California

Welfare and Institutions Code - WIC

7,184 sections, each with the official text and a plain-English explanation of what it means for you.

• § 14088.13 — The department shall approve those Medi-Cal services for which the contractor is at risk that shall be provided in any contract or contracts for services under the primary care provider case managemen
• § 14088.14 — The department may enter into contracts pursuant to this article with nurse practitioners, acting within the scope of practice of a nurse practitioner, certified nurse midwives, acting within the scop
• § 14088.15 — A plan shall not use false advertising or false statements to induce enrollment.
• § 14088.16 — The department or a county which has contracted for the provision of services pursuant to this article may, within service areas designated by the department, enter into contracts with primary care pr
• § 14088.17 — (a) The department may contract under this article, on an exclusive or nonexclusive basis, with an established professional organization with a membership which consists of physicians who engage in th
• § 14088.18 — (a) In order to increase the number of nonprofit providers under this article, the department may enter into contracts each fiscal year under this section with eligible nonprofit organizations to prov
• § 14088.19 — (a) The department may enter into primary care case management contracts pursuant to this article with any health care service plan that is licensed by the Director of the Department of Managed Health
• § 14088.2 — The primary care provider or other entity eligible pursuant to this article with whom a contract has been entered into pursuant to this article shall have responsibility for providing for case managem
• § 14088.22 — Sections 14408, 14409, 14410, and 14411 shall apply to primary care case management plans.
• § 14088.23 — (a) The department may apply one or more of the following sanctions against any contractor for failure to comply with the requirements of this article, regulations adopted by the department, the contr
• § 14088.25 — (a) The department may conduct onsite reviews of a provider or facility that has agreed with the primary care case management contractor or a potential contractor to provide services to beneficiaries
• § 14088.4 — (a) No reimbursement shall be provided, for any beneficiary receiving case management services, for any services covered by the contract entered into pursuant to this article, except emergency service
• § 14088.5 — The beneficiary shall be permitted to disenroll from any contract entered into pursuant to this article upon request, except where prohibited under the provisions of any federal waivers obtained by th
• § 14088.6 — In order to achieve maximum cost savings, the Legislature hereby determines that an expedited contract process for contracts under this article is necessary.
• § 14088.7 — Primary care providers and other entities with whom a contract has been entered into pursuant to this article shall be exempt from Chapter 2.
• § 14088.8 — (a) The department may establish modified primary care case management contracts pursuant to this article.
• § 14088.85 — (a) The department may enter into primary care case management contracts with primary care providers that serve persons infected with human immunodeficiency virus (HIV).
• § 14089 — (a) The purpose of this article is to provide a comprehensive program of managed health care plan services to Medi-Cal recipients residing in clearly defined geographical areas.
• § 14089.05 — (a) (1) The department may implement a multiplan project in the County of San Diego, upon approval of the Board of Supervisors of the County of San Diego, for the provision of benefits under this chap
• § 14089.07 — (a) The Sacramento County Department of Health and Human Services may establish a stakeholder advisory committee to provide input on the delivery of health care services provided in the county pursuan
• § 14089.08 — (a) Sacramento County may establish a stakeholder advisory committee to provide input on the delivery of oral health and dental care services, including prevention and education services, dental manag
• § 14089.09 — (a) It is the intent of the Legislature to improve access to oral health and dental care services provided to Medi-Cal beneficiaries enrolled in dental health managed care plans in the Counties of Sac
• § 14089.1 — In accordance with procedures required by Section 14408, all marketing activities shall require prior approval of the department.
