Certificate of Compliance must be transmitted to OAL
						1-20-92 or emergency language will be repealed on the following
						day.
6. Repealer of section refiled 1-23-92 as an emergency;
						operative 1-17-92 (Register 92, No. 25). A Certificate of Compliance must be
						transmitted to OAL 5-22-92 or emergency language will be repealed by operation
						of law on the following day.
7. Certificate of Compliance as to
						1-23-92 order transmitted to OAL 5-22-92 and filed 7-6-92 (Register 92, No.
						28).
8. Editorial correction of printing error in HISTORY 6.
						(Register 92, No. 28).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code; and Section
						  57(c), Chapter
						  328, Statutes of 1982. Reference: Sections
						  14053,
						  14105,
						  14105.7,
						  14132
						  and
						  14133,
						  Welfare and Institutions Code; and Section
						  57(c), Chapter
						  328, Statutes of 1982.
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 7 - Payment for Services and Supplies › Section 51513.4 - Maximum Allowable Cost. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1.
						Amendment of subsection (b) filed 7-10-81; effective thirtieth day thereafter
						(Register 81, No. 28). For prior history, see Register 81, No.
						18.
2. Amendment of subsection (b) filed 12-31-81 as an emergency;
						designated effective 1-1-82 (Register 82, No. 1). A Certificate of Compliance
						must be transmitted to OAL within 120 days or emergency language will be
						repealed on 5-1-82.
3. Amendment of subsection (b) filed 1-22-82;
						designated effective 3-1-82 (Register 82, No. 4).
4. Repealer filed
						2-2-82; effective thirtieth day thereafter (Register 82, No. 6).
5.
						Certificate of Compliance as to 12-31-81 order filed 4-23-82 (Register 82, No.
						17).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14053,
						  14105,
						  and
						  14132,
						  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 7 - Payment for Services and Supplies › Section 51513.5 - Estimated Acquisition Cost. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 2-4-77; effective thirtieth day thereafter (Register 77, No.
						6).
2. Amendment filed 8-7-78; effective thirtieth day thereafter
						(Register 78, No. 32).
3. Amendment filed 8-31-79; effective
						thirtieth day thereafter (Register 79, No. 35).
4. Amendment of
						subsection (b) filed 4-25-80; effective thirtieth day thereafter (Register 80,
						No. 17).
5. Certificate of Compliance transmitted to OAL 11-28-80
						and filed 12-24-80 (Register 80, No. 52).
6. Amendment of
						subsections (a) and (b), and Note filed 3-22-91; operative 4-21-91 (Register
						91, No. 15).
7. Editorial correction adding subsection (b)
						identifier (Register 91, No. 23).
8. Change without regulatory
						effect repealing section filed 1-26-2009 pursuant to section
						100, title 1, California Code of
						Regulations (Register 2009, No. 5).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14053,
						  14105,
						  14107,
						  14124.1,
						  14132,
						  and
						  14133,
						  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 7 - Payment for Services and Supplies › Section 51514.5 - Acupuncture Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Reimbursement for acupuncture services shall be the usual
						charges made to the general public not to exceed the maximum reimbursement
						rates listed in this section.
Procedure
								Code
Maximum Allowance
Z4800
First Visit
$27.03
Z4802
Subsequent Visits
$16.22
1.
						Amendment filed 8-1-84 as an emergency; effective upon filing (Register 84, No.
						31). A Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 11-29-84. For prior history, see
						Register 82, No. 52.
2. Certificate of Compliance transmitted to OAL
						11-27-84 and filed 12-27-84 (Register 84, No. 52).
3. Amendment
						filed 8-1-85 as an emergency; effective upon filing (Register 85, No. 32). A
						Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 11-29-85.
4. Certificate of
						Compliance transmitted to OAL 11-20-85 and filed 12-27-85 (Register 85, No.
						52).
5. Amendment of section and NOTE filed 9-25-92 as an emergency;
						operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be
						transmitted to OAL 1-25-93 or emergency language will be repealed by operation
						of law on the following day.
