(a) The department shall utilize existing contractual claims processing services in order to promote efficiency and to maximize use of funds.
(b) The department shall certify which primary care clinics are selected to participate in the program for each specific fiscal year, and how much in program funds each selected primary care clinic will be allocated each fiscal year.
(c) The department shall pay claims from selected primary care clinics up to each clinic’s annual allocation. Once a clinic has exhausted its annual allocation, the state shall stop paying its program claims.
(d) The department may adjust any selected primary care clinic’s allocation to take into account:
(1) An increase in program funds appropriated for the fiscal year.
(2) A decrease in program funds appropriated for the fiscal year.
(3) A clinic’s projected inability to fully spend its allocation within the fiscal year.
(4) Surplus funds reallocated from other selected primary care clinics.
(e) The department shall notify all affected primary care clinics in writing prior to adjusting selected primary care clinics’ allocations.
(f) Cessation of program payments under subdivision (e) or adjustment of selected primary care clinic’s allocations under subdivision (d) shall not be subject to the Medi-Cal appeals process referenced in subdivision (g) of Section 124900.
(g) A clinic’s allocation under this article shall not be reduced solely because the clinic has engaged in supplemental fundraising drives and activities, the proceeds of which have been used to defray the costs of services to the uninsured.
(Amended by Stats. 2006, Ch. 176, Sec. 4. Effective January 1, 2007.)
Last modified: October 25, 2018