• § 14089.2 — In accordance with procedures required by Chapter 8 (commencing with Section 14200), each contract with a capitated health system shall provide for a grievance procedure under which Medi-Cal beneficia
• § 14089.3 — The department shall not contract with insurance carriers, organized health systems, or provider organizations, that employ or subcontract with plans that employ providers under suspension from the Me
• § 14089.4 — The department may consult with the Department of Insurance or the Department of Managed Health Care, and shall consult with the Division of Medi-Cal Fraud and Elder Abuse within the Office of the Att
• § 14089.5 — (a) The department or its authorized agents shall conduct periodic audits or review, including onsite audits or review, to monitor compliance with Article 4 (commencing with Section 14400) of Chapter
• § 14089.6 — Current prepaid health plan and primary care case management contracts entered into by the department pursuant to Chapter 7 (commencing with Section 14088) and Chapter 8 (commencing with Section 14200
• § 14089.7 — (a) The department may adopt emergency regulations to implement this article in accordance with the rulemaking provisions of the Administrative Procedure Act (Chapter 3.
• § 14089.8 — (a) In order to achieve maximum cost savings, the Legislature finds and declares that an expedited contract process for contracts under this article is necessary.
• § 14091.21 — (a) Nursing facility services necessary for the treatment of illness or injury are covered subject to the provisions of this section: (b) Nursing facility services are covered only after prior authori
• § 14092 — It is the purpose of this article to ensure that the Medi-Cal program is operated in the most cost-effective and efficient manner possible by assuring that beneficiaries have early and ongoing access
• § 14092.05 — For purposes of this article “primary care provider” is defined as set forth in paragraph (1) of subdivision (a) of Section 14088.
• § 14092.1 — The department shall seek all federal waivers necessary to allow federal financial participation in expenditures under this article.
• § 14092.15 — The director shall investigate and may to the extent feasible require that: (a) Primary care providers specify their capacity to accept Medi-Cal Patients and obtain a primary care provider project cod
• § 14092.2 — The director may establish policy and procedures that assure that outpatient physician’s services, and any other Medi-Cal services the director may designate, provided by a source other than the prima
• § 14092.25 — In areas where a Medi-Cal beneficiary has the opportunity to enroll in a Medi-Cal managed care plan or to enroll with a primary care provider under this article, the director may require a beneficiary
• § 14092.3 — In implementing this article, the director has discretion to extend administrative or reimbursement flexibilities to participating primary care providers.
• § 14092.35 — To the extent that this article proves to be effective in reducing the cost of uncoordinated primary care delivered in the hospital emergency room or the costs of duplicative, unnecessary, or avoidabl
• § 14093 — The purpose of this article is to ensure quality of care and to provide increased access to health care services in the most cost-effective and efficient manner possible, to persons who are eligible t
• § 14093.05 — (a) (1) Except as otherwise authorized pursuant to this chapter, the director shall enter into contracts, under this chapter and Chapter 8 (commencing with Section 14200), with managed care plans lice
• § 14093.06 — (a) When a managed care contractor that is authorized to provide California Children’s Services (CCS) covered services pursuant to subdivision (a) of Section 14094.
• § 14093.07 — For purposes of this article the following definitions apply: (a) “Foster child” means any child who has been taken into custody or placed by a juvenile court pursuant to Article 6 (commencing with Se
• § 14093.08 — Sections 1371 and 1371.
• § 14093.09 — (a) No child in foster care shall be required to enroll in a Medi-Cal managed care plan.
• § 14093.10 — (a) Whenever a foster child enrolled in a county organized health system, established pursuant to Article 2.
• § 14094 — For purposes of this article “CCS” means California Children’s Services.
