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.

• § 14107 — (a) Any person, including any applicant or provider as defined in Section 14043.
• § 14107.1 — Any provider on whose behalf improper claims are submitted for authorization or payment under this chapter may be required to submit all such claims over the provider’s own signature for whatever time
• § 14107.11 — (a) Upon receipt of a credible allegation of fraud as defined in subdivision (d) and for which an investigation is pending under the Medi-Cal program against a provider as defined in Section 14043.
• § 14107.115 — (a) The Medi-Cal Anti-Fraud Special Deposit Fund is hereby created in the State Treasury.
• § 14107.12 — (a) The Department of Justice may pay, pursuant to subdivision (d), from funds recovered by the Department of Justice, and only to the extent that the money may be used for this purpose, a reward to a
• § 14107.13 — (a) (1) The department, in conjunction with the Department of Justice, shall identify those areas of the fee-for-service Medi-Cal program that are at greatest risk of fraud or abuse.
• § 14107.2 — (a) Any person who solicits or receives any remuneration, including, but not restricted to, any kickback, bribe, or rebate, directly or indirectly, overtly or covertly, in cash or in valuable consider
• § 14107.3 — Any person who knowingly and willfully charges, solicits, accepts, or receives, in addition to any amount payable under this chapter, any gift, money, contribution, donation, or other consideration as
• § 14107.4 — (a) Any person who, with the intent to defraud, certifies as true and correct any cost report, submitted by a hospital to a state agency for reimbursement pursuant to Section 14170, who knowingly fail
• § 14107.5 — (a) The department may, pursuant to regulations adopted pursuant to subdivision (b), rescind the privileges of a provider of durable medical equipment or incontinence supplies who fails to satisfy the
• § 14108 — Any developmentally disabled recipient under this chapter receiving care in a nursing facility or any category of intermediate care facility for the developmentally disabled is entitled as a part of t
• § 14108.1 — Any recipient receiving care in a nursing facility under this chapter, as part of a certified special treatment program for persons with mental illnesses, or as a part of a mental health therapeutic a
• § 14108.2 — Except as provided by Section 14108 and Section 14108.
• § 14109 — In determining the medical needs of any person eligible under this chapter, and the amount of health care such person is entitled to receive, the department shall include the cost of any deductibles o
• § 14109.5 — Notwithstanding the provisions of Section 14109, effective January 1, 1982, the reimbursement rate for costs specified in Section 14109 for all services, including, but not limited to, hospital inpati
• § 14109.6 — Notwithstanding Section 14109, effective September 1, 1997, and pursuant to Section 1396a(n) of Title 42 of the United States Code, as amended by Section 4714 of the federal Balanced Budget Act of 199
• § 14110 — No payment for care or services shall be made under Medi-Cal to a medical or health care facility unless it has been certified by the department for participation, and it meets one of the following: (
• § 14110.05 — (a) The department shall ensure that nursing facility applicants have access to assistance in identifying and securing the information necessary to complete the Medi-Cal application and to make the el
• § 14110.1 — Medi-Cal reimbursements for long-term care in any hospital shall be at a rate not to exceed the maximum rate paid for long-term care in nursing facilities which are distinct parts of acute care hospit
• § 14110.15 — (a) The department shall develop, collect, and maintain, in an electronic format, all data elements in the minimum data set specified by the federal government.
• § 14110.2 — The director shall, unless precluded by federal law or regulation, amend the state plan under Title XIX of the Social Security Act to conform to the policy directions and budgetary decisions of the Le
• § 14110.3 — Until the Secretary of Health, Education and Welfare establishes, by regulation, standards in accordance with Title XIX of the Federal Social Security Act for intermediate care facilities, there shall
• § 14110.4 — (a) All laundry services for all apparel, linen, garments, towels, and hospital gowns shall be provided by a nursing facility or any category of intermediate care facility for the developmentally disa
• § 14110.5 — Effective January 1, 1977, no payment for any prescription ophthalmic device shall be made under Medi-Cal if that device does not meet the standards adopted by the department, the State Board of Optom
• § 14110.55 — For the purposes of the pilot program established under Section 14495.
