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 3 - Standards for Participation › Section 51244 - In-Home Medical Care Waiver Services Provider and Nursing Facility Waiver Services Provider

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An
					 in-home medical care waiver services provider and a nursing facility waiver
					 services provider shall:
(1) Be licensed in
					 accordance with appropriate state or local laws; and
(2) Be certified in accordance with the
					 standards set forth in the applicable federal waiver and in a written agreement
					 between the Department and the provider of services necessary to implement the
					 in-home medical care waiver services program component or the Nursing Facility
					 Waiver Services program component. In the event the specific standards for
					 participation are not set forth in the waiver and agreement and the services to
					 be provided are the same as otherwise set forth in Article 2 of this chapter
					 (excluding Section
					 51173.1 and Section
					 51176), the provider shall adhere
					 to the provider standards applicable to the service to be provided, as
					 otherwise set forth in Article 3 of this chapter, commencing with Section
					 51200; and
(3) Be certified to participate in the
					 Medi-Cal program by meeting the standards for participation as a provider under
					 the Medi-Cal program, being in compliance, where applicable, with the Medicare
					 and Medicaid requirements of Titles XVIII and XIX of the Social Security
					 Act.
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 3 - Standards for Participation › Section 51245 - Nurse Midwife

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A nurse midwife shall be licensed as a registered nurse
						and currently certified as a nurse midwife by the California Board of
						Registered Nursing.
1. New
						section filed 12-21-83; effective thirtieth day thereafter (Register 83, No.
						52).
Note: Authority cited: Section
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14132.4,
						  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 3 - Standards for Participation › Section 51246 - Home and Community-Based Waiver Services Providers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A home and community-based waiver
					 services provider shall:
(1) Be licensed in
					 accordance with the appropriate state laws; and
(2) Be certified in accordance with the
					 standards set forth in the applicable federal waiver approved by the Department
					 of Health and Human Services; or
(3) In the event specific standards for
					 participation are not set forth in the waiver and the services to be provided
					 are the same as otherwise set forth in Article 2 of this chapter (excluding
					 Section 51176) as a Medi-Cal covered
					 benefit in the absence of a waiver, the provider shall adhere to the provider
					 standards applicable to the service to be provided, as otherwise set forth in
					 Article 3 of this chapter, commencing with Section
					 51200.
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 3 - Standards for Participation › Section 51247 - Swing Bed Facility

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Swing bed facilities as defined in Section
					 51178 shall:
(1) Meet the standards for hospitals
					 specified in Section
					 51207.
(2) Be certified as a special hospital
					 provider of long-term services under Title XVIII of the Federal Social Security
					 Act.
(3) Be approved by the
					 Department as a primary health service hospital in accordance with Division 2,
					 Article 10 of the Health and Safety Code commencing with Section
					 1339.
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 3 - Standards for Participation › Section 51248 - Ocularist

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
An ocularist shall be certified by the American
						Anaplastology Association, or by the National Examining Board of Ocularists, or
						shall be a graduate of at least a two year course in ocular prostheses
						sponsored by a school or college of medicine or optometry, and whose degrees
						are accepted by the applicable board, or shall be a California licensed
						physician and surgeon, optometrist, or optician.
1. New
						section filed 7-23-87; operative 8-22-87 (Register 87, No.
						31).
Note: Authority cited: Sections
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  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 3 - Standards for Participation › Section 51249 - Application Process for Comprehensive Perinatal Providers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Except where a capitated health system
					 contract entered into by the Department provides otherwise, to become a
					 comprehensive perinatal provider as defined in Section
					 51179.1, the Medi-Cal enrolled
					 provider shall complete and submit a Department approved application form
					 entitled Application for Certification As A Comprehensive Perinatal Provider
					 Under Medi-Cal to the local health department or designated State agent for
					 review. The designated agent may include counties or other non-profit
					 organizations as designated by the Director of the Department. Applications
					 shall be available from the local Comprehensive Perinatal Services Program
					 Coordinator or the State Maternal and Child Health Branch, 714 P Street,
					 Sacramento, CA 95814.
(b) The
					 Department shall utilize the following criteria in evaluating applications:
(1) Provider's ability to provide the
					 services specified in Section
					 51348 through the provider's own
					 service or through subcontractors.
(2) Training and experience of providers
					 rendering services specified in Section
					 51348.
(3) Quality of care rendered by providers as
					 evidenced by history of:
(A) Revocations,
					 suspensions, or restrictions by a licensing authority.
(B) The extent of training received in the
					 provision of comprehensive perinatal care which has been approved by the
					 State.
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 3 - Standards for Participation › Section 51250 - Hospice