• § 14094.1 — (a) The director shall investigate and to the extent feasible require any managed care contractor serving children with conditions eligible under the CCS program, to maintain and follow standards of c
• § 14094.10 — (a) Each Medi-Cal managed care plan participating in the Whole Child Model program shall establish an assessment process that, at a minimum, does all of the following: (1) Assesses each CCS child’s or
• § 14094.11 — A Medi-Cal managed care plan participating in the Whole Child Model program shall meet all of the following requirements: (a) Ensure that each CCS-eligible child or youth receives case management, car
• § 14094.12 — A Medi-Cal managed care plan serving children and youth with CCS-eligible conditions under the CCS program shall do all of the following: (a) Coordinate with each regional center operating within the
• § 14094.13 — (a) Each Medi-Cal managed care plan shall establish and maintain a process by which a CCS-eligible child or youth may maintain access to CCS providers that the child or youth has an existing relations
• § 14094.14 — (a) Each Medi-Cal managed care plan participating in the Whole Child Model program shall provide a mechanism for a CCS-eligible child’s and youth’s parent or caregiver to request a specialist or clini
• § 14094.15 — A Medi-Cal managed care plan shall meet all of the following requirements: (a) Use all current and applicable CCS program guidelines, including CCS program regulations, CCS numbered letters, and CCS p
• § 14094.16 — (a) The department shall pay any managed care plan participating in the Whole Child Model program a separate, actuarially sound rate specifically for CCS children and youth, to the extent that an actu
• § 14094.17 — (a) A Medi-Cal managed care plan participating in the Whole Child Model program shall create and maintain a clinical advisory committee, composed of the managed care contractor’s chief medical officer
• § 14094.18 — (a) (1) The department shall contract with an independent entity that has experience in performing robust program evaluations to conduct an evaluation to assess Medi-Cal managed care plan performance
• § 14094.19 — This article is not intended, and shall not be interpreted, to permit any reduction in benefits or eligibility levels under the CCS program.
• § 14094.2 — (a) This article is not intended, and shall not be interpreted, to permit any reduction in benefits or eligibility levels under the CCS program.
• § 14094.20 — (a) Notwithstanding Chapter 3.
• § 14094.3 — (a) Notwithstanding this article or Section 14093.
• § 14094.4 — For the purposes of this article, the following definitions shall apply: (a) “CCS provider” means any of the following: (1) A medical provider that is paneled by the CCS program to treat a CCS-eligibl
• § 14094.5 — (a) No sooner than July 1, 2017, the department may establish a Whole Child Model program for Medi-Cal eligible CCS children and youth enrolled in a managed care plan served by a county organized heal
• § 14094.6 — The goals for the Whole Child Model program for children and youth under 21 years of age who meet the eligibility requirements of Section 123805 of the Health and Safety Code and are enrolled in a man
• § 14094.65 — This article shall not be construed to exclude or restrict the specialty of neonatology from reimbursement under the California Children’s Services (CCS) program, subject to the program’s existing or
• § 14094.7 — (a) No sooner than July 1, 2017, the department may implement the Whole Child Model program established under this section, pursuant to the criteria described in this article.
• § 14094.9 — (a) The department shall develop a memorandum of understanding template, which shall be utilized by participating counties and health plans, and which shall include, but not be limited to, the standar
• § 14095 — (a) For any entity or program that seeks to contract with the department to provide, or arrange for the provision of, managed health care services, disease management, or other health services contrac
• § 14100 — The administration of this chapter shall be carried out by the same agents as are authorized by the several boards of supervisors to administer the public assistance programs.
• § 14100.1 — For purposes of administering this chapter and Chapter 8 (commencing with Section 14200) of this part, the director shall have those powers and duties necessary to conform to requirements for securing
• § 14100.2 — (a) Except as provided in subdivision (i), all types of information, whether written or oral, concerning a person, made or kept by any public officer or agency in connection with the administration of
• § 14100.3 — (a) The State Department of Health Care Services shall post on its Internet Web site all submitted state plan amendments and all federal waiver applications and requests for new waivers, waiver amendm
• § 14100.5 — (a) The department shall prepare and submit Medi-Cal program assumptions and estimates to the Department of Finance.
• § 14100.51 — (a) Each year, by no later than January 10 and concurrently with the release of the May Revision, the State Department of Health Care Services shall provide to the fiscal committees of the Legislature
• § 14100.52 — (a) Each year, by no later than January 10 and concurrently with the release of the May Revision, the State Department of Health Care Services shall provide to the fiscal committees of the Legislature
• § 14100.6 — The department, in cooperation with the Controller, shall establish a method of providing to the Controller, periodically, updated information regarding changes in the roster of Medi-Cal providers.
