ARTICLE 3. Administration

Article 3 added by Stats. 1965, 2nd Ex. Sess., Ch. 4.

§§ 14100–14124.16 · 200 sections

§ 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 public…
§ 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…
§ 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 agency…
§ 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…
§ 14100.5 (a) The department shall prepare and submit Medi-Cal program assumptions and estimates to the Department of Finance. The purpose of the assumptions and…
§ 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 provide to…
§ 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 provide to…
§ 14100.6 The department, in cooperation with the Controller, shall establish a method of providing to the Controller, periodically, updated information regarding…
§ 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…
§ 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…
§ 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 of…
§ 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,…
§ 14101 The director may contract with other state agencies for services in connection with the administration of this chapter, Chapter 8 (commencing with 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…
§ 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…
§ 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…
§ 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…
§ 14102.5 (a) The department shall, in collaboration with the Exchange, the counties, consumer advocates, and the Statewide Automated Welfare System consortia, develop…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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… see note
§ 14103.7 The department shall develop procedure codes for durable medical equipment and orthotic and prosthetic equipment and services, to enable the fiscal…
§ 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 to…
§ 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)…
§ 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…
§ 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…
§ 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…
§ 14104.36 (a) The following definitions apply for purposes of this section: (1) “Identified provider” means either a fee-for-service Medi-Cal provider or any other…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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,…
§ 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…
§ 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…
§ 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…
§ 14105.075 (a) (1) Notwithstanding any other law, for dates of service on or after August 1, 2016, payments to intermediate care facilities for the developmentally…
§ 14105.076 (a) Notwithstanding any other law, for dates of service on or after January 1, 2024, the department shall adopt a rate year based on the calendar year for…
§ 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…
§ 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 1, 2012,…
§ 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…
§ 14105.11 (a) The department may negotiate settlements with acute care hospitals with psychiatric units that unintentionally violate Medi-Cal cost reimbursement policies…
§ 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…
§ 14105.12 (a) The department shall specify circumstances under which requests shall be granted for authorization for services provided by a health facility licensed…
§ 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,…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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…
§ 14105.192 (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…
§ 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…
§ 14105.194 (a) (1) Notwithstanding Sections 14105.191, 14105.192, and 14105.193, and for dates of service on or after August 1, 2021, the reimbursement rates for…
§ 14105.195 (a) Notwithstanding Sections 14105.191 and 14105.192, the department shall not seek to retroactively implement the reductions and limitations to the…
§ 14105.197 (a) For dates of service on and after July 1, 2022, or the effective date of any necessary federal approvals as required by subdivision (b), whichever is…
§ 14105.200 (a) The Medi-Cal Provider Payment Reserve Fund is hereby created in the State Treasury. (b) Notwithstanding Section 16305.7 of the Government Code, any…
§ 14105.201 (a) (1) Notwithstanding any other law, for dates of service no sooner than January 1, 2024, or on the effective date of any necessary federal approvals as…
§ 14105.2 (a) The allowable markup payable for the dispensing of medical supplies, including diabetic supplies except as indicated in subdivision (b), by assistive…
§ 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…
§ 14105.22 (a) (1) It is the intent of the Legislature that the department develop reimbursement rates for clinical laboratory or laboratory services that are comparable…
§ 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…
§ 14105.222 (a) Notwithstanding Section 14105.22, the department shall not seek to retroactively implement the reductions and limitations to the reimbursement for clinical…
§ 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…
§ 14105.24 (a) Clinics and hospital outpatient departments, except for emergency rooms, owned or operated by Los Angeles County that participated in the California…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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… see note
§ 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…
§ 14105.291 (a) (1) Subject to subdivision (d), additional Medi-Cal payments shall be made to district and municipal hospitals and their affiliated government entities, in…
§ 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…
§ 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…
§ 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…
§ 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 manufacturer reports,…
§ 14105.334 (a) Notwithstanding any other law, upon approval of the Department of Finance, the department shall seek the necessary federal approvals to establish and…
§ 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…
§ 14105.35 (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 and the…
§ 14105.36 (a) (1) The Medi-Cal Drug Rebate Fund is hereby created in the State Treasury. (2) Nonfederal moneys collected by the department pursuant to Sections 14105.33,…
§ 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…
§ 14105.38 When the department determines that a drug should be removed from the list of contract drugs, the department shall provide individual notice to impacted…
§ 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 of…
§ 14105.395 (a) The department may implement utilization controls through the establishment of guidelines, protocols, algorithms, or criteria for drugs, medical supplies,…
§ 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…
§ 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…
§ 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 drug…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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 reimbursement…
§ 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…