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A hospice shall:
(a) Be certified and continue to meet the
					 conditions for participation as a hospice under Title XVIII of the Social
					 Security Act, Section
					 1861(dd),
					 (42 U.S.C.
					 1395x(dd)).
(b) Make available and provide core services
					 and other services, and utilize volunteers as specified in 42 Code of Federal
					 Regulations, Part 418, Subpart C, in accordance with the conditions specified.
					 Reference to Medicare beneficiaries shall apply equally to Medi-Cal
					 beneficiaries.
(c) Not discontinue
					 or diminish care provided to a Medi-Cal beneficiary based on expiration of the
					 beneficiary's final election period.
(d) Make available to the Department
					 complete, accurate medical and fiscal records, signed and dated by appropriate
					 staff, to fully substantiate all claims for hospice services submitted to the
					 Department, and shall permit access to all records and facilities for the
					 purpose of claims audit, program monitoring and utilization review.
(e) Notify the Department of Health Services
					 by mail postmarked within two working days of approval of hospice benefits for
					 an individual by a Medi-Cal Consultant.
1. New
						section filed 10-27-87 as an emergency; operative 10-27-87 (Register 87, No.
						44). A Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 2-24-88.
2. Certificate of
						Compliance including amendment of subsections (b) and (e) transmitted to OAL
						2-24-88 and filed 3-22-88 (Register 88, No. 15).
Note: Authority cited: Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference Sections
						  14053
						  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 3 - Standards for Participation › Section 51251 - Medical Device Retailer

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Any Medi-Cal provider who dispenses dangerous medical
						devices, as defined in Business and Professions Code section
						4034.5,
						shall have a valid pharmacy license or medical device retailer permit issued by
						the Board of Pharmacy pursuant to Business and Professions Code section
						4034.5
						and
						4081.
1. New
						section filed 2-15-91; operative 3-17-91 (Register 91, No.
						11).
Note: Authority cited: Section
						  208,
						  Health and Safety Code; and Section
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  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 3 - Standards for Participation › Section 51255 - Licensed Midwife

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) In
					 order to participate in the Medi-Cal Program, a licensed midwife shall enroll
					 as a Medi-Cal Provider, pursuant to Article 1 of Chapter 3 commencing with
					 Section 51000.
(b) A licensed midwife shall comply with the
					 provisions of the Licensed Midwifery Practice Act of 1993, as set forth in
					 Business and Professions Code Section
					 2505
					 et seq.
1. New
						section filed 9-3-2004; operative 10-3-2004 (Register
						2004,
						No. 36).
2. Change without regulatory effect repealing subsections
						(c)-(d) and amending NOTE filed 7-14-2017 pursuant to section
						100, title 1, California Code of
						Regulations (Register 2017, No. 28).
Note: Authority cited: Section
						  20, Health and Safety Code; and
						  Sections
						  10725
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Section
						  14132.39,
						  Welfare and Institutions Code; and Sections
						  2505-
						  2521,
						  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 3 - Standards for Participation › Section 51260 - Certified Nurse Practitioner