• § 14110.6 — (a) The director shall adopt regulations, establishing payment rates for nursing facilities, intermediate care facilities/developmentally disabled, and intermediate care facilities/developmentally dis
• § 14110.7 — (a) The director shall adopt regulations increasing the minimum number of equivalent nursing hours per patient required in skilled nursing facilities to 3.
• § 14110.8 — (a) For the purposes of this section: (1) “Facility” means any long-term health care facility as defined in subdivisions (c), (d), (e), (g), and (h) of Section 1250 of the Health and Safety Code.
• § 14110.9 — No nursing facility or any category of intermediate care facility for the developmentally disabled may require a security deposit from a Medi-Cal beneficiary who applies for admission to the facility.
• § 14111 — (a) As permitted by federal law or regulations, for health care services provided in a long-term health care facility that are reimbursed by Medicare, a physician and surgeon may delegate any of the f
• § 14111.5 — (a) As permitted by federal law or regulations, for health care services provided in a long-term health care facility that are reimbursed under this chapter, a nurse practitioner may, to the extent co
• § 14112 — Health care provided pursuant to this chapter shall not constitute a lien against the property of any recipient or medically indigent or other person eligible under this chapter.
• § 14113 — The department shall enter into cooperative arrangements with the Department of Rehabilitation and any other state agency or department responsible for health or vocational rehabilitation services in
• § 14114 — (a) This section shall be known, and may be cited, as Medi-Cal Physicians and Dentists Loan Repayment Program Act.
• § 14115 — (a) Bills for service under this chapter shall be submitted not more than six months after the month in which the service is rendered, and shall be in the form prescribed by the director, except that
• § 14115.1 — The department may not require that any hospital based physician submit a combined charge, which includes the physician and hospital charge, if it is not the customary practice of such physician to su
• § 14115.2 — (a) The department shall not require nursing facilities or any category of intermediate care facility for the developmentally disabled, as defined in Section 1250 of the Health and Safety Code to orig
• § 14115.3 — The department shall permit a nurse anesthetist to bill independently for services rendered by such nurse anesthetist.
• § 14115.4 — If the Budget Act should in any budget year restrict payment for pathology services under the Medi-Cal program to only the provider who actually performs those services, this restriction shall not pro
• § 14115.41 — (a) For services that are performed at a central laboratory as authorized pursuant to Section 1241.
• § 14115.5 — Moneys payable or rights existing under this chapter shall be subject to any claim, lien or offset of the State of California, and any claim of the United States of America made pursuant to federal st
• § 14115.7 — (a) The department, with the assistance of the Controller, shall develop a procedure by which approved claims for services rendered may be reimbursed through a means of electronic transfer of funds to
• § 14115.75 — (a) As a condition of payment for goods, supplies, and merchandise provided to Medi-Cal beneficiaries by a provider that receives or makes annual payments of at least five million dollars ($5,000,000)
• § 14115.8 — (a) (1) The department shall amend the Medicaid state plan with respect to the billing option for services by local educational agencies (LEAs), to ensure that schools shall be reimbursed for all elig
• § 14116 — The director of a county agency which administers the provisions of this chapter and also administers medical facilities may not delegate to an employee the decision to authorize or deny aid under thi
• § 14117 — Information relating to the medication provided to Medi-Cal recipients, shall be disclosed by the department or its agents, to physicians who are treating those same recipients as patients, upon reque
• § 14119 — The director shall employ sufficient consultants to assure compliance with the provisions of this code and the regulations, and the protection of the best interests of the state, and no county shall e
• § 14120 — (a) At the beginning of each fiscal year, for the current fiscal year, the director shall establish a monthly schedule of anticipated total payments and anticipated payments for categories of services
• § 14122 — The department may provide, by regulation and consistent with the requirements of the Federal Social Security Act, for the care and treatment, or both, of persons eligible for medical assistance pursu
• § 14123 — Participation in the Medi-Cal program by a provider of service is subject to suspension in order to protect the health of the recipients and the funds appropriated to carry out this chapter.
