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.

• § 14184.75 — In connection with the evaluation of the DTI required by Section 14184.
• § 14184.80 — (a) Within 90 days of the effective date of the act that added this section, the department shall amend its contract with the external quality review organization (EQRO) currently under contract with
• § 14184.800 — (a) Notwithstanding any other law, commencing no sooner than January 1, 2023, a qualifying inmate of a public institution shall be eligible to receive targeted Medi-Cal services for 90 days, or the nu
• § 14184.90 — (a) Subject to appropriation by the Legislature, beginning no sooner than July 1, 2019, and consistent with Section 14184.
• § 14185 — (a) A managed care plan, as defined in accordance with subdivision (a) of Section 14093.
• § 14186 — For purposes of this article, the following definitions apply: (a) “Medi-Cal managed care plan” has the same meaning as set forth in Section 14184.
• § 14186.1 — (a) (1) The department shall seek any federal approvals necessary to implement this article.
• § 14186.2 — It is the intent of the Legislature that implementation of this article not be duplicative of implementation of other Medi-Cal provisions, including, but not limited to, those regarding community heal
• § 14186.3 — (a) A Medi-Cal managed care plan may elect to offer Medi-Cal covered services through an in-network, contracted field medicine provider pursuant to this article.
• § 14188 — (a) The Legislature finds and declares both of the following: (1) Value-based payment (VBP) strategies offer financial incentives to health care providers that improve their performance on predetermin
• § 14188.1 — Subject to Section 14188, the department shall develop all of the following VBP programs: (a) A VBP program that is aimed at improving behavioral health integration in Medi-Cal managed care.
• § 14188.2 — (a) The VBP programs described in Section 14188.
• § 14188.3 — (a) To implement this article, the department may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis.
• § 14188.4 — (a) Notwithstanding any other law, the department shall only implement the payments described under Section 14188.
• § 14189 — Medi-Cal managed care plans shall provide mental health benefits covered in the state plan excluding those benefits provided by county mental health plans under the Specialty Mental Health Services Wa
• § 14190 — (a) The department shall convene an advisory group to receive feedback on the changes, modifications, and operational timeframes regarding the implementation of pharmacy benefits offered in the Medi-C
• § 14190.1 — (a) Subject to subdivision (b), and no later than January 1, 2025, a Medi-Cal managed care plan shall conduct annual outreach and education for its enrollees, based on a plan that the Medi-Cal managed
• § 14190.2 — (a) Once every three years, the department shall assess enrollee experience with mental health benefits covered by Medi-Cal managed care plans pursuant to Section 14189 and paragraph (1) of subdivisio
• § 14191 — Notwithstanding any other provision of law, no payment for care or services shall be made under Medi-Cal to the attending physician under this chapter for the costs of any voluntary nonemergency steri
• § 14192 — Willful failure on the part of a health facility to comply with the provisions of the regulations of the department under this article shall constitute cause for suspension as a provider of services u
• § 14193 — The department shall transmit any data acquired by it regarding willful failure of a physician and surgeon to comply with the regulations of the department under this article to the Medical Board of C
• § 14194 — The department shall submit reports to the Legislature as to compliance by health facilities with the requirements of this article, 6, 12, and 24 months after its operative date.
• § 14195 — It is the intent of the Legislature to provide medical assistance, including prescribed drugs, to the state’s eligible poor in a manner consistent with the provisions of the federal Medicaid Act, prov
• § 14195.2 — The open drug formulary, as established pursuant to this article, shall be implemented in one pilot project site.
• § 14195.3 — (a) For purposes of the open drug formulary pilot project as established by this article, a provider may be reimbursed for any drug prescribed to a beneficiary if the drug is prescribed by a licensed
• § 14195.4 — A Medi-Cal Therapeutic Drug Utilization and Review Committee is hereby established.