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A Certified Nurse Practitioner shall meet the standards
						prescribed by the Board of Registered Nursing within the State of
						California.
1. New
						section filed 5-3-93 as an emergency; operative 5-3-93 (Register 93, No. 19). A
						Certificate of Compliance must be transmitted to OAL 8-31-93 or emergency
						language will be repealed by operation of law on the following
						day.
2. Emergency adoption of section filed 5-3-93 repealed by
						operation of Government Code section
						11346.1(g)
						(Register 93, No. 44).
3. New section refiled 10-27-93 as an
						emergency; operative 10-27-93 (Register 93, No. 44). A Certificate of
						Compliance must be transmitted to OAL by 2-25-94 or emergency language will be
						repealed by operation of law on the following day.
4. Certificate of
						Compliance as to 10-27-93 order including amendment of NOTE transmitted to OAL
						10-18-93 and filed 12-2-93 (Register 93, No.
						49).
Note: Authority cited: Sections
						  14105,
						  14124.5
						  and
						  14132.41,
						  Welfare and Institutions Code. Reference: Sections
						  14132
						  and
						  14132.41,
						  Welfare and Institutions Code; and Sections
						  2834,
						  2835,
						  2835.5
						  and
						  2836,
						  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 3 - Standards for Participation › Section 51270 - Local Educational Agency (LEA) Provider

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A Local Educational Agency (LEA)
					 Provider, as defined in Section
					 51190.2, shall be certified by the
					 Department of Education as meeting all of the following conditions for
					 participation:
(1) The LEA Provider meets the
					 definition of an LEA as stated in Education Code, Section
					 33509(e),
					 and
(2) The LEA Provider has signed
					 a contract with the Department of Health 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 3 - Standards for Participation › Section 51271 - Targeted Case Management Services Provider Qualifications

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A targeted case management provider of
					 services shall be a local governmental agency and shall:
(1) Contract with the department to provide
					 targeted case management services as a condition of enrollment as a targeted
					 case management provider in the Medi-Cal program, and
(2) Provide and certify the non-federal
					 match, and
(3) Have an established
					 fee mechanism effective January 1, 1995, specific to targeted case management
					 services provided, which may include a sliding fee schedule based on income and
					 vary by program, and
(4) Have an
					 established procedure for performance monitoring that assures the participating
					 units are complying with state and federal requirements, and
(5) Make available to the department a
					 performance monitoring plan, including protocols and procedures, establishing a
					 countywide system to assure non-duplication of services and to ensure
					 coordination and continuity of care among providers of targeted case management
					 services provided to beneficiaries who are eligible to receive case management
					 services from two or more programs.
(6) Have an administrative capacity to ensure
					 quality of services in accordance with state and federal
					 requirements.
(7) Have a financial
					 management capacity and system that provides documentation of services and
					 costs.
(8) Have a capacity to
					 document and maintain individual case records in accordance with state and
					 federal requirements.
(9) Have a
					 demonstrated ability to meet all requirements of state and federal law
					 governing the participation of providers in the state Medicaid program,
					 including but not limited to, the ability to meet federal and state
					 requirements for documentation, billing and audits.
(10) Have a minimum of five years of
					 experience in providing case management services to the target
					 population.
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 3 - Standards for Participation › Section 51272 - Targeted Case Manager

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Case managers employed by a targeted case management services provider shall
					 meet the following minimum requirements for education, training and experience:
(1) For the targeted population specified in
					 Section 51185(b), be
					 certified as a Public Health Nurse or a Registered Nurse, or a Licensed
					 Vocational Nurse under the direct supervision of a skilled professional medical
					 person, or an individual who possesses the education and/or experience
					 specified in (3) below and who is under the direct supervision of a skilled
					 professional medical person.
(2)
					 For the targeted populations specified in Sections
					 50262.7(a)(2),
					 and 50262.7(a)(3)(E),
					 be a Registered Nurse; or possess the education and/or experience specified in
					 subsection (a)(3) below, under the direct supervision of a skilled professional
					 medical person.
(3) For the target
					 populations specified in Sections
					 50262.7(a)(3)(A), (B), (C) and
					 (D), have education or relevant case
					 management experience consisting of a Bachelor's degree in a health or human
					 services field; an Associate of Arts degree with two years experience
					 performing case management duties in a health and human services field; or four
					 years experience performing case management duties in a health or human
					 services field.
(4) All individuals
					 providing case management services pursuant to this section, except Public
					 Health Nurses and Registered Nurses, shall have completed agency-approved case
					 management training.
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 3 - Standards for Participation › Section 51273 - Targeted Case Management Advisory Committee. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 7-1-96; operative 7-1-96. Submitted to OAL for printing only
						pursuant to Section
						6, Chapter 305, Statutes of 1995
						(Register 96, No. 27).
2. New section refiled 10-29-96 as an
						emergency; operative 10-29-96 (Register 96, No. 44). Submitted to OAL for
						printing only pursuant to Section
						6, Chapter 305, Statutes of 1995.
						A Certificate of Compliance must be transmitted to OAL by 2-26-97 or emergency
						language will be repealed by operation of law on the following
						day.
3. Editorial correction of HISTORY 2 (Register 97, No.
						15).
4. Repealer filed 4-10-97; operative 4-10-97 pursuant to
						Government Code section
						11343.4(d)
						(Register 97, No. 15).
Note: Authority cited: Sections
						  14105,
						  14124.5
						  and
						  14132.44,
						  Welfare and Institutions Code. Reference: Section
						  14132.44,
						  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 3 - Standards for Participation › Section 51276 - Directly Observed Therapy (DOT) Provider Qualifications