• § 14123.05 — The department shall develop, in consultation with provider representatives, including, but not limited to, physician, pharmacy, and medical supplies providers, a process that enables a provider to me
• § 14123.1 — Subdivision (a) of Section 14123 as added by Section 2 of Chapter 994 of the Statutes of 1969 does not constitute a change in, but is declaratory of, the preexisting law, and shall be construed merely
• § 14123.2 — Any provider or person that presents or causes to be presented a claim for services to an officer, employee, or agent of the state, or of any department or agency thereof as defined in appropriate sta
• § 14123.25 — (a) In lieu of, or in addition to, the imposition of any other sanction available to it, including the sanctions and penalties authorized under Section 14123.
• § 14124 — Notice of any suspension under Section 14123, along with any information obtained as a result of the director’s investigation shall be sent by the director to the appropriate state licensing, certifyi
• § 14124.1 — Each provider, as defined in Section 14043.
• § 14124.10 — (a) No licensed long-term health care facility participating as a provider under the Medi-Cal program shall discriminate against a Medi-Cal patient on the basis of the source of payment for the facili
• § 14124.11 — (a) The department shall establish a two-year pilot program to utilize the federal Public Assistance Reporting Information System (PARIS) to identify veterans and their dependents or survivors who are
• § 14124.12 — (a) (1) Notwithstanding any other law, for the duration of the COVID-19 emergency period, the department shall implement any federal Medicaid program waiver or flexibility approved by the federal Cent
• § 14124.13 — (a) The department may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis for purpose of administering or implementing any federal grant awarded
• § 14124.14 — (a) The department shall develop and submit an application to solicit a grant authorized under Section 9007 of the federal 21st Century Cures Act (42 U.
• § 14124.15 — (a) Effective January 1, 2023, subject to appropriation by the Legislature, the department shall design and implement a supplemental payment program for emergency medical air transportation services t
• § 14124.16 — (a) (1) Upon appropriation by the Legislature for this purpose, the department shall complete an independent analysis to determine whether network adequacy exists to obtain federal approval for a cove
• § 14124.2 — (a) (1) During normal working hours, the department may make any examination of the books and records of, and may visit and inspect the premises or facilities of, those identified in paragraphs (2) an
• § 14124.20 — (a) The department may enter into a Drug Medi-Cal Treatment Program contract with each county for the provision of alcohol and drug use services within the county service area.
• § 14124.21 — (a) If a county decides to not enter a Drug Medi-Cal Treatment Program contract with the department, the county shall notify the department of this decision in writing by the May 20 preceding the fisc
• § 14124.22 — (a) In addition to narcotic treatment program services, a narcotic treatment program provider who is also enrolled as a Medi-Cal provider may provide medically necessary medical treatment of concurren
• § 14124.23 — The department may enter into contracts for the procurement of services to assist the department in administering the Drug Medi-Cal Treatment Program.
• § 14124.24 — (a) For purposes of this chapter, “Drug Medi-Cal reimbursable services” means the substance use disorder services described in the California Medicaid State Plan and includes, but is not limited to, a
• § 14124.25 — Service providers may assist Medi-Cal beneficiaries, upon request, to file a fair hearing request in accordance with Chapter 7 (commencing with Section 10950) of Part 2, or may inform Medi-Cal benefic
• § 14124.26 — (a) Except as provided in subdivisions (b) and (c), regulations adopted by the State Department of Alcohol and Drug Programs pursuant to former Sections 11758.
• § 14124.29 — (a) If the department seeks a waiver pursuant to subdivision (a) of Section 14021.
• § 14124.3 — Notice of any act of the department required by law or department regulation to be given may be signed and given by the director or an authorized employee of the department and may be made personally
• § 14124.39 — Title This article shall be known and may be cited as the Protect Patients Now Act of 2024.
