CHAPTER 4. Administration [12693.25. - 12693.55.]

Chapter 4 added by Stats. 1997, Ch. 623, Sec. 2.

§§ 12693.25–12693.55 · 35 sections

§ 12693.25 The board may use a purchasing pool model, issuance of purchasing credits, supplemental coverage, or other means as appropriate to meet the purposes of this…
§ 12693.26 (a) The board shall establish a purchasing pool for coverage of program subscribers to enable applicants without access to affordable and comprehensive…
§ 12693.27 (a) The board shall develop a purchasing credit mechanism to enable applicants with access to affordable and comprehensive employer-sponsored dependent…
§ 12693.271 (a) The Legislature finds and declares that the state faces a fiscal crisis that requires unprecedented measures to reduce General Fund expenditures. (b)…
§ 12693.28 The program shall be administered without regard to gender, gender identity, gender expression, race, creed, color, sexual orientation, health status,…
§ 12693.29 (a) The board shall use appropriate and efficient means to notify families of the availability of health coverage from the program. (b) The State Department of…
§ 12693.30 (a) The board shall assure that written enrollment information issued or provided by the program is available to program subscribers and applicants in each of…
§ 12693.31 No participating health, dental, or vision plan shall, in an area served by the program, directly, or through an employee, agent, or contractor, provide an…
§ 12693.32 (a) The board may pay designated individuals or organizations an application assistance fee, if the individual or organization assists an applicant to complete…
§ 12693.325 (a) (1) Notwithstanding any provision of this chapter, a participating health, dental, or vision plan that is licensed and in good standing as required by…
§ 12693.326 Notwithstanding any other provision of this part, a new subscriber in the program shall be allowed to switch his or her choice of plans once within the first…
§ 12693.33 To the extent feasible and permissible under federal law and with receipt of necessary federal approvals, the State Department of Health Services and the board…
§ 12693.34 (a) The board may establish geographic areas within which participating health, dental, and vision plans may offer coverage to subscribers. (b) Nothing in this…
§ 12693.35 Participating health, dental, and vision plans shall have, but need not be limited to, all of the following operating characteristics satisfactory to the board…
§ 12693.36 (a) Notwithstanding any other provision of law, the board shall not be subject to licensure or regulation by the Department of Insurance or the Department of…
§ 12693.37 (a) The board shall contract with a broad range of health plans in an area, if available, to ensure that subscribers have a choice from among a reasonable…
§ 12693.38 (a) The board shall contract with a sufficient number of dental and vision plans to assure that dental and vision benefits are available to all subscribers.…
§ 12693.39 The board shall establish a process for determining which employer-sponsored health plans are eligible to receive a purchasing credit issued by the program.…
§ 12693.40 The board shall contract with health plans to provide coverage supplemental to that provided by an applicant’s or applicant’s spouse’s employer-sponsored…
§ 12693.41 (a) The board shall consult and coordinate with the State Department of Health Services in implementing a preenrollment program into the Healthy Families…
§ 12693.42 Any purchasing credit issued by the board, or a contractor acting on behalf of the board, pursuant to this part shall have an overall cost to the program no…
§ 12693.43 (a) Applicants applying to the purchasing pool shall agree to pay family contributions, unless the applicant has a family contribution sponsor. Family…
§ 12693.44 (a) The board shall establish family contribution amounts for purchasing credit members that are equivalent to the amounts charged to subscribers participating…
§ 12693.45 (a) After two consecutive months of nonpayment of family contributions by an applicant, and a reasonable written notice period of no less than 30 days is…
§ 12693.46 The board may prohibit applicants who drop coverage after enrolling in the pool from reenrollment in the program for up to six months.
§ 12693.47 The program may place a lien on compensation or benefits, recovered or recoverable by a subscriber or applicant from any party or parties responsible for the…
§ 12693.48 The board may adjust payments made to a participating health plan if the board finds that the plan has a significantly disproportionate share of high- or…
§ 12693.49 (a) When an applicant is dissatisfied with any action or inaction of a participating plan in which a subscriber is enrolled through the purchasing pool, the…
§ 12693.50 (a) The board shall consult and coordinate with the State Department of Health Services to implement the Medi-Cal to Healthy Families Accelerated Enrollment…
§ 12693.51 (a) A transfer of enrollment from one participating health plan to another may be made by a subscriber at times and under conditions as may be prescribed by…
§ 12693.515 (a) Effective July 1, 2004, any subscriber who affirmatively selects, or is assigned by default to, a federally qualified health center, as defined by Section…
§ 12693.52 The board may negotiate or arrange for stop-loss insurance coverage that limits the program’s fiscal responsibility for the total costs of health services…
§ 12693.53 The board shall develop and utilize appropriate cost containment measures to maximize the coverage offered under the program. Those measures may include…
§ 12693.54 A contract entered pursuant to this part shall be exempt from any provision of law relating to competitive bidding, and shall be exempt from the review or…
§ 12693.55 (a) A health care provider who is furnished documentation of a person’s enrollment in the program shall not seek reimbursement nor attempt to obtain payment…