• § 14100.7 — (a) Any Medi-Cal provider of incontinence supplies or medical supplies, or both, shall provide, to the department, a bond, or other security satisfactory to the department, of not less than twenty-fiv
• § 14100.75 — (a) (1) Each provider and each applicant, as defined in Section 14043.
• § 14100.8 — (a) For purposes of this section, “provider of home health agency services” means a home health agency that is licensed by the department under Section 1726 of the Health and Safety Code that meets th
• § 14100.9 — (a) For purposes of this section, “provider of durable medical equipment” means any person or entity that furnishes medical equipment and medical supplies, meets state and local laws applicable to the
• § 14101 — The director may contract with other state agencies for services in connection with the administration of this chapter, Chapter 8 (commencing with Section 14200), Chapter 8.
• § 14101.1 — The department shall enter into an agreement with the Secretary of Health, Education and Welfare under which such secretary will determine eligibility for Medi-Cal in the case of aged, blind or disabl
• § 14101.5 — The department and the State Department of Social Services shall provide to the other any information necessary for the performance of such department’s duties under this chapter.
• § 14101.7 — The Workers’ Compensation Appeals Board and the department shall exchange information and cooperate to assure that health services provided by Medi-Cal which are reimbursable by Workers’ Compensation
• § 14102 — (a) If any program under the Medi-Cal program that provides full-scope Medi-Cal benefits to an applicable individual is not statutorily specified in Section 5000A of the Internal Revenue Code (26 U.
• § 14102.5 — (a) The department shall, in collaboration with the Exchange, the counties, consumer advocates, and the Statewide Automated Welfare System consortia, develop and prepare one or more reports that shall
• § 14103 — (a) The implementation of the optional expansion of Medi-Cal benefits to adults who meet the eligibility requirements of Section 1902(a)(10)(A)(i)(VIII) of Title XIX of the federal Social Security Act
• § 14103.2 — Whenever the director determines that the services or products of a provider cost the program in excess of reasonable value received, the provider shall thereafter be disqualified from participation i
• § 14103.4 — The director, with the advice of the Medicaid Advisory Committee required by federal law or regulation, shall determine which of the health care and related remedial or preventive services are electiv
• § 14103.5 — (a) A noncontract hospital that is in a closed health facility planning area is not eligible to receive reimbursement for services provided to a Medi-Cal beneficiary, unless either of the following ap
• § 14103.6 — The director, or a carrier acting under regulations adopted by the director, may require that any individual provider shall receive prior authorization before providing services when the director or c
• § 14103.7 — The department shall develop procedure codes for durable medical equipment and orthotic and prosthetic equipment and services, to enable the fiscal intermediary to efficiently and expeditiously proces
• § 14103.75 — Prior authorization may be required by the director for services or items prescribed or ordered by a practitioner who has been determined by the director to have been prescribing or ordering medically
• § 14103.8 — (a) Medi-Cal services for beneficiaries who are eligible for services under the California Children’s Services Act (Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of Division 106 of
• § 14104 — (a) The department may, to the extent feasible, and to the extent permitted or required by applicable provisions of federal law, enter into agreements with organizations of licensed professional perso
• § 14104.3 — (a) The department may, to the extent feasible, enter into nonexclusive contracts providing arrangements under which funds available for health care under this chapter shall be administered and disbur
• § 14104.35 — (a) Any contract amendments, modifications, or change orders to a fiscal intermediary contract entered into by the department for the purposes of implementing Section 14104.