• § 14124.4 — The director may on his own motion at any time before a suspension is placed into effect and without further proceedings, review the penalty against a provider, but such review shall be limited to red
• § 14124.40 — Findings and Declarations (a) In 1992, the federal government established a program giving safety net health care providers access to discounted prescription drugs.
• § 14124.41 — Statement of Intent In enacting this article, the purpose and intent of the people of the State of California is to do all of the following: (a) To permanently authorize the Medi-Cal Rx program so tha
• § 14124.42 — Permanent Authorization for the Medi-Cal Rx Program The State Department of Health Care Services is authorized to provide and administer Medi-Cal pharmacy services under a single statewide fee-for-ser
• § 14124.43 — Limitation on Pharmacy Sales Agreements Involving Prescription Drug Price Manipulators (a) On and after January 1, 2025, a prescription drug price manipulator shall not enter into, or participate in,
• § 14124.44 — Patient Protection Requirements Imposed on Prescription Drug Price Manipulators Notwithstanding any other provision of law, on and after January 1, 2025, a prescription drug price manipulator shall on
• § 14124.45 — Oversight of Prescription Drug Price Manipulators (a) (1) In order to determine compliance with Section 14124.
• § 14124.46 — Conclusions Regarding Compliance (a) (1) Within 60 calendar days of the deadline established pursuant to subdivision (e) of Section 14124.
• § 14124.47 — Final Determinations Notwithstanding any other provision of law, if a prescription drug price manipulator is finally determined pursuant to the procedures set forth in this article to have violated th
• § 14124.48 — Definitions For purposes of this article, as used in both the singular and plural form, the following definitions shall apply: (a) “Clinic” means an entity operating as one or more of the clinics desc
• § 14124.49 — Unprofessional Conduct, Dishonest Dealing, and Conduct Inimical to Public Health, Welfare, or Safety (a) In addition to any other conduct, standard, or requirement described in Article 7 (commencing w
• § 14124.5 — (a) The director may, in accordance with Section 10725, adopt, amend, or repeal, in accordance with Chapter 3.
• § 14124.50 — State and Local Grants and Contracts Eligibility (a) (1) The people of California hereby find and declare that their state and local tax dollars should not be awarded to prescription drug price manipu
• § 14124.51 — Public Input The Attorney General, the California State Board of Pharmacy, the Department of Managed Health Care, and the State Department of Public Health shall invite, and provide a process for subm
• § 14124.52 — Effective Date and Severability (a) This article shall take effect on the next January 1 following its adoption by the voters.
• § 14124.6 — In the event the director orders that oral argument or a hearing be held upon a petition for reinstatement or reduction of penalty filed pursuant to Section 11522 of the Government Code, he or she may
• § 14124.7 — (a) No long-term health care facility participating as a provider under the Medi-Cal program shall seek to evict out of the facility or, effective January 1, 2002, transfer within the facility, any re
• § 14124.70 — As used in this article: (a) “Carrier” includes any insurer as defined in Section 23 of the Insurance Code, including any private company, corporation, mutual association, trust fund, reciprocal or in
• § 14124.71 — (a) When benefits are provided or will be provided to a beneficiary under this chapter because of an injury for which another party is liable, or for which a carrier is liable in accordance with the p
• § 14124.72 — (a) If an action is brought by the director pursuant to Section 14124.