§ 14105.44 (a) The department shall establish an expedited review process to examine the effectiveness of investigational drugs and investigational services, and their…
§ 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…
§ 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…
§ 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”…
§ 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.…
§ 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)…
§ 14105.467 (a) The department shall establish, implement, and maintain a supplemental payment pool for nonhospital 340B community clinics, subject to an appropriation by…
§ 14105.468 (a) (1) Beginning for dates of service on or after January 1, 2025, the department shall establish and implement a directed payment program under which a…
§ 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.…
§ 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…
§ 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…
§ 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…
§ 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 license under…
§ 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…
§ 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 entitled to…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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…
§ 14105.945 (a) For purposes of this section, the following definitions apply: (1) “Eligible provider” means a provider who is eligible for reimbursement of Medi-Cal…
§ 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…
§ 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…
§ 14105.97 (a) The department shall annually develop an outpatient disproportionate share factor for each hospital in California that receives Medi-Cal payments for…
§ 14105.98 (a) The following definitions shall apply for purposes of this section: (1) “Disproportionate share list” means an annual list of disproportionate share…
§ 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 the…
§ 14105.985 (a) (1) Disproportionate share payment augmentation programs shall be maintained for eligible providers pursuant to Section 14087.5, 14088, 14089, 14093, or…
§ 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…
§ 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…
§ 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…
§ 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…
§ 14106.6 The director shall establish and update annually a rate schedule of reimbursement for paramedic services which provides reimbursement based upon reasonable…
§ 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 the…
§ 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 the…
§ 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 a…
§ 14107.115 (a) The Medi-Cal Anti-Fraud Special Deposit Fund is hereby created in the State Treasury. (b) All outstanding Medi-Cal payments intercepted by the State…
§ 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 money…
§ 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…
§ 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…
§ 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,…
§ 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 reimbursement…
§ 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…
§ 14108 Any developmentally disabled recipient under this chapter receiving care in a nursing facility or any category of intermediate care facility for the…
§ 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…
§ 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 be…
§ 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 department…
§ 14109.5 Notwithstanding the provisions of Section 14109, effective January 1, 1982, the reimbursement rate for costs specified in Section 14109 for all services,…
§ 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…
§ 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 department for…
§ 14110.05 (a) The department shall ensure that nursing facility applicants have access to assistance in identifying and securing the information necessary to complete…
§ 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 facilities…
§ 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…
§ 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 the policy…
§ 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…
§ 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…
§ 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 by…
§ 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…
§ 14110.6 (a) The director shall adopt regulations, establishing payment rates for nursing facilities, intermediate care facilities/developmentally disabled, and…
§ 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,…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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…
§ 14113 The department shall enter into cooperative arrangements with the Department of Rehabilitation and any other state agency or department responsible for health…
§ 14114 (a) This section shall be known, and may be cited, as Medi-Cal Physicians and Dentists Loan Repayment Program Act. (b) Notwithstanding any other law, the…
§ 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 be in the form…
§ 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 the…
§ 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…
§ 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…
§ 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 those…
§ 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…
§ 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 of the United…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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…
§ 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 funds…
§ 14123.05 The department shall develop, in consultation with provider representatives, including, but not limited to, physician, pharmacy, and medical supplies…
§ 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 is declaratory of, the…
§ 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 of any department or…
§ 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…
§ 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 to…
§ 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…
§ 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…
§ 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 an authorized employee of…
§ 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 a…
§ 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…
§ 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 to 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,…
§ 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…
§ 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…
§ 14124.12 (a) (1) Notwithstanding any other law, for the duration of the COVID-19 emergency period, the department shall implement any federal Medicaid program waiver or…
§ 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…
§ 14124.14 (a) The department shall develop and submit an application to solicit a grant authorized under Section 9007 of the federal 21st Century Cures Act (42 U.S.C.…
§ 14124.15 (a) Effective January 1, 2023, subject to appropriation by the Legislature, the department shall design and implement a supplemental payment program for…
§ 14124.16 (a) (1) Upon appropriation by the Legislature for this purpose, the department shall complete an independent analysis to determine whether network adequacy…