• § 14104.36 — (a) The following definitions apply for purposes of this section: (1) “Identified provider” means either a fee-for-service Medi-Cal provider or any other provider participating in a program administer
• § 14104.5 — Notwithstanding any other provision of law, the director shall by regulation adopt such procedures as are necessary for the review of a grievance or complaint concerning the processing or payment of m
• § 14104.6 — No Medi-Cal fiscal intermediary contract shall be approved, renewed or continued if a state employee is employed in a management, consultant or technical position by the contractor or a subcontractor
• § 14104.7 — The Director of the Department of Health Services shall negotiate a modification of the contract with Computer Sciences Corporation for the provision of fiscal intermediary services for the Medi-Cal p
• § 14104.8 — (a) The Secretary of the Health and Welfare Agency shall be responsible for oversight of the contract for fiscal intermediary services awarded by the State Department of Health Services to Computer Sc
• § 14104.9 — Any Medi-Cal contract for fiscal intermediary services entered into on or after January 1, 1992, shall permit the submission of all paper claims for hospital services using billing forms that are as s
• § 14104.93 — (a) The department may distribute provider bulletins and other provider communications for the Medi-Cal program by either print or electronic medium, including posting on the department’s Medi-Cal pro
• § 14105 — (a) The director shall prescribe the policies to be followed in the administration of this chapter, may limit the rates of payment for health care services, and shall adopt any rules and regulations a
• § 14105.05 — (a) Notwithstanding Section 14105, and any other provision of law, the director may, without taking regulatory action pursuant to Chapter 3.
• § 14105.06 — (a) Notwithstanding Section 14105 and any other provision of law, the Medi-Cal reimbursement rates in effect on August 1, 2003, shall remain in effect through July 31, 2005, for the following provider
• § 14105.07 — (a) The Legislature finds and declares all of the following: (1) Costs within the Medi-Cal program continue to grow due to the rising cost of providing health care throughout the state and also due to
• § 14105.075 — (a) (1) Notwithstanding any other law, for dates of service on or after August 1, 2016, payments to intermediate care facilities for the developmentally disabled that are licensed pursuant to subdivis
• § 14105.076 — (a) Notwithstanding any other law, for dates of service on or after January 1, 2024, the department shall adopt a rate year based on the calendar year for nursing facilities providing level A services
• § 14105.08 — (a) Notwithstanding any other provision of law, in order to implement changes in the level of funding for radiology services, as defined in Section 51139 of Title 22 of the California Code of Regulati
• § 14105.09 — Notwithstanding any other provision of law, if subdivision (b) of Section 3.
• § 14105.1 — (a) Notwithstanding any other provision of law, to the extent permitted by federal law, reimbursement to hospitals for inpatient services rendered to Medi-Cal program beneficiaries between July 1, 198
• § 14105.11 — (a) The department may negotiate settlements with acute care hospitals with psychiatric units that unintentionally violate Medi-Cal cost reimbursement policies or procedures governing the operation of
• § 14105.115 — (a) The department may negotiate or renegotiate settlements with any acute care hospital in San Diego County that has a distinct part pediatric convalescent facility and that has violated any Medi-Cal
• § 14105.12 — (a) The department shall specify circumstances under which requests shall be granted for authorization for services provided by a health facility licensed under subdivisions (c) and (d) of Section 125
• § 14105.13 — (a) Private duty nursing agencies shall be a provider of skilled nursing services provided on a shift basis covered under the early and periodic screening, diagnosis, and treatment supplemental and ho
• § 14105.15 — (a) (1) In determining rates of reimbursement for inpatient hospital services the department shall use the reimbursement policy existing on June 29, 1982.
• § 14105.16 — (a) The department may establish per diem or bundled reimbursement rates for pharmacies that provide home infusion supplies and services.
• § 14105.17 — (a) Each hospital designated by the department as a critical access hospital, and certified as such by the Secretary of the United States Department of Health and Human Services under the federal Medi
• § 14105.18 — (a) Notwithstanding any other law, provider rates of payment for services rendered in all of the following programs shall be identical to the rates of payment for the same service performed by the sam
• § 14105.181 — (a) For purposes of this section, the following definitions shall apply: (1) “The Family Planning, Access, Care, and Treatment (Family PACT) waiver” or “Family PACT waiver” means the program described
• § 14105.19 — (a) Notwithstanding any other provision of law, in order to implement changes in the level of funding for health care services, the director shall reduce provider payments as specified in this section
• § 14105.191 — (a) Notwithstanding any other provision of law, in order to implement changes in the level of funding for health care services, the director shall reduce provider payments, as specified in this sectio
• § 14105.192 — (a) The Legislature finds and declares all of the following: (1) Costs within the Medi-Cal program continue to grow due to the rising cost of providing health care throughout the state and also due to
• § 14105.193 — (a) (1) Notwithstanding paragraph (7) of subdivision (j) of Section 14105.