• § 14124.73 — (a) If either the beneficiary or the director brings an action or claim against such third party or carrier, the beneficiary or the director shall within 30 calendar days of filing the action give to
• § 14124.74 — In the event of a settlement, judgment, or award in a suit or claim against a third party or carrier: (a) If the action or claim is prosecuted by the beneficiary alone, the court or agency shall first
• § 14124.75 — The court or agency shall, upon further application at any time before the judgment or award is satisfied, allow as a further lien the reasonable value of additional benefits provided arising out of t
• § 14124.76 — (a) No settlement, judgment, or award in any action or claim by a beneficiary to recover damages for injuries, where the director has an interest, shall be deemed final or satisfied without first givi
• § 14124.77 — When the director has perfected a lien upon a judgment or award in favor of a beneficiary against any third party for an injury for which the beneficiary has received benefits under the Medi-Cal Progr
• § 14124.78 — Notwithstanding any other provision of law, in no event shall the director recover more than the beneficiary recovers after deducting, from the settlement judgment, or award, attorney’s fees and litig
• § 14124.785 — The director’s recovery is limited to the amount derived from applying Section 14124.
• § 14124.79 — In the event that the beneficiary, his guardian, conservator, personal representative, estate or survivors or any of them brings an action against the third person who may be liable for the injury, no
• § 14124.791 — (a) Subject to the director’s prior right of recovery, a provider who has rendered services to a beneficiary because of an injury for which a third party is liable and who has received payment under t
• § 14124.792 — If any provision of this article, or the application of any provision of this article to any person, firm, corporation, or other entity or to any circumstance or situation, shall be held invalid, the
• § 14124.795 — It is the intent of the Legislature to comply with federal law requiring that when a beneficiary has other available health coverage or insurance, the Medi-Cal program shall be the payer of last resor
• § 14124.81 — (a) The department shall administer the provisions of Sections 14124.
• § 14124.82 — (a) The department, in its reasonable discretion, may execute one or more at-risk performance contracts to identify, quantify, or recover, or any combination thereof, Medi-Cal payments from responsibl
• § 14124.83 — The agreement shall include, but is not limited to, the following provisions: (a) The agreement shall stipulate when the contractor may identify, quantify, or recover amounts owing by third parties th
• § 14124.84 — The department shall provide the contractor with such information as is reasonably necessary for the contractor to perform its obligations under the contract, including accounting data and other infor
• § 14124.86 — The contractor shall retain its rights to compensation upon recovery for completed duties under the contract with respect to any claims or liens processed in whole or in part prior to the termination
• § 14124.89 — (a) (1) This section applies to all of the following entities: (A) Health insurer, or any health care entity licensed through the Department of Insurance.
• § 14124.90 — (a) (1) It is the intent of the Legislature to comply with federal law requiring that when a beneficiary has third-party health coverage or insurance, the State Department of Health Care Services shal
• § 14124.91 — The State Department of Health Services shall, whenever it is cost-effective, pay the premium for third-party health coverage for beneficiaries under this chapter.
• § 14124.92 — (a) The department may pay administrative expenses and make incentive payments to any county, state, or federal agency, or a contracting agent of the department for identifying and reporting third-par
• § 14124.94 — (a) When the rights of a Medi-Cal beneficiary to health care benefits from an insurer have been assigned to the department, an insurer shall not impose any requirement on the department that is differ
• § 14125 — (a) The purpose of this article is to establish provider reimbursement rates for incontinence medical supplies covered by the Medi-Cal program.
• § 14125.1 — Unless the context requires otherwise, the definitions set forth in this section shall govern the construction and meaning of the terms and phrases used in this article.
• § 14125.2 — (a) (1) To qualify for Medi-Cal coverage a product shall be in general retail distribution, sold to the general public, and comply with any standards for products established by law or regulation.
• § 14125.3 — The department shall reduce the weighted average of the negotiated contract prices within each product category in effect on June 30, 1992, as follows: (a) For all premium underpads, as defined by the
• § 14125.4 — (a) No later than January 1, 1994, the department shall establish utilization controls that limit expenditures for incontinence medical supplies per beneficiary to no more than one hundred sixty-five
• § 14125.8 — (a) In order to more fully identify the owner or owners of companies or corporations that apply to be or currently are providers of incontinence medical supplies, within 30 days of the receipt of a re
• § 14125.9 — Nothing in this article shall be interpreted as limiting or interfering in any way with the department’s authority to contract for the provision of incontinence medical supplies pursuant to subdivisio
• § 14126 — This article shall be known as the Medi-Cal Long-Term Care Reimbursement Act.
