California Administrative Code

“Supplier” means any manufacturer, principal labeler, wholesaler and any other primary supplier from which an applicant or provider purchases services, goods, supplies, or merchandise, used in carrying out its responsibilities under Medi-Cal.

(a) A provider of services employed by or under subcontract to a plan shall meet those standards for participation as a provider of health care services under the Medi-Cal program set forth in this subdivision in Chapter 3, Article 3, beginning with Section 51200. (b) The Departm…

Contract means the written agreement entered into between a health care service plan, as defined in Section 1345, Health and Safety Code, and the Department and approved by appropriate state agencies to provide health care services to members under the provisions of the Waxman-Du…

(a) Hospice care means the provision of palliative and supportive items and services described below to a terminally ill individual as defined in Section 51180.2, who has voluntarily elected to receive such care in lieu of curative treatment related to the terminal condition, by …

(a) Counties may allow marketing of prospective PHP members on county premises by a county employee under any one of the following conditions: (1) Marketing is performed under the terms of a demonstration project approved by the Department provided the demonstration project meets…

A SWSAP WRA shall ensure that the recycled municipal wastewater used for a SWSAP shall be from a wastewater management agency that: (a) administers an industrial pretreatment and pollutant source control program; and (b) implements and maintains a source control program that incl…

(a) Allowable outdoor uses of onsite treated nonpotable water are limited to ornamental plant surface irrigation, landscape surface irrigation, dust suppression, decorative fountains, and car washing. (b) Outdoor use of onsite treated nonpotable water for decorative fountains mus…

(a) The following definitions shall govern the construction of this article unless the context or subject matter otherwise requires: (1) “Day” means a calendar day. (2) “Dispute” means a dispute concerning payment for care under emergency circumstances provided to plan members by…

After the board's investigation has been completed, a copy of the proposed findings will be mailed to the person who filed the notice, the person who requested the investigation, and any other person who has submitted information. The proposed findings will be accompanied by a no…

“Continuing education course” means a presentation that transmits information related to the operation of a treatment facility and/or distribution system.

Prepaid patient population means the entire patient population both Medi-Cal and non-Medi-Cal, that is entitled to receive medical care from a plan in consideration for a predetermined, periodic, fixed subscription premium.

In terminating a contract with a plan in a designated region, the department shall adhere to the procedures and requirements prescribed in section 53352, except for subsection (d) and (e).

Blood is covered as ordered by a physician or dentist and only upon certification of the blood bank supplying the blood, or the facility where the transfusion is given, that voluntary blood donations cannot be obtained. Blood derivatives are covered as prescribed by a physician o…

(a) A laboratory performing analyses to comply with a requirement in this Article shall be accredited pursuant to division 101, part 1, chapter 4, article 3 of the Health and Safety Code (commencing with section 100825), known as the Environmental Laboratory Accreditation Act. (b…

“System with a single service connection” means a system which supplies drinking water to consumers via a single service line.

Intermediate care services are covered subject to the following: (a) Intermediate care services are covered only after prior authorization has been obtained from the designated Medi-Cal consultant for the district where the facility is located. The authorization request shall be …

(a) Members desiring disenrollment shall make their requests to an authorized representative of the plan, on forms prescribed by the Department, or to the Department. (b) Plans shall furnish disenrollment request forms to members immediately upon request by the member. Disenrollm…

“Rural shortage area” means a census tract designated by the Secretary, Department of Health and Human Services, as rural and deficient in personal health services or primary medical manpower.

(a) The requirements of this Article apply to public water systems. (b) In addition to the bacteriological monitoring requirements in Sections 64423, 64424, 64425, and 64426.9, a public water system shall perform special purpose bacteriological monitoring as follows: (1) After an…

(a) A provider shall not bill or submit a claim for service involving the referral of a beneficiary to or from another provider unless each provider has disclosed any significant beneficial interest existing between the providers. Disclosure shall be accomplished by completing an…

Staff physician services means those services provided by a physician employed by the adult day health care provider.

(a) Each GMC plan shall meet the requirements specified in Section 53216. (b) Each GMC plan shall arrange for and make payment, at the lowest of the Medi-Cal fee-for-service rate or the plan negotiated rate, for emergency services as defined in Section 51056. (c) Each GMC plan sh…

(a) To determine compliance with the MCL for nitrate in Table 64431-A, all public water systems using groundwater and transient-noncommunity systems using approved surface water shall monitor annually, and all community and nontransient-noncommunity systems using approved surface…

(a) Each adult day health center shall: (1) Be licensed or have a special permit pursuant to Chapter 3.5, commencing with Section 1570, Division 2, Health and Safety Code, to provide adult day health care. (2) Have appropriate licensed and allied health personnel to provide servi…

(a) Program aides may be full-time or part-time employees. Aides shall evidence capacity for learning, the ability to comprehend the use of written and spoken English and shall have personal qualities conducive to good interpersonal relationships with demonstrated competence in h…

(a) Each GMC plan shall revise, if necessary, and distribute the information specified in Section 53926.5(b)(2) to each member or the member's family unit at least once every twelve months.