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each provider of Directly Observed
					 Therapy (DOT) shall:
(1) Have a manager
					 responsible for the tuberculosis (TB) DOT program who supervises and monitors
					 DOT staff activities and ensures appropriate documentation of TB patient
					 records.
(2) Ensure all staff
					 providing DOT have provider-approved DOT training.
(3) Have policies and protocols for the
					 provision of DOT to ensure the following:
(A)
					 Assessment of individual barriers to DOT, such as a TB patient's need for
					 transportation.
(B) Appropriate
					 selection of either field-based or clinic-based DOT based upon potential
					 patient barriers to completion of DOT.
1.
					 Field-based DOT means DOT provided to a TB patient at his/her place of
					 residence, work site, shelter, or any other location agreed upon between DOT
					 staff an the TB patient.
2.
					 Clinic-based DOT means DOT provided to a TB patient at the site of the provider
					 agency.
(C) Patients
					 receive and ingest the prescribed medications and insuring renewals of and/or
					 changes to medications are promptly obtained.
(D) Patient ingestion of medications is
					 recorded in the patient's case record.
(E) Documentation in patient case files
					 include all activities related to the provision of DOT.
(F) Reporting to both the local health
					 department and the treating physician when there is failure to make contact
					 with a TB patient at any time during the course of treatment.
(G) Reporting to the treating physician all
					 side effects or other patient problems.
(H) Confidentiality of patient
					 records.
(4) Have the
					 capacity to provide TB DOT in a manner that is linguistically and culturally
					 appropriate to the population being served.
(5) Initiate active outreach to locate a
					 patient after a patient's missed appointment with DOT staff. Active outreach
					 shall include, but is not limited to, the following:
(A) Reviewing patient information and
					 evaluating locating information.
(B) Developing a strategy for locating the
					 patient.
(C) Promptly dispatching
					 DOT staff to physically search for the patient at the last known place of
					 residence, work site, shelter, or other location. DOT staff shall attempt to
					 locate the patient on at least three separate
					 occasions.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 4 - Scope and Duration of Benefits › Section 51301 - Schedule of Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The benefits covered by Medi-Cal are limited to those set
						forth in this article and in Chapter 5, Article 4.
1.
						Amendment filed 5-14-76 as an emergency; effective upon filing (Register 76,
						No. 20). For prior history, see Register 72, No. 5.
2. Certificate
						of Compliance filed 9-8-76 (Register 76, No. 37).
3. Amendment filed
						6-28-78 as an emergency; designated effective 7-1-78 (Register 78, No.
						26).
4. Change without regulatory effect of NOTE (Register 86, No.
						49).
Note: Authority cited: Sections
						  10721,
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14021,
						  14053,
						  14131-
						  14145.9,
						  14550
						  and
						  14551,
						  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 4 - Scope and Duration of Benefits › Section 51304 - Benefit Limitations