• § 14126.02 — (a) It is the intent of the Legislature to devise a Medi-Cal long-term care reimbursement methodology that more effectively ensures individual access to appropriate long-term care services, promotes q
• § 14126.021 — The department shall develop and implement a cost-based reimbursement rate methodology using the cost categories as described in Section 14126.
• § 14126.023 — (a) The methodology developed pursuant to this article shall be facility specific and reflect the sum of the projected cost of each cost category and passthrough costs, as follows: (1) Labor costs lim
• § 14126.024 — (a) For managed care rating periods that begin between January 1, 2023, and December 31, 2025, inclusive, the department, in consultation with representatives from the long-term care industry, organiz
• § 14126.025 — (a) The department shall seek approval of an amendment to the Medicaid state plan specifically outlining the reimbursement methodology developed pursuant to this article not later than February 1, 200
• § 14126.026 — (a) Notwithstanding any other law, and in addition to any other remedial action available to the department, if a skilled nursing facility fails to meet or exceed one or more of the measures developed
• § 14126.027 — Notwithstanding the rulemaking provisions of Chapter 3.
• § 14126.028 — (a) The Legislature finds and declares both of the following: (1) Section Q of the Minimum Data Set, Version 3.
• § 14126.029 — (a) For purposes of this section, the following definitions apply: (1) “Long-term health care facility” means a skilled nursing facility or nursing facility as those terms are defined in paragraph (1)
• § 14126.031 — (a) In implementing this article, the department may use the process outlined in subdivision (c) of Section 14126.
• § 14126.032 — (a) (1) Notwithstanding any other law, the department shall audit the costs and revenues of skilled nursing facilities that are associated with the COVID-19 Public Health Emergency, as determined by t
• § 14126.033 — (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
• § 14126.034 — (a) (1) The department shall convene a workgroup of interested stakeholders to make recommendations to the department to ensure compliance with the intent of this article, as provided in subdivision (
• § 14126.035 — (a) This article shall remain operative only as long as Article 7.
• § 14126.036 — This article shall become inoperative after December 31, 2026, except that the department shall be authorized to conduct all necessary closeout activities after this date and to continue implementing
• § 14129 — For purposes of this article, the following definitions apply: (a) “Annual quality assurance fee rate” means the quality assurance fee assessed on each emergency medical transport during each applicab
• § 14129.1 — (a) (1) The department shall establish the manner and format for emergency medical transport providers to report the data required pursuant to this section.
• § 14129.2 — (a) (1) Commencing with the state fiscal quarter beginning on July 1, 2018, and continuing each state fiscal quarter thereafter for which this article is implemented, there shall be imposed a quality
• § 14129.3 — (a) Except as provided in subdivision (i) of Section 14105.
• § 14129.4 — If there is a delay in the implementation of this article for any reason, including a delay in any required approval of the quality assurance fee and reimbursement methodology specified by the federal
• § 14129.5 — Notwithstanding Chapter 3.
• § 14129.6 — (a) (1) The department shall request any approval from the federal Centers for Medicare and Medicaid Services it deems necessary for the use of fees pursuant to this article and for the purpose of rec
• § 14129.7 — (a) This article shall be implemented only if, as long as, and to the extent that, all of the following conditions are met: (1) The federal Centers for Medicare and Medicaid Services does not determin
• § 14131 — The Medi-Cal Benefits Program comprises a department-administered uniform schedule of health care benefits.
• § 14131.05 — (a) Notwithstanding any other provision of this chapter or Chapter 8 (commencing with Section 14200), optional hearing aid benefits are subject to per beneficiary benefit cap amounts under the Medi-Ca
• § 14131.10 — (a) Notwithstanding this chapter, Chapter 8 (commencing with Section 14200), or Chapter 8.