• § 14195.5 — The Medi-Cal Therapeutic Drug Utilization and Review Committee shall set standards for evaluation of the therapeutic outcomes of prescribed drugs to be applied by an expert contractor to the departmen
• § 14195.6 — The department shall develop a request for a proposal, and may award a contract to an expert contractor to implement the standards and practices established by the Medi-Cal Therapeutic Drug Utilizatio
• § 14195.7 — This article shall not apply to any service rendered by a provider in conjunction with any capitated rate or primary care case contract negotiated pursuant to this chapter or Chapter 8 (commencing wit
• § 14195.9 — In no case shall the director’s discretion under Section 14120 be exercised to reduce reimbursement to providers of pharmaceutical services because of increased costs in the drug component of the Medi
• § 14196 — (a) The department shall adopt any regulations necessary to implement this article.
• § 14196.2 — (a) (1) The Legislature finds and declares that in order to reduce the risk of transmission of COVID-19 during the current pandemic and to further the objectives of the Money Follows the Person Rebala
• § 14196.4 — The following definitions apply for purposes of this article: (a) “Eligible individual” means a Medi-Cal beneficiary who meets both of the following requirements: (1) The individual meets the definiti
• § 14196.5 — (a) A Medi-Cal beneficiary who has resided for at least 60 consecutive days in an inpatient facility, as required by the Money Follows the Person Rebalancing Demonstration, is ineligible for services
• § 14196.6 — This article shall remain in effect only until January 1, 2028, and as of that date is repealed.
• § 14197 — (a) It is the intent of the Legislature that the department implement and monitor compliance with the time or distance requirements set forth in Sections 438.
• § 14197.04 — (a) (1) A Medi-Cal managed care plan that has received approval from the department to utilize an alternative access standard pursuant to subdivision (f) of Section 14197, upon the request of an enrol
• § 14197.05 — (a) As part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care plans in the annual detailed technical report required by Section 438.
• § 14197.07 — (a) A Medi-Cal managed care plan shall ensure access to care for latent tuberculosis infection and active tuberculosis disease and coordination with local health department tuberculosis control progra
• § 14197.08 — (a) A contract between the department and a Medi-Cal managed care plan shall require the Medi-Cal managed care plan to do both of the following: (1) Identify, on a quarterly basis, every enrollee who
• § 14197.09 — (a) (1) No later than 12 months after the working group develops its recommendations for curriculum pursuant to subdivision (b) of Section 150950 of the Health and Safety Code, and no later than March
• § 14197.1 — (a) The department shall ensure that all covered mental health benefits and substance use disorder benefits, as those terms are defined in Section 438.
• § 14197.11 — (a) Notwithstanding any other law, subject to subdivisions (e) and (g), the department may enter into one or more comprehensive risk contracts with an alternate health care service plan (AHCSP) to ser
• § 14197.2 — (a) This section implements the state option in subsection (j) of Section 438.
• § 14197.3 — (a) A Medi-Cal managed care plan shall give a beneficiary timely and adequate notice of an adverse benefit determination in writing consistent with the requirements in Sections 438.
• § 14197.4 — (a) The Legislature finds and declares all of the following: (1) Designated public hospital systems play an essential role in the Medi-Cal program, providing high-quality care to a disproportionate nu
• § 14197.45 — (a) Notwithstanding any other law, for covered benefits under its contract, as applicable, a Medi-Cal managed care plan shall comply with all of the following: (1) Make a good faith effort to contract
• § 14197.5 — (a) Notwithstanding any other law, but no sooner than July 1, 2019, the Cost-Based Reimbursement Clinic Directed Payment Program shall be in operation.
• § 14197.6 — (a) For purposes of this section, the following definitions apply: (1) “Children’s hospital” has the same meaning as that term is defined in Section 10727.