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Program coverage of services specified in Sections
					 51308,
					 51308.5,
					 51309,
					 51310,
					 51312, and
					 51331(a)(3) through
					 (9), unless noted otherwise, is limited to a
					 maximum of two services from among those services set forth in those sections
					 in any one calendar month.
(b) For
					 purposes of this section, "services" means all care, treatment, or procedures
					 provided a beneficiary by an individual practitioner on one occasion.
1.
						Amendment filed 5-14-76 as an emergency; effective upon filing (Register 76,
						No. 20). For prior history, see Register 75, No. 9.
2. Certificate
						of Compliance filed 9-8-76 (Register 76, No. 37).
3. Amendment of
						subsection (a) filed 3-9-79; effective thirtieth day thereafter (Register 79,
						No. 10).
4. Amendment of subsection (a) filed 4-30-81; effective
						thirtieth day thereafter (Register 81, No. 18).
5. Repealer of
						subsection (c) and amendment of NOTE filed 4-4-94 as an emergency; operative
						4-4-94 (Register 94, No. 14). A Certificate of Compliance must be transmitted
						to OAL by 8-2-94 or emergency language will be repealed by operation of law on
						the following day.
6. Repealer of subsection (c) and amendment of
						NOTE refiled 8-1-94 as an emergency; operative 8-1-94 (Register 94, No. 31). A
						Certificate of Compliance must be transmitted to OAL by 11-29-94 or emergency
						language will be repealed by operation of law on the following
						day.
7. Repealer of subsection (c) and amendment of NOTE refiled
						10-24-94 as an emergency; operative 10-24-94 (Register 94, No. 43). A
						Certificate of Compliance must be transmitted to OAL by 2-21-95 or emergency
						language will be repealed by operation of law on the following
						day.
8. Repealer of subsection (c) and amendment of NOTE refiled
						2-22-95; operative 2-22-95 (Register 95, No. 8). A Certificate of Compliance
						must be transmitted to OAL by 6-22-95 or emergency language will be repealed by
						operation of law on the following day.
9. Certificate of Compliance
						as to 2-22-95 order transmitted to OAL 3-16-95 and filed 4-27-95 (Register 95,
						No. 17).
Note: Authority cited: Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14053,
						  14132,
						  14133
						  and
						  14133.1,
						  Welfare and Institutions Code; and Section
						  690,
						  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 4 - Scope and Duration of Benefits › Section 51305.1 - Criteria for the Performance of Sterilization

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A sterilization shall be performed only
					 if the following conditions are met:
(1) The
					 individual is at least 21 years old at the time consent is obtained.
(2) The individual is not a mentally
					 incompetent individual.
(3) The
					 individual is able to understand the content and nature of the informed consent
					 process as specified in 51305.3.
(4) The individual is not an
					 institutionalized individual.
(5)
					 The individual has voluntarily given informed consent in accordance with all
					 the requirements prescribed in Section
					 51305.1 through
					 51305.4.
(6) At least 30 days, but not more than 180
					 days, have passed between the date of written informed consent and the date of
					 the sterilization, except in the following instances:
(A) Sterilization may be performed at the
					 time of emergency abdominal surgery if the following requirements are met:
1. The written informed consent to be
					 sterilized was given at least 30 days before the individual intended to be
					 sterilized.
2. At least 72 hours
					 have passed after written informed consent to be sterilized was
					 given.
(B) Sterilization
					 may be performed at the time of premature delivery if the following
					 requirements are met:
1. The written informed
					 consent was given at least 30 days before the expected date of the
					 delivery.
2. At least 72 hours have
					 passed after written informed consent to be sterilized was
					 given.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 4 - Scope and Duration of Benefits › Section 51305.2 - Requirements for Sterilization Other Than Emergency Sterilization. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 5-27-77; effective thirtieth day thereafter (Register 77, No.
						22).
2. Repealer filed 6-24-80; designated effective 10-15-80
						(Register 80, No. 26).
Note: Authority cited: Chapter 220, Statutes of 1975.
						  Reference: Sections
						  14053,
						  14053.6,
						  14059,
						  14105,
						  14124.5,
						  14132
						  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 4 - Scope and Duration of Benefits › Section 51305.3 - Informed Consent Process for Sterilization