• § 14131.11 — (a) Notwithstanding any other provision of this chapter or Chapter 8 (commencing with Section 14200), any increase in the amount charged to the Medi-Cal program for patient care or treatment that is d
• § 14131.15 — (a) In geographic areas in which Medi-Cal managed care plans contracting under this chapter or Chapter 8 (commencing with Section 14200) are operating with capacity to enroll additional qualifying Med
• § 14132 — The following is the schedule of benefits under this chapter: (a) Outpatient services are covered as follows: Physician, hospital or clinic outpatient, surgical center, respiratory care, optometric, c
• § 14132.01 — (a) Notwithstanding any other provision of law, a community clinic or free clinic licensed pursuant to subdivision (a) of Section 1204 of the Health and Safety Code or an intermittent clinic operating
• § 14132.02 — (a) The department shall seek approval from the United States Secretary of Health and Human Services to provide individuals made eligible pursuant to Section 14005.
• § 14132.025 — (a) Notwithstanding any other law, emergency services and care necessary for the treatment of an emergency medical condition, as defined in subdivision (b) of Section 1317.
• § 14132.03 — (a) The following shall be covered Medi-Cal benefits effective January 1, 2014: (1) Mental health services included in the essential health benefits package adopted by the state pursuant to Section 13
• § 14132.05 — The department shall provide the fiscal and appropriate policy committees of the Legislature with a copy of their submittal to the federal Health Care Financing Administration pertaining to any evalua
• § 14132.06 — (a) Services specified in this section that are provided by a local educational agency are covered Medi-Cal benefits, to the extent federal financial participation is available, and subject to utiliza
• § 14132.07 — (a) A Medi-Cal managed care plan shall not restrict the choice of the qualified provider from whom a beneficiary enrolled in the managed care plan may receive family planning services covered by the M
• § 14132.09 — (a) By July 1, 2024, biomarker testing, as specified in this section, is a covered benefit, subject to utilization controls and medical necessity requirements, as described in Section 14059.
• § 14132.1 — As used in this chapter “surgical center” means a surgical clinic that is licensed under Section 1203 of the Health and Safety Code.
• § 14132.10 — (a) (1) Pediatric day health care provided by a health facility licensed under paragraph (11) of subdivision (a) of Section 1250.
• § 14132.100 — (a) The federally qualified health center services described in Section 1396d(a)(2)(C) of Title 42 of the United States Code are covered benefits.
• § 14132.101 — (a) Notwithstanding paragraphs (4) and (5) of subdivision (e) of Section 14132.
• § 14132.102 — (a) With the exception of clinics and hospital outpatient departments that are subject to Section 14105.
• § 14132.107 — Claims for reimbursement under subdivision (e) of Section 14132.
• § 14132.108 — Notwithstanding any other provision of law, requests for rate adjustments for scope-of-service rate changes under paragraph (4) of subdivision (e) of Section 14132.
• § 14132.11 — (a) Commencing on July 1, 2024, pharmacogenomic testing shall be a covered benefit under the Medi-Cal program, subject to utilization controls and evidence-based clinical practice guidelines.
• § 14132.13 — (a) Services provided by a community paramedicine program, triage to alternate destination program, or mobile integrated health program are covered benefits under the Medi-Cal program.