• § 14197.7 — (a) (1) Notwithstanding any other law, if the director finds that an entity that contracts with the department for the delivery of health care services (contractor), including a Medi-Cal managed care
• § 14197.71 — (a) The department may, at its discretion, align relevant terms of its contract with a Medi-Cal behavioral health delivery system with the terms of its contract with a Medi-Cal managed care plan, as d
• § 14197.8 — (a) (1) As part of the health care options information posted by the department, in the provider directory that lists accepted Medi-Cal managed care plans, through the Medi-Cal Managed Care Health Car
• § 14197.9 — (a) To the extent permitted under federal law, the department shall require a Medi-Cal managed care plan that is not licensed by the Department of Managed Health Care to comply with the applicable req
• § 14198.1 — (a) A hospital or its successor entity, that has received funds pursuant to Section 14198 shall maintain burn and trauma services and continue to provide medical services to beneficiaries of Medi-Cal
• § 14198.2 — (a) The Regional Burn and Trauma Center Fund is hereby created in the State Treasury, under the administrative control of the State Department of Health Services, for the purposes specified in Section
• § 14199.1 — (a) The Legislature finds and declares the following: (1) Beginning January 1, 2014, many low-income individuals will be eligible for Medi-Cal coverage pursuant to federal law, as part of health care
• § 14199.100 — Title This chapter shall be known and may be cited as the Protect Access to Health Care Act of 2024.
• § 14199.101 — Findings and Declarations The people of the State of California find and declare all of the following: (a) In 2019, Governor Newsom and the Legislature embarked on a series of investments and initiati
• § 14199.102 — Statement of Purpose In enacting this chapter, the purpose and intent of the people of the State of California is to do all of the following: (a) Increase access to quality health care by establishing
• § 14199.103 — Creation of the Protect Access to Health Care Fund (a) (1) The Protect Access to Health Care Fund (fund) is hereby established in the State Treasury.
• § 14199.104 — Fund Oversight and Accountability (a) The people of the State of California hereby declare their unqualified intent for the moneys deposited into the fund to be used to support the purposes set forth
• § 14199.105 — Treatment of Moneys Deposited in and Expended from the Fund Notwithstanding any other law: (a) The fund, and every subfund, account, and subaccount within the fund, is hereby declared to be a trust fu
• § 14199.106 — Administration (a) (1) The department shall be annually reimbursed from moneys in the Health Care Oversight & Accountability Subfund for actual and necessary costs incurred in administering this chapt
• § 14199.107 — Nonsupplantation (a) (1) Except as otherwise specified in Article 4 (commencing with Section 14199.
• § 14199.108 — Deposit and Allocation of Moneys Notwithstanding any other law: (a) (1) On and after January 1, 2025, all moneys annually derived from the tax imposed pursuant to Article 7.
• § 14199.108.3 — Expenditures During Calendar Years 2025 and 2026 (a) During each of calendar year 2025 and calendar year 2026 only, and notwithstanding Section 13340 of the Government Code, moneys are hereby continuo
• § 14199.108.5 — Treatment of Increased or Supplemental Payments Increased or supplemental payments made pursuant to Sections 14199.
• § 14199.109 — Primary Care Account (a) Moneys in the Primary Care Account shall be used for the purpose of providing Medi-Cal patients with increased access to quality primary care services as set forth in this sec
• § 14199.110 — Specialty Care Account (a) Moneys in the Specialty Care Account shall be used for the purpose of increasing Medi-Cal patient access to specialty care services as set forth in this section.
• § 14199.110.5 — Emergency Department Physicians Account (a) Moneys in the Emergency Department Physicians Account shall be used for the purpose of increasing reimbursements for emergency department physicians treatin
• § 14199.111 — Community Health Workers Account (a) The Community Health Workers Account is hereby created within the Improving Access to Health Care Subfund.
• § 14199.112 — Outpatient and Clinic Access Account (a) Moneys in the Outpatient and Clinic Access Account shall be used for the purpose of increasing net reimbursements for outpatient facilities, including ambulato
• § 14199.113 — Family Planning Account (a) Moneys in the Family Planning Account shall be used for the purpose of expanding the scope and availability of family planning services as set forth in this section.