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An individual has given informed consent
					 only if:
(1) The person who obtained consent
					 for the sterilization procedure:
(A) Offered
					 to answer any questions the individual to be sterilized may have concerning the
					 procedure.
(B) Provided the
					 individual with a copy of the consent form and the booklet on sterilization
					 published by the Department.
(C)
					 Provided orally all of the following to the individual to be sterilized:
1. Advice that the individual is free to
					 withhold or withdraw consent to the procedure at any time before the
					 sterilization without affecting the right to future care or treatment and
					 without loss or withdrawal of any federally funded program benefits to which
					 the individual might be otherwise entitled.
2. A full description of available
					 alternative methods of family planning and birth control.
3. Advice that the sterilization procedure is
					 considered to be irreversible.
4. A
					 thorough explanation of the specific sterilization procedure to be
					 performed.
5. A full description of
					 the discomforts and risks that may accompany or follow the performing of the
					 procedure, including an explanation of the type and possible effects of any
					 anesthetic to be used.
6. A full
					 description of the benefits or advantages that may be expected as a result of
					 the sterilization.
7. Approximate
					 length of hospital stay.
8.
					 Approximate length of time for recovery.
9. Financial cost to the patient.
10. Information that the procedure is
					 established or new.
11. Advice that
					 the sterilization will not be performed for at least 30 days, except under the
					 circumstances specified in Section
					 51305.1.
12. The name of the physician performing the
					 procedure. If another physician is to be substituted, the patient shall be
					 notified, prior to administering pre-anesthetic medication, of the physician's
					 name and the reason for the change in physician.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 4 - Scope and Duration of Benefits › Section 51305.4 - Certification of Informed Consent for Sterilization

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Consent Form, provided by the
					 Department in English and Spanish, shall be the only approved form and shall be
					 signed and dated by the:
(1) Individual to be
					 sterilized.
(2) Interpreter, if one
					 is provided.
(3) Person who
					 obtained the consent.
(4) Physician
					 who performed the sterilization procedure.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 4 - Scope and Duration of Benefits › Section 51305.5 - Additional Requirements for Informed Consent Process for Elective Sterilization. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 5-27-77; effective thirtieth day thereafter (Register 77, No.
						22).
2. Repealer of section filed 6-24-80; designated effective
						10-15-80 (Register 80, No. 26).
Note: Authority cited: Chapter 220, Statutes of 1975.
						  Reference: Sections
						  14053,
						  14053.6,
						  14059,
						  14105,
						  14124.5,
						  14132
						  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 4 - Scope and Duration of Benefits › Section 51305.6 - Hysterectomy

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A hysterectomy
					 shall not be covered if:
(1) Performed solely
					 for the purpose of rendering an individual permanently sterile.
(2) There is more than one purpose to the
					 procedure, and the hysterectomy would not be performed except for the purpose
					 of rendering the individual permanently sterile.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 4 - Scope and Duration of Benefits › Section 51305.7 - Noncompliance