• § 14132.15 — For purposes of subdivision (p) of Section 14132, “rehabilitation services” means services intended to assist physically or cognitively impaired persons to achieve or regain their maximum functional p
• § 14132.16 — Mammography for screening or diagnostic purposes upon the referral of a patient’s physician shall be covered under this chapter on or after January 1, 1988, to the extent required or permitted by fede
• § 14132.17 — Annual cervical cancer tests for screening or diagnostic purposes, upon the referral of a patient’s physician, is a covered benefit under this chapter, on or after January 1, 1991, to the extent requi
• § 14132.171 — (a) (1) An annual cognitive health assessment for Medi-Cal beneficiaries who are 65 years of age or older is a covered benefit if they are otherwise ineligible for a similar assessment as part of an a
• § 14132.18 — (a) Community supported living arrangement services approved by the United States Department of Health and Human Services in accordance with Section 1396v of Title 42 of the United States Code is a co
• § 14132.19 — (a) (1) The department, in consultation with the State Department of Social Services, county mental health experts, managed care plan experts, behavioral health experts, child welfare experts, and sta
• § 14132.195 — (a) Consistent with federal law, screening services provided as an Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit pursuant to subdivision (v) of Section 14132 shall include de
• § 14132.20 — (a) The department shall establish a program to provide continuous skilled nursing care to persons with developmental disabilities as a benefit of the Medi-Cal program, when those services are provide
• § 14132.21 — The department shall assess the feasibility of applying to the federal Health Care Financing Administration for a Medicaid State Plan amendment to provide targeted case management to pregnant substanc
• § 14132.22 — (a) For purposes of this section, dental restorative materials are limited to composite resin, glass ionomer cement, resin ionomer cement, and amalgam, as described on the Dental Board of California’s
• § 14132.23 — (a) (1) Except as set forth in paragraph (2), and notwithstanding any other provision of law or regulation, the active and retentive phases of orthodontic treatment covered under the Medi-Cal program
• § 14132.25 — (a) On or before July 1, 1983, the State Department of Health Care Services shall establish a subacute care program in health facilities in order to more effectively use the limited Medi-Cal dollars a
• § 14132.26 — (a) The department shall develop a program that requires a waiver of federal law to test the efficacy of providing an assisted living benefit to beneficiaries under the Medi-Cal program.
• § 14132.27 — (a) (1) The department shall apply for a waiver of federal law pursuant to Section 1396n of Title 42 of the United States Code to test the efficacy of providing a disease management benefit to benefic
• § 14132.28 — (a) If the department decides to terminate or not renew a health facility’s subacute care services provider contract, the department shall notify the health facility 30 days before the termination or
• § 14132.29 — (a) A health facility that has a subacute services provider contract with the department under this chapter shall comply with the patient transfer and discharge requirements of this section.
• § 14132.3 — In addition to any other criteria as provided in subdivision (p) of Section 14132, no reimbursement shall be made pursuant to this chapter for any service in a general acute care hospital for which a
• § 14132.34 — (a) Human milk and human milk derivatives supplied by a mothers’ milk bank for human consumption are a covered service under this chapter.
• § 14132.35 — (a) Outpatient rehabilitation services are covered under this chapter, subject to utilization controls.
• § 14132.36 — (a) Community health worker services are a covered Medi-Cal benefit.
• § 14132.39 — Midwifery services provided by a licensed midwife shall be covered under this chapter, to the extent that federal financial participation is available, and, subject to utilization controls.
• § 14132.4 — Nurse-midwifery services provided by a certified nurse-midwife shall be covered under the provisions of this chapter, to the extent required by federal law, subject to utilization controls.
• § 14132.41 — (a) Services provided by a certified nurse practitioner shall be covered under this chapter to the extent authorized by federal law, and subject to utilization controls.
• § 14132.42 — Benefits under this chapter shall not be restricted for inpatient hospital care to a time period less than 48 hours following a normal vaginal delivery and less than 96 hours following delivery by cae
• § 14132.44 — (a) Targeted case management (TCM), pursuant to Section 1915(g) of the Social Security Act as amended by Public Law 99-272 (42 U.
• § 14132.45 — Regulations implementing, interpreting, or making specific the provisions of subdivision (z) of Section 14132 shall not be subject to Chapter 3.
• § 14132.46 — Pursuant to Sections 14024 and 14124.
• § 14132.47 — (a) It is the intent of the Legislature to provide local governmental agencies the choice of participating in either or both of the Targeted Case Management (TCM) and Administrative Claiming process p
• § 14132.48 — Targeted case management services to which Sections 14132.
• § 14132.49 — (a) Upon federal approval of the state plan amendments made pursuant to Section 14021.