• § 14199.114 — Reproductive Health Account (a) Moneys in the Reproductive Health Account shall be used as set forth in this section.
• § 14199.115 — Emergency Medical Transportation Account (a) Moneys in the Emergency Medical Transportation Account shall be used for the purpose of increased payments to private ground emergency medical transport pr
• § 14199.116 — Emergency Department and Hospital Services Account (a) Moneys in the Emergency Department and Hospital Services Account shall be used for the purpose of protecting access to, and improving the quality
• § 14199.117 — Designated Public Hospital Account (a) Moneys in the Designated Public Hospital Account shall be used for the purpose of sustaining and promoting access to hospital and nonhospital care at designated
• § 14199.118 — Affordable Prescription Drugs Account (a) The Affordable Prescription Drugs Account is hereby created within the Improving Access to Health Care Subfund.
• § 14199.119 — Improving Mental Health Account (a) (1) Moneys in the Improving Mental Health Account shall be used for the purpose of expanding access to mental health programs and services as set forth in this sect
• § 14199.120 — Health Care Workers Account (a) The department shall, subject to the stakeholder input requirements of Section 14199.
• § 14199.120.5 — Clinic Quality Account (a) Moneys in the Clinic Quality Account shall be used for the purpose of providing monetary incentives for clinics that demonstrate improved quality and increased access to car
• § 14199.120.6 — Improved Dental Services Account (a) Moneys in the Improved Dental Services Account shall be used for the purpose of providing enhanced access to Medi-Cal patients for specialty and restorative dental
• § 14199.120.7 — Health Care Workforce Loan Repayment Account (a) The Health Care Workforce Loan Repayment Account is hereby created within the Improving Access to Health Care Subfund.
• § 14199.120.9 — Medi-Cal Access and Support Account (a) Moneys in the Medi-Cal Access and Support Account shall be used as set forth in this section.
• § 14199.121 — Stakeholder Input (a) (1) The department, or any other state government agency or entity that implements any part of this chapter, shall consult with, and obtain written input from, the stakeholder ad
• § 14199.122 — Implementation; Federal Financial Participation; Modifications and Adjustments Necessary for Federal Approval (a) The department shall seek any federal approvals that are necessary to implement this c
• § 14199.123 — Continued Imposition of Tax (a) It is the intent of the people of the State of California to permanently continue in existence a managed care organization provider tax upon the expiration of the tax i
• § 14199.124 — Implementation of Tax (a) In implementing the tax imposed by subdivision (b) of Section 14199.
• § 14199.125 — Tax Computation and Collection (a) Before each applicable calendar year or years, the department shall compute the annual tax liability for each taxpayer subject to the tax imposed by Section 14199.
• § 14199.126 — Limits on Tax Amounts (a) Notwithstanding any other provision of this chapter or any other law, and except as provided in subdivisions (b) and (c), the tax imposed by this article shall comply with bo
• § 14199.127 — Operation (a) This article shall be inoperative during any portion of a calendar year for which the department does not obtain the necessary federal approvals for the tax imposed pursuant to Section 1
• § 14199.128 — Definitions For purposes of this chapter, as used in both the singular and plural form, the following definitions shall apply: (a) “Abortion” has the same meaning as set forth in subdivision (a) of Se
• § 14199.129 — Stakeholder Advisory Committee Established (a) The Protect Access to Health Care Act Stakeholder Advisory Committee is hereby established within the department.
• § 14199.130 — Committee Membership (a) The committee shall be composed of 10 members as follows: (1) One member that represents both primary and specialty physicians on a statewide basis.
• § 14199.131 — Committee Member Terms (a) Each appointing authority described in subdivision (b) of Section 14199.
• § 14199.132 — Powers and Duties of the Committee (a) (1) The committee is advisory only and does not possess decisionmaking authority.
• § 14199.133 — Compensation Members of the committee shall serve without compensation, but shall receive reimbursement for necessary expenses, subject to approval by the department.