6. Certificate of Compliance as to
						9-25-92 order transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No.
						11).
Note: Authority cited: Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14105,
						  Welfare and Institutions Code; Statutes of 1982, Chapter 1594, Section
						  77; Statutes of 1983, Chapter 323,
						  Section 149; Statutes of 1984, Chapter
						  258, Items 4260-106-001 and 890; Statutes of 1984, Chapter 268, Section
						  66; and Statutes of 1985, Chapter
						  111, Items 4260-106-001 and 890.
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 7 - Payment for Services and Supplies › Section 51516 - Reimbursement for Short-Doyle/Medi-Cal Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The federal Medicaid share of
					 reimbursement for Short-Doyle Medi-Cal mental health services shall be based on
					 the lowest of the following.
(1) The
					 provider's usual and customary charge to the general public for the same or
					 similar services, unless the provider is a nominal charge provider pursuant to
					 Medicare rules at 42 CFR
					 413.13.
(2) The provider's reasonable and allowable
					 cost of rendering the services, based on year-end cost reports and Medicare
					 principles of reimbursement pursuant to 42 CFR Part 413 and as described in
					 HCFA Publication 15-1, for providers not contracting on a negotiated rate
					 basis.
(3) The negotiated rates as
					 approved by the Department of Mental Health for Short-Doyle/Medi-Cal providers
					 contracting on a negotiated rate basis pursuant to section
					 5705.2
					 of the Welfare and Institutions Code.
(4) The following maximum allowances are
					 effective for fiscal year 1998-1999:
Service
								Function
Maximum Allowance
Hospital inpatient services, per
								day..........................
..........................$724.16
Psychiatric Health Facilities, per
								day..........................
..........................414.13
Adult crisis residential services, per
								day..........................
..........................233.53
Adult residential services, per
								day..........................
..........................113.89
Day treatment intensive, half
								day..........................
..........................110.51
Day treatment intensive, full
								day..........................
..........................155.22
Day rehabilitative services, half
								day..........................
..........................64.47
Day rehabilitative services, full
								day..........................
..........................100.63
Mental health services, per
								minute..........................
..........................1.99
Medication support services, per
								minute..........................
..........................3.70
Crisis intervention services, per
								minute..........................
..........................2.98
Crisis stabilization - emergency room, per
								hour..........................
..........................72.50
Crisis stabilization - urgent care, per
								hour..........................
..........................72.50
Case management, brokerage, per
								minute..........................
..........................1.55
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 7 - Payment for Services and Supplies › Section 51517 - Hearing Aids

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Reimbursement for hearing aids, hearing aid supplies and accessories, molds or
					 inserts and repairs using the list of Healthcare Common Procedure Coding System
					 codes billable to the Medi-Cal program, shall be the usual charges made to the
					 general public not to exceed the maximum reimbursement rates published in the
					 Medi-Cal Provider Manual, pursuant to Welfare and Institutions Code Section
					 14105.49.
(b) The following conditions shall apply to
					 the reimbursement for hearing aids, hearing aid supplies and accessories, molds
					 or inserts and repairs under this section.
(1) All hearing aids shall be guaranteed for
					 at least one year exclusive of ear piece, cord and batteries. The guarantee
					 shall cover the repair or replacement of any or all defective parts and labor
					 on a new aid. Out of guarantee repairs shall have a minimum guarantee for at
					 least six months.
(2) Hearing aid
					 maximum allowances listed in this section are for new instruments and include
					 up to six post-sale visits for training, adjustments and fitting, an initial
					 standard package of batteries, a cord, receiver, and such other components
					 normally required for use of the instrument.
(3) Dealer charges for repairs, subsequent to
					 the guarantee period, may be reimbursed. Repair facility reports shall be
					 available for review upon request.
(4) Retail sales tax is reimbursable in
					 addition to the allowances listed in subsection (c). Taxes shall be itemized
					 separately.