(a) Water systems fluoridating as of July 1, 1996 shall submit a fluoridation system operations contingency plan by July 1, 1998. All other water systems shall submit the plan at least three months before initiating fluoridation treatment. All fluoridating water systems shall ope…

(a) Each adult day health center shall serve only participants living in the service area specified in the county plan and approved by the Department. An exception to this requirement may be granted only if the center meets a special need of a particular individual residing outsi…

(a) The water supplier shall determine the physical water quality in the distribution system. This determination shall be based on one or more of the following: (1) Main flushing operations and flushing records. (2) Consumer complaint records showing location, nature and duration…

(a) Each adult day health center shall provide a readily available source of emergency health services. (1) The participant, or the participant's sponsor shall sign an agreement granting the center permission to transfer the participant to a hospital or other health facility in c…

(a) Each adult day health center shall be organized and staffed to carry out the requirements of this Chapter. Staffing and administrative requirements and capabilities shall include: (1) An administrator. (2) A program director with appropriate qualifications. (3) Sufficient cle…

(a) The nutrition service shall as a minimum: (1) Be staffed and equipped to assure that food provided to the participants is safe, appetizing and provides for nutritional needs. (2) Include dietary counseling and education as part of the nutrition service. (3) Provide at least o…

(a) Each PCCM plan shall provide or arrange for the provision of the full scope of Medi-Cal services set forth in Chapter 3, Article 4, beginning with section 51301, and in Chapter 11, beginning with section 59998, unless services are specifically excluded under the terms of the …

(a) Community water systems and nontransient noncommunity water systems that treat their water with a chemical disinfectant in any part of the treatment process or which provide water that contains a chemical disinfectant shall comply with the requirements of this chapter beginni…

(a) Each water treatment facility shall be classified pursuant to Table 64413.1-A based on the calculation of total points for the facility using the factors specified in subsection (b). Total Points Class Less than 20 T1 20 through 39 T2 40 through 59 T3 60 through 79 T4 80 or m…

(a) The Director shall use the following criteria when evaluating drugs to add to and to delete from the Medi-Cal List of Contract Drugs. The Director may restrict usage of any drug or therapeutic category of drugs on the Medi-Cal List of Contract Drugs. The Director's decision s…

“Supplemental reimbursement” for the purposes of this chapter means reimbursement by the Department to an eligible hospital pursuant to the provisions of the Welfare and Institutions Code, section 14085.5.

(a) Every public pool shall be under the supervision of a pool operator. (b) The pool operator shall maintain pool operating procedures at the public pool site for use by the pool operator and for inspection by the enforcing agent. (c) The pool operator shall maintain manufacture…

“Physician-Practitioner Interface” means the system of collaboration and physician supervision by which medical treatment services provided by physicians and nonphysician medical practitioners are integrated and made consistent with accepted medical practice.

(a) Each POU must: (1) be independently certified in accordance with an American National Standard Institute (ANSI) standard that is applicable to the specific type of proposed POU and that adequately addresses a California drinking water standard; or (2) be approved by the State…

(a) Systems required to meet the enhanced coagulation or enhanced softening requirements in section 64536.2(a) or (b) shall report the following: (1) The number of paired (source water and treated water) samples taken during the last quarter. (2) The location, date, and result of…

Continuous home care means care provided in the individual's residence, which consists predominately of skilled nursing care, for a minimum of eight hours in a 24-hour period, for the palliation or management of acute medical symptoms and/or when the family or caregiver is physic…

Each fluoridation system installed or modified after January 1, 1997, shall meet the following criteria, as a minimum: (a) Operate only when a flow of water is detected. If the water system serves less than 200 service connections, a secondary flow-based control device shall be p…

Each water system shall: (a) Except for inactive sources, install a flow meter at a location between each water source and the entry point to the distribution system; (b) Meter the quantity of water flow from each source, and record the total monthly production each month.

(a) All PCCM plan marketing representatives shall complete the PCCM plan's marketing education program required by Section 56400(c) and shall receive a passing score of 90 percent or better, based on a straight percentage method, on the Department's examination for marketing repr…

All providers of personal care program services must be approved by Department of Health Services and shall sign the “Personal Care Program Provider/Enrollment Agreement” form [SOC 426(1/93)] designated by the Department agreeing to comply with all applicable laws and regulations…

(a) PCCM plans shall submit all completed designation forms to the Department within 15 calendar days of the date the PCCM plan receives the completed designation form. (b) Unless otherwise provided in writing by the Department, each PCCM plan shall accept designation forms from …

(a) Each adult day health center shall establish a utilization review committee. Membership in this committee shall include, but is not limited to, a representative from the adult day health center, and professional personnel such as a physician, psychiatrist, nurse, social worke…

Individualized plan of care means a written plan designed to provide a participant of an adult day health center with appropriate treatment in accordance with the assessed needs of the participant.

Sub-subcontract means any agreement, descending from and subordinate to a subcontract, which is entered into for the purpose of providing any goods or services connected with a prepaid health plan's obligations under a contract entered into pursuant to this Chapter.