• § 14199.134 — Amendment of Chapter (a) The Legislature may amend this chapter by a statute passed in each house of the Legislature by rollcall vote entered into the journal, three-fourths of the membership concurri
• § 14199.135 — Construction of Chapter (a) Severability.
• § 14199.136 — Standing to Defend Chapter Notwithstanding any other law, if the State of California or any of its officers or officials fail to defend the constitutionality of this chapter, following its approval by
• § 14199.2 — (a) Subject to subdivision (e), Medi-Cal managed care plans serving newly eligible beneficiaries, as defined in subdivision (s) of Section 17612.
• § 14199.70 — The Legislature finds and declares all of the following: (a) Qualified clinics, as defined in this article, are fundamental to the California health care safety net, as their mission is to provide pri
• § 14199.71 — For purposes of this article, the following definitions apply: (a) “Date of record” means a date determined by the department on which eligible employees are deemed to qualify for a retention payment,
• § 14199.72 — (a) Upon appropriation by the Legislature of funds for this purpose, the department shall establish a clinic workforce stabilization retention payment program to provide funds to eligible qualified cl
• § 14199.73 — (a) (1) Except as required by federal law, any payment made pursuant to this article shall be exempt from any adjustments or deductions made to Medi-Cal payments to qualified clinics, including, but n
• § 14199.74 — (a) In the event of a dispute as to the status of an employee as an eligible employee, the retention payment amount, or a qualified clinic’s failure to make a retention payment, an eligible employee o
• § 14199.75 — (a) In serving as a conduit for payments under this article, qualified clinics are carrying out a state program.
• § 14199.76 — The provisions of this article are severable.
• § 14199.80 — The Legislature finds and declares all of the following: (a) The Legislature continues to recognize that an enrollment-based managed care organization provider tax is an essential and necessary source
• § 14199.81 — The following definitions shall apply for purposes of this article: (a) “Base data source” means the quarterly financial statement filings or annual enrollment data submitted by health plans to the De
• § 14199.82 — (a) The Managed Care Enrollment Fund is hereby created in the State Treasury.
• § 14199.83 — (a) The department shall determine for each health plan, using the base data source, all of the following: (1) Total cumulative enrollment for the base year.
• § 14199.84 — (a) A managed care organization provider tax shall be imposed on each health plan.
• § 14199.85 — (a) For each tax period, the Medi-Cal taxing tiers shall be as follows: (1) Medi-Cal taxing tier I shall consist of all countable Medi-Cal enrollees in a health plan from zero to 1,250,000, inclusive.
• § 14199.86 — (a) The tax assessed under this article shall become effective and operative on April 1, 2023, or the effective date, certified in writing by the director, of the federal approval necessary for receip
• § 14199.87 — (a) This article shall become operative on the effective date, certified in writing by the director, of the federal approval necessary for receipt of federal financial participation, as described in s
• § 14200 — This chapter shall be known and may be cited as the Waxman-Duffy Prepaid Health Plan Act.
• § 14200.1 — The purpose of this chapter is to afford persons eligible to receive benefits under Chapter 7 (commencing with Section 14000) of this part the opportunity to enroll as regular subscribers in prepaid h
• § 14201 — The intent of the Legislature is to provide, to the extent feasible, through the provisions of this chapter and the necessarily related provisions of Chapter 7 (commencing with Section 14000) of this
• § 14203 — (a) For purposes of administering this chapter and Chapter 7 (commencing with Section 14000) of this part, the department is hereby designated as the single or appropriate state agency with full power
• § 14204 — (a) Pursuant to the provisions of this chapter, the department may contract with one or more prepaid health plans in order to provide the benefits authorized under this chapter and Chapter 7 (commenci
• § 14205 — Except where the context otherwise requires, or where specific exceptions are authorized, all provisions of Chapter 7 (commencing with Section 14000) of this part shall be applicable to the provisions
• § 14206 — (a) No prepaid health plan or pilot program shall be deemed to transact insurance or to be subject to any provision of the Insurance Code by virtue of negotiating, executing, or performing a prepaid h
• § 14250 — Unless the context otherwise requires, the definitions set forth in this article govern the construction of this chapter.