(5) Hearing aid
					 provider billings shall include the provider's usual and customary charges for
					 services provided.
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 7 - Payment for Services and Supplies › Section 51518 - Optometry Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 General Provisions.
(1) The reimbursement for
					 optometric services shall be in accordance with the maximum reimbursement rates
					 listed below; however, billing shall not exceed charges made to the general
					 public.
(2) Additional routine
					 tests that may be needed shall be considered a part of the basic examination.
					 Extensive treatment programs or difficult tests not included in the list below
					 may be billed as unlisted items.
(3) Maximum allowances include preparation of
					 necessary forms when an eye appliance is prescribed.
(4) Procedure Codes 92004, 92012 and 92014
					 are from the "Physicians' Current Procedural Terminology" Fourth Edition, 1990,
					 (CPT-4), which is hereby incorporated by reference. Providers shall use all
					 related guidelines and criteria listed in the 1990 CPT-4, as adopted by the
					 Department, to bill for these CPT-4 procedure codes.
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 7 - Payment for Services and Supplies › Section 51519 - Eye Appliances

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 General Provisions.
(1) The reimbursement for
					 eye appliances shall be in accordance with maximum reimbursement rates listed
					 below; however, billing shall not exceed charges made to the general
					 public.
(2) The listed allowances
					 include impact resistance and testing, oversize lenses, special beveling,
					 drilling, mounting, fitting and adjusting, loaners for postcataract cases,
					 sales taxes paid by the provider, and follow-up services for a period of six
					 months after date of service.
(3)
					 "Diopters" refers to the power of the strongest meridian of the major portion
					 of the lens, the maximum cylindrical power, or the power of the segment
					 addition, as appropriate.
(4) When
					 a Medi-Cal beneficiary resides in a geographic area where a fabricating optical
					 laboratory has entered into an exclusive area negotiated contract with the
					 Department, the lens dispensing fees listed in Section
					 51519.1(b) shall
					 be used instead of HCPCS codes V2100 through V2430, and V2700 through V2755
					 listed in (b) below. When a fabricating optical laboratory, which has entered
					 into an exclusive area negotiated contract with the Department, also supplies
					 the frames, the frame dispensing fee listed in Section
					 51519.1(b) shall
					 be used instead of HCPCS codes V2020 and Z2910 through Z2916 listed in (b)
					 below.
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 7 - Payment for Services and Supplies › Section 51519.1 - Dispensing Fees for Ophthalmic Appliances Supplied by a Fabricating Optical Laboratory Under an Exclusive Area Negotiated Contract

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) General Provisions.
(2) Dispensing Fees include ordering, fitting
					 and adjusting eye appliances and follow-up services for a period of six months
					 after date of service.
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 7 - Payment for Services and Supplies › Section 51519.2 - Reimbursement Rates for Ophthalmic Appliances Supplied by a Fabricating Optical Laboratory Under an Exclusive Area Negotiated Contract

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) General Provisions.
(1) Reimbursement rates listed in (b) below
					 include lens grinding, cutting, edging, impact resistance and testing, oversize
					 lenses, special beveling, drilling and mounting.
(2) "Diopters" refers to the power of the
					 strongest meridian of the major portion of the lens, the maximum cylindrical
					 power, or the power of the segment addition, as
					 appropriate.
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 7 - Payment for Services and Supplies › Section 51520.1 - Establishment of Maximum Allowable Product Cost for Medical Supplies. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 5-22-91 as an emergency pursuant to Statutes of 1990, chapter
						456, section
						36, p. 1658-1659; operative
						5-22-91 (Register 91, No. 27). A Certificate of Compliance must be transmitted
						to OAL by 9-19-91 or emergency language will be repealed by operation of law on
						the following day.
2. New section refiled 9-19-91 as an emergency;
						operative 9-20-91 (Register 92, No. 4). A Certificate of Compliance must be
						transmitted to OAL 1-20-92 or emergency language will be repealed by operation
						of law on the following day.