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Noncompliance
					 with Sections
					 51305.1 through
					 51305.6 shall result in nonpayment
					 for sterilization services.
(b)
					 Noncompliance with Sections
					 51305.1 through
					 51305.6 shall result in a referral
					 to the Board of Medical Quality Assurance.
1. New
						section filed 5-27-77; effective thirtieth day thereafter (Register 77, No.
						22).
2. Change without regulatory effect of NOTE (Register 86, No.
						49).
Note: Authority cited: Sections
						  14191
						  and
						  14193,
						  Welfare and Institutions Code. Reference: Sections
						  14053,
						  14059
						  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 4 - Scope and Duration of Benefits › Section 51305.8 - Effective Date. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 6-27-77 as an emergency; effective upon filing (Register 77, No.
						27).
2. Amendment filed 8-3-77 as an emergency; effective upon
						filing (Register 77, No. 32).
3. Certificate of Compliance filed
						11-30-77 (Register 77, No. 49).
4. Repealer filed 6-24-80;
						designated effective 10-15-80 (Register 80, No.
						26).
Note: Authority cited: Chapter 220, Statutes of 1975.
						  Reference: Chapter 220, Statutes of
						  1975.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 4 - Scope and Duration of Benefits › Section 51305.9 - Interim Coverage of Intermediate and Comprehensive Ophthalmological Services for Nonaphakic Beneficiaries. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 91-82 as an emergency; effective upon filing (Register 82, No.
						37). A Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 12-30-82.
2. Certificate of
						Compliance transmitted to OAL 12-30-82 and withdrawn 1-28-83 (Register 83, No.
						10).
3. New section refiled 1-28-83 as an emergency; effective upon
						filing (Register 83, No. 10). (Corrected copy of 1-28-83 emergency order
						refiled 1-31-83.) A Certificate of Compliance must be transmitted to OAL within
						120 days or emergency language will be repealed on 5-28-83.
4.
						Emergency language repealed by operation of Government Code Section
						11346.1(f)
						(Register 83, No. 26).
5. New section filed 6-24-83 as an emergency;
						effective upon filing (Register 83, No. 26). A Certificate of Compliance must
						be transmitted to OAL within 120 days or emergency language will be repealed on
						10-22-83.
6. Certificate of Compliance transmitted to OAL 10-21-83
						and filed 11-23-83 (Register 83, No. 48).
7. Editorial correction of
						NOTE filed 12-20-83 (Register 83, No. 52).
8. Repealer filed 9-30-85
						as an emergency; effective upon filing (Register 85, No. 40). A Certificate of
						Compliance must be transmitted to OAL within 120 days or emergency language
						will be repealed on 1-28-86.
9. Certificate of Compliance
						transmitted to OAL 1-8-86 and filed 2-6-86 (Register 86, No.
						6).
Note: Authority cited: Section
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14132,
						  14133
						  and
						  14133.1,
						  Welfare and Institutions Code; and Section
						  149, Chapter 323, Statutes of
						  1983.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 4 - Scope and Duration of Benefits › Section 51306 - Optometry Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Services provided by optometrists acting within the scope of their practice as
					 authorized by California law are covered, except as otherwise limited by these
					 regulations.
(b) Orthoptics and
					 pleoptics are not covered.
(c) A
					 second eye examination with refraction within twenty-four months is covered
					 only when a sign or symptom indicates a need for this service. The provider of
					 services shall make a reasonable effort to ascertain the date of any prior eye
					 examination with refraction.
1. New
						section filed 9-30-71 as an emergency; designated effective 10-1-71 (Register
						71, No. 40).
2. Certificate of Compliance--Section
						11422.1,
						Gov. Code, filed 1-25-72 (Register 72, No. 5).
3. Amendment filed
						10-3-78; designated effective 11-15-78 (Register 78, No. 40).
4.
						Change without regulatory effect of NOTE (Register 86, No.
						49).
Note: Authority cited: Section
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14053,
						  14060,
						  14132(a) and
						  (k), and
						  14133(a) and
						  (b), Welfare and Institutions Code; and
						  Sections
						  690
						  and
						  3041,
						  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 4 - Scope and Duration of Benefits › Section 51306.1 - Interim Coverage of Optometric Services for Nonaphakic Beneficiaries over 21. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 9-1-82 as an emergency; effective upon filing (Register 82, No.
						37). A Certificate of Compliance must be transmitted to OAL within 120 days or
						emergency language will be repealed on 12-30-82.
2. Certificate of
						Compliance transmitted to OAL 12-30-82 and withdrawn 1-28-83 (Register 83, No.
						10).
3. New section refiled 1-28-83 as an emergency; effective upon
						filing (Register 83, No. 10). (Corrected copy of 1-28-83 emergency order
						refiled 1-31-83.) A Certificate of Compliance must be transmitted to OAL within
						120 days or emergency language will be repealed on 5-28-83.
4.
						Emergency language repealed by operation of Government Code Section
						11346.1(f)
						(Register 83, No. 26).
5. New section filed 6-24-83 as an emergency;
						effective upon filing (Register 83, No. 26). A Certificate of Compliance must