• § 14251 — (a) (1) “Prepaid health plan” means a plan that meets all of the following criteria: (A) Is licensed as a health care service plan by the Director of the Department of Managed Health Care pursuant to
• § 14252 — “Medi-Cal beneficiary” means a person who is eligible to receive benefits under Chapter 7 (commencing with Section 14000) of this part.
• § 14253 — “Subcontract” means an agreement entered into by the prepaid health plan with any of the following: (a) A provider of health care services who agrees to furnish such services to Medi-Cal beneficiaries
• § 14254 — (a) “Primary care physician” is a physician who has the responsibility for providing initial and primary care to patients, for maintaining the continuity of patient care, and for initiating referral f
• § 14255 — “Specialist” means a physician who is board certified or board eligible in the specialty of medical care provided.
• § 14256 — The “basic scope of health care benefits” means: (a) Physician’s services; (b) Hospital outpatient services; (c) Laboratory and X-ray; (d) Prescription drugs; (e) Hospital inpatient care; (f) Skilled
• § 14257 — Nothing in this act shall preclude the director from contracting with licensed specialized health care service plans which provide only dental, pharmaceutical, optometric, or psychological services in
• § 14258 — “Service area” means a geographical area designated by the department within which a prepaid health plan shall provide health care services and within which the Medi-Cal beneficiaries eligible for enr
• § 14259 — “Director” means the State Director of Health Services.
• § 14260 — “Department” means the State Department of Health Services.
• § 14261 — “Vendor” means any person who provides services or supplies to a prepaid health plan or a subcontractor of a prepaid health plan and who does not have a subcontract as defined by Section 14253 with ei
• § 14263 — “Marketing” means any activity conducted by or on behalf of a prepaid health plan where information regarding the services offered by a prepaid health plan is disseminated in order to persuade Medi-Ca
• § 14264 — “Marketing organization” means any subcontractor who agrees to provide marketing services for a prepaid health plan.
• § 14265 — “Marketing representative” means any person who engages in marketing activities on behalf of a marketing organization or the prepaid health plan.
• § 14300 — The department shall publish a notice of intent to contract at least 60 days prior to the effective date of any initial or renewed contract.
• § 14301 — (a) The department shall determine, by actuarial methods, prospective per capita rates of payment for services provided under this chapter for Medi-Cal beneficiaries enrolled in a prepaid health plan.
• § 14301.1 — (a) For rates established on or after August 1, 2007, the department shall pay capitation rates to health plans participating in the Medi-Cal managed care program using actuarial methods and may estab
• § 14301.11 — (a) Notwithstanding any law, and subject to subdivisions (e) and (f), in order to account for the impacts of the COVID-19 public health emergency on Medi-Cal managed care capitation rates, the departm
• § 14301.2 — (a) The director may defer fee-for-service payments or payments to Medi-Cal managed care health plans contracting with the department pursuant to Article 2.
• § 14301.3 — The department shall ensure that Medi-Cal managed care plans demonstrate ongoing ability and readiness to perform the obligations set forth in Section 14132.
• § 14301.4 — (a) It is the intent of the Legislature, to the extent federal financial participation is not jeopardized and consistent with federal law, that the intergovernmental transfers described in this sectio
• § 14301.5 — (a) (1) To the extent federal financial participation is not jeopardized and consistent with federal law, and subject to the conditions set forth in subdivision (b), the department shall pay Medi-Cal
• § 14302 — Except as provided in Section 14490, the duration of initial contracts entered into pursuant to this chapter shall be for a maximum of one year and of renewed contracts for a maximum of five years.