3. New section refiled 1-23-92 as an
						emergency; operative 1-17-92 (Register 92, No. 25). A Certificate of Compliance
						must be transmitted to OAL 5-22-92 or emergency language will be repealed by
						operation of law on the following day.
4. Certificate of Compliance
						as to 1-23-92 order including amendment of section heading, subsections (a),
						(f)-(h) and NOTE transmitted to OAL 5-22-92 and filed 7-6-92 (Register 92, No.
						28).
5. Amendment of subsections (b)-(d) filed 1-9-95; operative
						3-1-95 (Register 95, No. 2).
6. Editorial correction restoring
						current version of section and adding HISTORY NOTE 5 (Register 95, No.
						8).
7. Repealed by operation of Welfare and Institutions Code
						section
						14105.47
						(Assembly Bill No. 442 (2001-2002 Reg. Sess.) section
						74 (Register 2009, No.
						5).
Note: Authority cited: Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14053,
						  14105.7,
						  14124.1,
						  14132
						  and
						  14133,
						  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 7 - Payment for Services and Supplies › Section 51520.2 - List of Generic Medical Supply Types. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 5-22-91 as an emergency pursuant to Statutes of 1990, chapter
						456, section
						36, p. 1658-1659; operative
						5-22-91 (Register 91, No. 27). A Certificate of Compliance must be transmitted
						to OAL by 9-19-91 or emergency language will be repealed by operation of law on
						the following day.
2. New section refiled 9-19-91 as an emergency;
						operative 9-20-91 (Register 92, No. 4). A Certificate of Compliance must be
						transmitted to OAL 1-20-92 or emergency language will be repealed by operation
						of law on the following day.
3. New section refiled 1-23-92 as an
						emergency; operative 1-17-92 (Register 92, No. 25). A Certificate of Compliance
						must be transmitted to OAL 5-22-92 or emergency language will be repealed by
						operation of law on the following day.
4. Certificate of Compliance
						as to 1-23-92 order including amendment of section transmitted to OAL 5-22-92
						and filed 7-6-92 (Register 92, No. 28).
5. Amendment of subsection
						(b) and NOTE filed 1-9-95; operative 3-1-95 (Register 95, No. 2).
6.
						Editorial correction restoring current version of section and adding HISTORY
						NOTE 5 (Register 95, No. 8).
7. Change without regulatory effect
						repealing section filed 1-26-2009 pursuant to section
						100, title 1, California Code of
						Regulations (Register 2009, No. 5).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code; and Section
						  57(c), Chapter
						  328, Statutes of 1982. Reference: Sections
						  14053,
						  14105,
						  14105.7,
						  14132
						  and
						  14133,
						  Welfare and Institutions Code; and Section
						  57(c), Chapter
						  328, Statutes of 1982.
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 7 - Payment for Services and Supplies › Section 51521 - Durable Medical Equipment

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Reimbursement for the rental or purchase of durable medical equipment, except
					 wheelchairs, wheelchair accessories, and speech-generating devices and related
					 accessories, shall be the lesser of:
(1) The
					 amount billed pursuant to Section
					 51008.1, or
(2) An amount that does not exceed 80 percent
					 of the lowest maximum allowance for California established by the federal
					 Medicare Program for the same or similar item or service, or
(3) The guaranteed acquisition cost
					 negotiated by means of the contracting process provided for pursuant to Welfare
					 and Institutions Code Section
					 14105.3
					 plus a percentage markup to be established 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 7 - Payment for Services and Supplies › Section 51522 - Hearing and Speech Centers. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 2-23-67 as an emergency; effective upon filling (Register 67, No.
						8).
2. Certificate of Compliance--Section
						11422.1,
						Government Code--filed 4-12-67 (Register 67, No. 15).
3. Repealer
						filed 4-17-67; effective thirtieth day thereafter (Register 67, No.
						16).