California Welfare and Institutions Code ARTICLE 2.9 - Primary Care Provider Case Management

• Section 14088.
  (a) It is the purpose of this article to ensure that the Medi-Cal program shall be operated in the most cost-effective and efficient manner possible with...
• Section 14088.05.
  For purposes of this article, “primary care case management plan” means a primary care provider or other entity who has contracted with the department pursuant...
• Section 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...
• Section 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,...
• Section 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...
• Section 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. Therefore, contracts...
• Section 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 2.2 (commencing...
• Section 14088.8.
  (a) The department may establish modified primary care case management contracts pursuant to this article. This authority shall be subject to the department seeking and obtaining...
• Section 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). Except as...
• Section 14088.12.
  Primary care case management contractors shall establish, maintain, and conduct an active, ongoing outreach and recruitment effort to add primary care and specialty providers to...
• Section 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...
• Section 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...
• Section 14088.15.
  A plan shall not use false advertising or false statements to induce enrollment. No solicitation of enrollees shall include the granting or offering of any...
• Section 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,...
• Section 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...
• Section 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...
• Section 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...
• Section 14088.22.
  Sections 14408, 14409, 14410, and 14411 shall apply to primary care case management plans.(Amended by Stats. 1995, Ch. 859, Sec. 4. Effective January 1, 1996.)
• Section 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...
• Section 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...

Last modified: October 22, 2018