• § 14302.1 — (a) (1) Once it is determined that a contract shall be renewed pursuant to this chapter with a prepaid health plan, by the state agency responsible for negotiating these contracts, the agency shall, n
• § 14303 — No contract between the department and the prepaid health plan shall be amended without the public notice and if necessary the holding of a public hearing as required in Section 14300 if such amendmen
• § 14303.1 — The department shall have authority to amend a prepaid health plan contract in accordance with the terms of a merger of a prepaid health plan with another organization or organizations other than the
• § 14303.2 — The department shall have authority to amend a prepaid health plan contract in accordance with the terms of the reorganization of a prepaid health plan or a merger of the plan with its subsidiary corp
• § 14303.3 — The department shall renew a contract unless good cause is shown for nonrenewal.
• § 14304.5 — Each prepaid health plan shall provide directly or through subcontractors, not less than the basic scope of health care benefits as defined in Section 14256.
• § 14305 — The department may limit the scope of health care benefits provided by a prepaid health plan under this chapter to exclude the care of illness or injury which results from or is greatly aggravated by,
• § 14308 — (a) Each prepaid health plan shall furnish to the director such information and reports as required by Title XIX of the federal Social Security Act.
• § 14309 — The department shall provide for a continuing study of the quality of care and services resulting from the operation of this chapter and for surveys and reports on prepaid health plans.
• § 14311 — Prepaid health plans, the services they provide, and the persons receiving these services shall not be subject to the limitations on services set forth in Section 14133, 14133.
• § 14312 — The director shall adopt all necessary rules and regulations to carry out the provisions of this chapter.
• § 14314 — The director may recover a due and payable overpayment made to a prepaid health plan by means of a repayment agreement executed between such prepaid health plan and the director, and by any other mean
• § 14315 — When it has been determined that a prepaid health plan has received an overpayment which is due and payable, the director may recover such overpayment by offset against any amount currently due to the
• § 14316 — Notwithstanding any other provisions of law, contracts with plans which are entered into, renewed, or amended pursuant to this article may include one or more of the following: (1) A provision to the
• § 14400 — Every prepaid health plan shall have an open enrollment period at least once every year.
• § 14401 — No Medi-Cal beneficiary shall be enrolled in a prepaid health plan prior to the time a contract under this chapter is signed by the department and such prepaid health plan is approved by the appropria
• § 14402 — The prepaid health plan shall enroll only those Medi-Cal beneficiaries who reside within the contract service area.
• § 14403 — No Medi-Cal beneficiary shall be enrolled in more than one prepaid health plan at any time.
• § 14406 — (a) Within seven days after the effective date of enrollment, the prepaid health plan shall provide in writing the following information to a new enrollee or the family unit of the new enrollee: (1) A
• § 14407 — Enrollment in a prepaid health plan shall be voluntary and a prepaid health plan shall not use false advertising or false statements to induce enrollment.
• § 14407.1 — (a) A contractor that has entered into a contract with the department under this chapter, or under another Medi-Cal managed care contracting authority, may offer nonmonetary incentives to promote good
• § 14407.6 — (a) Notwithstanding Section 14407.
• § 14408 — (a) Except as otherwise prohibited by law, a contractor that has entered into a contract with the department pursuant to this chapter may make the benefits known to potential enrollees by methods appr
• § 14408.5 — A prepaid health plan that contracts with Medi-Cal managed care or contracts with the Healthy Families Program may provide application assistance pursuant to Section 12693.
• § 14409 — (a) No prepaid health plan, marketing representative, or marketing organization shall in any manner misrepresent itself, the plans it represents, or the Medi-Cal program.
• § 14410 — No prepaid health plan or marketing representative shall adopt or utilize any procedure to identify prospective enrollees with medical or psychiatric problems in order to exclude them from enrollment
• § 14411 — (a) No prepaid health plan or marketing organization shall solicit prospective enrollees on county premises for benefits or services available pursuant to this chapter except under any one of the foll
• § 14412 — (a) The enrollment of a Medi-Cal beneficiary in the prepaid health plan shall not be terminated except for loss of eligibility, for good cause as determined by the department, or at the request of the
• § 14413 — (a) Requests for disenrollment shall be made to an authorized representative of the prepaid health plan or to the department.