• § 14105.194 — (a) (1) Notwithstanding Sections 14105.
• § 14105.195 — (a) Notwithstanding Sections 14105.
• § 14105.197 — (a) For dates of service on and after July 1, 2022, or the effective date of any necessary federal approvals as required by subdivision (b), whichever is later, the reimbursement rates or payments for
• § 14105.2 — (a) The allowable markup payable for the dispensing of medical supplies, including diabetic supplies except as indicated in subdivision (b), by assistive device and sickroom supply dealers and pharmac
• § 14105.200 — (a) The Medi-Cal Provider Payment Reserve Fund is hereby created in the State Treasury.
• § 14105.201 — (a) (1) Notwithstanding any other law, for dates of service no sooner than January 1, 2024, or on the effective date of any necessary federal approvals as required by subdivision (e), whichever is lat
• § 14105.21 — (a) An assistive device and sickroom supply dealer may not bill the Medi-Cal program for prosthetic and orthotic appliances.
• § 14105.22 — (a) (1) It is the intent of the Legislature that the department develop reimbursement rates for clinical laboratory or laboratory services that are comparable to the payment amounts received from othe
• § 14105.221 — Notwithstanding Section 51501(a) of Title 22 of the California Code of Regulations, donation of, or discounts for, clinical laboratory tests or examinations or laboratory services to a federally quali
• § 14105.222 — (a) Notwithstanding Section 14105.
• § 14105.23 — (a) Reimbursement for portable X-ray transportation services, as defined in paragraph (2) of subdivision (b) of Section 51531 of Title 22 of the California Code of Regulations, shall not exceed 100 pe
• § 14105.24 — (a) Clinics and hospital outpatient departments, except for emergency rooms, owned or operated by Los Angeles County that participated in the California Section 1115 Medicaid Demonstration Project for
• § 14105.25 — (a) Notwithstanding any other provision of law, to the extent permitted by federal law and regulations, the maximum rate of reimbursement under the Medi-Cal program for any service or item that is a b
• § 14105.26 — (a) Each eligible facility, as described in paragraph (2) of subdivision (b), may, in addition to the rate of payment that the facility would otherwise receive for skilled nursing services, receive su
• § 14105.27 — (a) Each eligible facility, as described in subdivision (b) may, in addition to the rate of payment that the facility would otherwise receive for skilled nursing services, receive supplemental Medi-Ca
• § 14105.28 — (a) It is the intent of the Legislature to design a new Medi-Cal inpatient hospital reimbursement methodology based on diagnosis-related groups that more effectively ensures all of the following: (1)
• § 14105.281 — (a) The Legislature finds and declares all of the following: (1) That because the implementation of Section 14105.
• § 14105.29 — (a) (1) Subject to subdivision (d), additional Medi-Cal payments shall be made to designated public hospitals and their affiliated government entities, in recognition of the Medi-Cal managed care shar
• § 14105.291 — (a) (1) Subject to subdivision (d), additional Medi-Cal payments shall be made to district and municipal hospitals and their affiliated government entities, in recognition of the Medi-Cal managed care
• § 14105.3 — (a) The department is considered to be the purchaser, but not the dispenser or distributor, of prescribed drugs under the Medi-Cal program for the purpose of enabling the department to obtain from man
• § 14105.31 — For purposes of the Medi-Cal contract drug list, the following definitions shall apply: (a) “Single-source drug” means a drug that is produced and distributed under an original New Drug Application ap
• § 14105.33 — (a) The department may enter into contracts with manufacturers of single-source and multiple-source drugs, on a bid or nonbid basis, for drugs from each major therapeutic category, and shall maintain
• § 14105.332 — State and federal rebates that are owed to the state for drugs dispensed to Medi-Cal beneficiaries shall not be reduced to the state if a manufacturer reports, to the federal Centers for Medicare and
• § 14105.334 — (a) Notwithstanding any other law, upon approval of the Department of Finance, the department shall seek the necessary federal approvals to establish and administer a drug rebate program to collect re
• § 14105.34 — (a) The department shall provide for an annual written report of Medi-Cal pharmacy costs or Medi-Cal drug costs, as defined in subdivision (e) of Section 14105.