						be transmitted to OAL within 120 days or emergency language will be repealed on
						10-22-83.
6. Certificate of Compliance transmitted to OAL 10-21-83
						and filed 11-23-83 (Register 83, No. 48).
7. Repealer filed 9-30-85
						as an emergency; effective upon filing (Register 85. No. 40). A Certificate of
						Compliance must be transmitted to OAL within 120 days or emergency language
						will be repealed on 1-28-86.
8. Certificate of Compliance
						transmitted to OAL 1-8-86 and filed 2-6-86 (Register 86, No. 6).
9.
						Editorial correction of HISTORY 6 (Register 95, No.
						45).
Note: Authority cited: Sections
						  10725
						  and
						  14124.5,
						  Welfare and Institutions Code; and Section
						  57(c), Chapter
						  328, Statutes of 1982. Reference: Sections
						  14132,
						  14133
						  and
						  14133.1,
						  Welfare and Institutions Code; and Section
						  53, 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 4 - Scope and Duration of Benefits › Section 51308 - Chiropractic Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Services provided by chiropractors, acting within the
						scope of their practice as authorized by California law, are covered, except
						that such services shall be limited to treatment of the spine by means of
						manual manipulation and subject to the limitations set forth in Section
						51304(a).
1. New
						section filed 9-30-71 as an emergency; designated effective 10-1-71 (Register
						71, No. 40).
2. Certificate of Compliance--Section
						11422.1,
						Gov. Code, filed 1-25-72 (Register 72, No. 5).
3. Amendment filed
						6-29-73 as an emergency; designated effective 7-1-73. Certificate of Compliance
						included (Register 73, No. 26).
4. Amendment filed 2-27-74 as an
						emergency; effective upon filing (Register 74, No. 9).
5.
						Certificate of Compliance filed 4-12-74 (Register 74, No. 15).
6.
						Change without regulatory effect adding NOTE (Register 86, No.
						49).
Note: Authority cited: Sections
						  10725,
						  14105
						  and
						  14124.5,
						  Welfare and Institutions Code. Reference: Sections
						  14132,
						  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 4 - Scope and Duration of Benefits › Section 51308.5 - Acupuncture Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Acupuncture services are covered, subject to the limitations set forth below
					 and in Section
					 51304(a), when
					 provided by one of the following:
(1) A
					 physician, dentist or podiatrist.
(2) An acupuncturist.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 4 - Scope and Duration of Benefits › Section 51309.5 - Scope of Sign Language Interpreter Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Sign language interpreter services, as
					 set forth in Section
					 51098.5, are covered as part of
					 the Medi-Cal enrolled provider service subject to the limitation specified in
					 subsection (b). Sign language interpreter services may be utilized for
					 medically necessary health care services and related services such as, or
					 similar to:
(1) Obtaining medical
					 history.
(2) Obtaining informed
					 consent and permission for treatment.
(3) Explaining diagnoses, treatment and
					 prognoses of an illness.
(4)
					 Communicating prior to, during or after medical procedures.
(5) Providing instructions regarding
					 medication.
(6) Explaining
					 instructions for self-care and/or therapy activities, upon discharge from a
					 health care facility to an unsupervised home setting.
(7) Providing mental health assessment,
					 therapy or counseling.
(8)
					 Obtaining or providing case management information.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 3 - Health Care Services › Article 4 - Scope and Duration of Benefits › Section 51310 - Podiatry Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Services provided by podiatrists, acting within the scope of their practice as
					 authorized by California law, are covered subject to the following:
(1) Podiatric office visits described by
					 procedure codes 99201-99203 and 99211-99213 in the latest edition of the
					 Physicians' Current Procedural Terminology are covered as medically necessary.
					 All other outpatient podiatry services are subject to prior authorization and
					 are limited to medical and surgical services necessary to treat disorders of
					 the feet, ankles, or tendons that insert into the foot, secondary to or
					 complicating chronic medical diseases, or which significantly impair the
					 ability to walk.
EDITORIAL NOTE: For full incorporation by reference of
						the Physicians' Current Procedural Terminology Codes, see CCR, Title 22,
						section 51050.
(2) Podiatry services rendered on an
					 emergency basis are exempt from prior authorization. Emergency services shall
					 conform to and be in compliance with the provisions of section
					 51056.
(3) Podiatry services rendered to hospital,
					 skilled nursing facility or intermediate care facility inpatients are covered
					 only when provided pursuant to an order on the patient's chart, signed by the
					 physician or podiatrist who admitted the patient, specifying the care to be
					 given. Services to skilled nursing facility and intermediate care facility
					 inpatients are further subject to prior authorization.
(4) Hospitalization of patients by
					 podiatrists is subject to the procedures set forth in section
					 51327. Podiatry services provided
					 to hospital inpatients are covered only to the extent that the period of
					 hospitalization is covered by the program.