• § 14450 — (a) No contract between the department and a prepaid health plan shall be approved or renewed unless the providers and the facilities of the prepaid health plan meet the Medi-Cal program standards for
• § 14450.5 — (a) No contract between the department and a prepaid health plan that is contracting with, or that is governed, owned, or operated by, a county board of supervisors, shall be approved or renewed unles
• § 14451 — Services under a prepaid health plan contract shall be provided in accordance with the requirements of the Knox-Keene Health Care Service Plan Act of 1975.
• § 14451.5 — (a) A prepaid health plan contractor may not enter into subcontracts when such an action would remove from the contractor his obligation to bear a significant portion of the risk encountered in provid
• § 14452 — (a) (1) All subcontracts shall be entered into pursuant to the requirements of the Knox-Keene Health Care Service Plan Act of 1975 and federal law.
• § 14452.3 — Each prepaid health plan shall provide the services of an optometrist and ophthalmologist when the prepaid health plan contract requires the provision of vision care services.
• § 14452.4 — Where the prepaid health plan agrees to provide dental services such services shall be provided in a manner that does not require the enrollees to receive prior screening or authorization by nondental
• § 14452.5 — Each prepaid health plan shall provide the services of a psychologist and psychiatrist when the prepaid health plan contract requires the provision of mental health services.
• § 14452.6 — Prepaid health plans, or their subcontractors, shall not bill any enrollee for covered benefits provided under this chapter and for which capitation has been paid, except as provided in Article 7 (com
• § 14453 — In compensating directors and officers, the prepaid health plan shall not compensate at a rate substantially greater than the prevailing charge for similar services in the community.
• § 14454 — (a) The prepaid health plan shall be liable for all in-area and out-of-area emergency services which are required by the contract and rendered by a nonprepaid health plan provider.
• § 14455 — The prepaid health plan shall maintain a complete unit medical record for each enrollee.
• § 14456 — The department shall conduct annual medical audits of each prepaid health plan unless the director determines there is good cause for additional reviews.
• § 14456.3 — (a) The department shall share with the Department of Managed Health Care its findings from medical audits and monthly provider files of a Medi-Cal managed care plan that provides services to Medi-Cal
• § 14456.5 — (a) For purposes of this section, Medi-Cal managed care plan means any prepaid health plan or Medi-Cal managed care plan contracting with the department to provide services to enrolled Medi-Cal benefi
• § 14457 — (a) In addition to the reviews required or authorized by Section 14456, the department shall conduct periodic onsite visits or additional visits after a determination by the director of good cause by
• § 14458 — The prepaid health plan shall establish procedures for continuously reviewing the quality of care, performance of medical personnel, the utilization of services and facilities, and costs.
• § 14459 — (a) The prepaid health plan shall maintain financial records and shall have an annual audit or additional audits after a determination by the director of good cause, performed by an independent certif
• § 14459.5 — (a) As delegated by the federal government, the department has responsibility for monitoring the quality of all Medicaid services provided in the state.
• § 14459.6 — (a) The department shall establish a list of performance measures to ensure dental health plans meet quality criteria required by the department.
• § 14459.7 — (a) The department shall implement a Management Information System/Decision Support System (MIS/DSS) for the Medi-Cal Program, that shall integrate data from managed care plans to monitor and evaluate
• § 14459.8 — (a) By no later than March 15, 2013, with annual updates thereafter, the department shall provide the fiscal and appropriate policy committees of the Legislature with either a comprehensive report or
• § 14460 — A schedule of reviews, visits, and audits shall be jointly established by the Department of Managed Health Care or the Department of Insurance, as the case may be, and the State Department of Health S
• § 14461 — Upon request by the department, each prepaid health plan shall submit to the department a copy of any financial report submitted to any other public or private organization, if such report differs in