• § 14105.35 — (a) (1) On and after July 1, 1990, drugs included on the Medi-Cal drug formulary shall be included on the list of contract drugs until the department and the manufacturer have concluded contract negot
• § 14105.36 — (a) (1) The Medi-Cal Drug Rebate Fund is hereby created in the State Treasury.
• § 14105.37 — (a) The department shall notify each manufacturer of drugs in therapeutic categories selected pursuant to Section 14105.
• § 14105.38 — When the department determines that a drug should be removed from the list of contract drugs, the department shall provide individual notice to impacted beneficiaries, at least 60 calendar days prior
• § 14105.39 — (a) (1) A manufacturer of a new single-source drug may request inclusion of its drug on the list of contract drugs pursuant to Section 14105.
• § 14105.395 — (a) The department may implement utilization controls through the establishment of guidelines, protocols, algorithms, or criteria for drugs, medical supplies, durable medical equipment, and enteral fo
• § 14105.4 — (a) The director shall appoint a Medi-Cal Contract Drug Advisory Committee for the purpose of providing scientific and medical analysis on drugs contained on the list of contract drugs.
• § 14105.405 — (a) A Medi-Cal beneficiary, within 90 days of receipt of the director’s notice to beneficiaries pursuant to subdivision (i) of Section 14105.
• § 14105.406 — The director shall, in considering suspension or deletion of drugs from the list of contract drugs, ensure that the department has the ability to process drug treatment authorization requests (TARs) w
• § 14105.41 — Moneys accruing to the department from contracts executed pursuant to Section 14105.
• § 14105.42 — (a) The department shall report to the Legislature after the first three major therapeutic categories have been reviewed and contracts executed.
• § 14105.425 — The provisions of Sections 14105.
• § 14105.43 — (a) (1) Notwithstanding other provisions of this chapter, any drug which is approved by the federal Food and Drug Administration for use in the treatment of acquired immunodeficiency syndrome (AIDS) o
• § 14105.435 — (a) Within 60 days of the approval of a drug in accordance with subdivision (a) of Section 14105.
• § 14105.436 — (a) Effective July 1, 2002, all pharmaceutical manufacturers shall provide to the department a state rebate, in addition to rebates pursuant to other provisions of state or federal law, for any drug p
• § 14105.44 — (a) The department shall establish an expedited review process to examine the effectiveness of investigational drugs and investigational services, and their eligibility for Medi-Cal reimbursement.
• § 14105.45 — (a) For purposes of this section, the following definitions shall apply: (1) “Actual acquisition cost” has the same meaning as that term is defined in Section 447.
• § 14105.451 — (a) (1) The Legislature finds and declares all of the following: (A) The United States Department of Health and Human Services has identified the critical need for state Medicaid agencies to establish
• § 14105.455 — (a) Pharmacy providers shall submit their usual and customary charge when billing the Medi-Cal program for prescribed drugs.
• § 14105.456 — (a) For purposes of this section, the following definitions shall apply: (1) “Blood factors” has the same meaning as that term is defined in Section 14105.
• § 14105.46 — (a) For purposes of this section: (1) “Covered entity” means a provider defined as a covered entity in Section 256b of Title 42 of the United States Code.
• § 14105.467 — (a) The department shall establish, implement, and maintain a supplemental payment pool for nonhospital 340B community clinics, subject to an appropriation by the Legislature.
• § 14105.468 — (a) (1) Beginning for dates of service on or after January 1, 2025, the department shall establish and implement a directed payment program under which a qualifying nonhospital 340B community clinic m
• § 14105.47 — (a) (1) The department shall establish a list of medical supplies.
