California Welfare and Institutions Code ARTICLE 3 - Administration

  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 14100.5.
    The department shall prepare and submit Medi-Cal program assumptions and estimates to the Department of Finance. The purpose of the assumptions and estimates shall be...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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,...
  • Section 14100.75.
    (a) (1) Each provider and each applicant, as defined in Section 14043.1, when applying for enrollment and continued enrollment, shall provide, to the department, a bond, or...
  • Section 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...
  • Section 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...
  • Section 14100.95.
    (a) The department shall enter into demonstration contracts with manufacturers of medical supplies for four items of its own selection of medical supplies existing on the...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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,...
  • Section 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...
  • Section 14103.6.a.
    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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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 14104.3 shall...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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,...
  • Section 14105.05.
    (a) Notwithstanding Section 14105, and any other provision of law, the director may, without taking regulatory action pursuant to Chapter 3.5 (commencing with Section 11340) of...
  • Section 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...
  • Section 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...
  • Section 14105.075.
    (a) 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...
  • Section 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...
  • Section 14105.09.
    Notwithstanding any other provision of law, if subdivision (b) of Section 3.94 of the Budget Act of 2011 is operative, effective on or after January...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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,...
  • Section 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. The director shall have...
  • Section 14105.16.
    (a) The department may establish per diem or bundled reimbursement rates for pharmacies that provide home infusion supplies and services. The per diem or bundled reimbursement...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • 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...
  • Section 14105.192.
    (a) The Legislature finds and declares the following:(1) Costs within the Medi-Cal program continue to grow due to the rising cost of providing health care throughout the...
  • Section 14105.193.
    (a) (1) Notwithstanding paragraph (7) of subdivision (j) of Section 14105.192 and any other law, beginning June 1, 2011, reimbursement rates for freestanding pediatric subacute care units,...
  • Section 14105.195.
    (a) Notwithstanding Sections 14105.191 and 14105.192, the department shall not seek to retroactively implement the reductions and limitations to the reimbursement for services provided by skilled...
  • Section 14105.2.
    (a) The allowable markup payable for the dispensing of medical supplies by assistive device and sickroom supply dealers and pharmacies shall not exceed 23 percent of...
  • Section 14105.21.
    (a) An assistive device and sickroom supply dealer may not bill the Medi-Cal program for prosthetic and orthotic appliances.(b) A pharmacy may not bill the Medi-Cal program...
  • Section 14105.22.
    (a) (1) Reimbursement for clinical laboratory or laboratory services, as defined in Section 51137.2 of Title 22 of the California Code of Regulations, shall not exceed 80...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 14105.281.
    (a) The Legislature finds and declares all of the following:(1) That because the implementation of Section 14105.28 is expected to require several years and further rate changes...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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 14105.31.(b) The...
  • Section 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...
  • Section 14105.37.
    (a) The department shall notify each manufacturer of drugs in therapeutic categories selected pursuant to Section 14105.33 of the provisions of Sections 14105.31 to 14105.42, inclusive.(b) If,...
  • Section 14105.38.
    (a) (1) In the event the department determines a drug should be deleted from the list of contract drugs, the department shall conduct a public hearing, as...
  • Section 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 14105.33 provided all...
  • Section 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 formulae....
  • Section 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...
  • Section 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 14105.33, informing them of the...
  • Section 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...
  • Section 14105.41.
    Moneys accruing to the department from contracts executed pursuant to Section 14105.33 shall be deposited in the Health Care Deposit Fund, and shall be subject...
  • Section 14105.42.
    (a) The department shall report to the Legislature after the first three major therapeutic categories have been reviewed and contracts executed. The report shall include the...
  • Section 14105.425.
    The provisions of Sections 14105.4 to 14105.41, inclusive, and Section 14105.65 shall not preclude the department from taking emergency regulatory action as it deems appropriate.This...
  • Section 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...
  • Section 14105.435.
    (a) Within 60 days of the approval of a drug in accordance with subdivision (a) of Section 14105.43, the department shall assign to that drug a...
  • Section 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...
  • Section 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.(b) The department...
  • Section 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 447.502 of...
  • Section 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...
  • Section 14105.455.
    (a) Pharmacy providers shall submit their usual and customary charge when billing the Medi-Cal program for prescribed drugs.(b) “Usual and customary charge” means the lower of the...
  • Section 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 14105.86.(2) “Generically equivalent drugs”...
  • Section 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.(2) “340B”...
  • Section 14105.47.
    (a) (1) The department shall establish a list of medical supplies. The list shall specify utilization controls to be applied to each medical supply product.(2) The utilization controls...
  • Section 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...
  • Section 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...
  • Section 14105.485.
    (a) Commencing July 1, 2006, any provider of custom rehabilitation equipment and custom rehabilitation technology services to a Medi-Cal beneficiary shall have on staff, either as...
  • Section 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...
  • Section 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...
  • Section 14105.51.
    (a) The department shall establish “capped rental” reimbursement for specific items of durable medical equipment. Items in this category shall be reimbursed on a monthly rental...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 14105.965.
    (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...
  • Section 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. That factor shall...
  • Section 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...
  • Section 14105.982.
    (a) (1) The department may adopt emergency regulations in accordance with Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 1 of Title 2 of...
  • Section 14105.985.
    (a) (1) Disproportionate share payment augmentation programs shall be maintained for eligible providers pursuant to Section 14087.5, 14088, 14089, 14093, or 14200.(2) The department shall make payment augmentations...
  • Section 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 14105.99.
    (a) For purposes of this section, “Attachment 4.19-A” means the Medi-Cal payment adjustment system for acute inpatient hospital services set forth in Attachment 4.19-A of the...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 14107.
    (a) Any person, including any applicant or provider as defined in Section 14043.1, or billing agent, as defined in Section 14040.1, who engages in any of...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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,...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 14108.2.
    Except as provided by Section 14108 and Section 14108.1, any recipient of services under this chapter who is residing in a long-term care facility shall...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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. The...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 14110.55.
    For the purposes of the pilot program established under Section 14495.10, or, if Section 14495.10 is repealed and replaced by Section 14132.20, then under the...
  • Section 14110.6.
    (a) The director shall adopt regulations, establishing payment rates for nursing facilities, intermediate care facilities/developmentally disabled, and intermediate care facilities/developmentally disabled-habilitative as defined in Section 1250...
  • Section 14110.7.
    (a) The director shall adopt regulations increasing the minimum number of equivalent nursing hours per patient required in skilled nursing facilities to 3.2, in skilled nursing...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 14115.3.
    The department shall permit a nurse anesthetist to bill independently for services rendered by such nurse anesthetist. If a nurse anesthetist chooses to bill independently...
  • Section 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...
  • Section 14115.41.
    (a) For services that are performed at a central laboratory as authorized pursuant to Section 1241.1 of the Business and Professions Code, the department shall provide...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 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 14123.2...
  • Section 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...
  • Section 14124.1.
    Each provider, as defined in Section 14043.1, of health care services rendered under the Medi-Cal program or any other health care program administered by the...
  • Section 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...
  • Section 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...
  • Section 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...
  • Section 14124.5.
    (a) The director may, in accordance with Section 10725, adopt, amend, or repeal, in accordance with Chapter 3.5 (commencing with Section 11340) of Part 1 of...
  • Section 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...
  • Section 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,...
  • Section 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...
  • Section 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...
  • Section 14124.12.
    (a) The department may enter into contracts for the purposes of undertaking administrative activities by the department’s Mental Health and Substance Use Disorder Services Division concerning...
  • Section 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...

Last modified: October 22, 2018