• § 14105.475 — (a) In maintaining the lists of medical supplies, incontinence medical supplies, and enteral nutrition products, the department may perform a review of, and contract for, various products in a specifi
• § 14105.48 — (a) The department shall establish a list of covered services and maximum allowable reimbursement rates for durable medical equipment, as defined in Section 51160 of Title 22 of the California Code of
• § 14105.49 — (a) (1) The department shall establish a list of Healthcare Common Procedure Coding System (HCPCS) codes billable to the Medi-Cal program and reimbursement rates, subject to Section 51319 of Title 22
• § 14105.5 — The director or prepaid health plans shall make no payment for services rendered prior to January 1, 1977, to any health facility that secures a license under the provisions of Chapter 2 (commencing w
• § 14105.51 — (a) The department shall establish “capped rental” reimbursement for specific items of durable medical equipment.
• § 14105.6 — No health facility licensed under the provisions of Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code shall be entitled to receive, or shall receive, any payment wha
• § 14105.7 — (a) In order to fairly reimburse pharmacies for the furnishing of prescription drugs to Medi-Cal beneficiaries, the director shall update allowable drug product prices within seven days of receiving n
• § 14105.75 — (a) In order to ensure that drug products in an injectable form that are not administered by the patient are available to Medi-Cal beneficiaries pursuant to federal law, the department shall do all of
• § 14105.8 — (a) The department may enter into contracts with manufacturers of enteral nutrition products that can be used as a therapeutic regimen to prevent serious disability or death in patients with medically
• § 14105.85 — (a) Effective July 1, 2002, payment for enteral nutrition products dispensed by a pharmacy provider shall be based on the estimated acquisition cost for that product plus a percentage markup to be det
• § 14105.86 — (a) For the purposes of this section, the following definitions apply: (1) (A) “Average sales price” means the price reported to the federal Centers for Medicare and Medicaid Services by the manufactu
• § 14105.94 — (a) An eligible provider, as described in subdivision (b), may, in addition to the rate of payment that the provider would otherwise receive for Medi-Cal ground emergency medical transportation servic
• § 14105.945 — (a) For purposes of this section, the following definitions apply: (1) “Eligible provider” means a provider who is eligible for reimbursement of Medi-Cal emergency medical transports pursuant to this
• § 14105.95 — (a) Each eligible facility, as described in subdivision (b), may, in addition to the rate of payment that the facility would otherwise receive for adult day health services, receive supplemental Medi-
• § 14105.96 — (a) Each eligible facility, as described in subdivision (b), may, in addition to the rate of payment that the facility would otherwise receive for Medi-Cal outpatient services, receive supplemental Me
• § 14105.97 — (a) The department shall annually develop an outpatient disproportionate share factor for each hospital in California that receives Medi-Cal payments for outpatient services.
• § 14105.98 — (a) The following definitions shall apply for purposes of this section: (1) “Disproportionate share list” means an annual list of disproportionate share hospitals that provide acute inpatient services
• § 14105.982 — (a) (1) The department may adopt emergency regulations in accordance with Chapter 3.
• § 14105.985 — (a) (1) Disproportionate share payment augmentation programs shall be maintained for eligible providers pursuant to Section 14087.
• § 14105.986 — (a) Any children’s hospital as defined in Section 10727 that holds a consolidated license issued pursuant to subparagraph (C) of paragraph (4) of subdivision (b) of Section 1250.
• § 14105.99 — (a) For purposes of this section, “Attachment 4.
• § 14106 — If a Medi-Cal provider negotiates a rate of payment for inpatient, outpatient, or ancillary services with a prepaid health plan under contract with the department pursuant to Chapter 8 (commencing wit
• § 14106.2 — Insofar as permitted by federal law, for purposes of determining the reasonable costs of any service reimbursable under the provisions of this chapter, or determining prospective per capita rates of p
• § 14106.6 — The director shall establish and update annually a rate schedule of reimbursement for paramedic services which provides reimbursement based upon reasonable cost standards of the department.