Title WIC, California Welf. & Inst. Code

(a) (1) A Medi-Cal managed care plan that has received approval from the department to utilize an alternative access standard pursuant to subdivision (f) of Section 14197, upon the request of an enrollee who is required to travel farther than the time or distance standards, as es…

(a) As part of the federally required external quality review organization (EQRO) review of Medi-Cal managed care plans in the annual detailed technical report required by Section 438.364 of Title 42 of the Code of Federal Regulations, effective for contract periods commencing on…

(a) A Medi-Cal managed care plan shall ensure access to care for latent tuberculosis infection and active tuberculosis disease and coordination with local health department tuberculosis control programs for plan enrollees with active tuberculosis disease, including, but not limit…

(a) A contract between the department and a Medi-Cal managed care plan shall require the Medi-Cal managed care plan to do both of the following: (1) Identify, on a quarterly basis, every enrollee who is a child without a record of completing the blood lead screening tests require…

(a) (1) No later than 12 months after the working group develops its recommendations for curriculum pursuant to subdivision (b) of Section 150950 of the Health and Safety Code, and no later than March 1, 2025, a Medi-Cal managed care plan shall require all of its subcontractors, …

(a) The department shall ensure that all covered mental health benefits and substance use disorder benefits, as those terms are defined in Section 438.900 of Title 42 of the Code of Federal Regulations, are provided in compliance with Parts 438, 440, 456, and 457 of Title 42 of t…

(a) Notwithstanding any other law, subject to subdivisions (e) and (g), the department may enter into one or more comprehensive risk contracts with an alternate health care service plan (AHCSP) to serve as a primary Medi-Cal managed care plan for eligible beneficiaries described …

(a) This section implements the state option in subsection (j) of Section 438.8 of Title 42 of the Code of Federal Regulations. (b) Commencing July 1, 2019, a Medi-Cal managed care plan shall comply with a minimum 85 percent medical loss ratio (MLR) consistent with Section 438.8 …

(a) A Medi-Cal managed care plan shall give a beneficiary timely and adequate notice of an adverse benefit determination in writing consistent with the requirements in Sections 438.404, 438.408, and 438.10 of Title 42 of the Code of Federal Regulations. For purposes of this subdi…

(a) The Legislature finds and declares all of the following: (1) Designated public hospital systems play an essential role in the Medi-Cal program, providing high-quality care to a disproportionate number of low-income Medi-Cal and uninsured populations in the state. Because Medi…

(a) Notwithstanding any other law, for covered benefits under its contract, as applicable, a Medi-Cal managed care plan shall comply with all of the following: (1) Make a good faith effort to contract with at least one National Cancer Institute (NCI)-designated comprehensive canc…

(a) Notwithstanding any other law, but no sooner than July 1, 2019, the Cost-Based Reimbursement Clinic Directed Payment Program shall be in operation. (b) For purposes of this section, the following definitions apply: (1) “Cost-based reimbursement clinics” or “CBRCs” have the sa…

(a) For purposes of this section, the following definitions apply: (1) “Children’s hospital” has the same meaning as that term is defined in Section 10727. (2) “Medi-Cal managed care plan” has the same meaning as that term is defined in subdivision (j) of Section 14184.101. (b) N…

(a) (1) Notwithstanding any other law, if the director finds that an entity that contracts with the department for the delivery of health care services (contractor), including a Medi-Cal managed care plan or a prepaid health plan, fails to comply with contract requirements, state…

(a) The department may, at its discretion, align relevant terms of its contract with a Medi-Cal behavioral health delivery system with the terms of its contract with a Medi-Cal managed care plan, as defined in subdivision (j) of Section 14184.101, for those requirements that appl…

(a) (1) As part of the health care options information posted by the department, in the provider directory that lists accepted Medi-Cal managed care plans, through the Medi-Cal Managed Care Health Care Options internet website and any other applicable mechanisms, the directory sh…

(a) To the extent permitted under federal law, the department shall require a Medi-Cal managed care plan that is not licensed by the Department of Managed Health Care to comply with the applicable requirements in Article 11.9 (commencing with Section 1399.870) of Chapter 2.2 of D…

(a) A hospital or its successor entity, that has received funds pursuant to Section 14198 shall maintain burn and trauma services and continue to provide medical services to beneficiaries of Medi-Cal or a successor program through the year 2028. (b) The state and a hospital subje…

(a) The Regional Burn and Trauma Center Fund is hereby created in the State Treasury, under the administrative control of the State Department of Health Services, for the purposes specified in Section 14198 upon appropriation by the Legislature. Except as otherwise limited by thi…

(a) The Legislature finds and declares the following: (1) Beginning January 1, 2014, many low-income individuals will be eligible for Medi-Cal coverage pursuant to federal law, as part of health care reform. (2) In implementing this expansion of Medi-Cal coverage, it is critical …

(a) Subject to subdivision (e), Medi-Cal managed care plans serving newly eligible beneficiaries, as defined in subdivision (s) of Section 17612.2, shall pay county public hospital health systems, as defined in subdivision (f) of Section 17612.2, for services provided to newly el…

The Legislature finds and declares all of the following: (a) The Legislature continues to recognize that an enrollment-based managed care organization provider tax is an essential and necessary source of nonfederal funding for maintaining and improving access to care and reimburs…

The following definitions shall apply for purposes of this article: (a) “Base data source” means the quarterly financial statement filings or annual enrollment data submitted by health plans to the Department of Managed Health Care retrieved by the department no later than June 3…

(a) The Managed Care Enrollment Fund is hereby created in the State Treasury. (b) All revenues, less refunds, derived from the taxes provided for in this article shall be deposited in the State Treasury to the credit of the Managed Care Enrollment Fund. (c) Notwithstanding Sectio…

(a) The department shall determine for each health plan, using the base data source, all of the following: (1) Total cumulative enrollment for the base year. (2) Total Medicare cumulative enrollment for the base year. (3) Total Medi-Cal cumulative enrollment for the base year. (4…

(a) A managed care organization provider tax shall be imposed on each health plan. The tax shall be imposed for the following tax periods: (1) April 1, 2023, through December 31, 2023. (2) 2024 calendar year. (3) 2025 calendar year. (4) 2026 calendar year. (b) (1) The department …

(a) For each tax period, the Medi-Cal taxing tiers shall be as follows: (1) Medi-Cal taxing tier I shall consist of all countable Medi-Cal enrollees in a health plan from zero to 1,250,000, inclusive. (2) Medi-Cal taxing tier II shall consist of all countable Medi-Cal enrollees i…

(a) The tax assessed under this article shall become effective and operative on April 1, 2023, or the effective date, certified in writing by the director, of the federal approval necessary for receipt of federal financial participation, whichever occurs later. The director shall…

(a) This article shall become operative on the effective date, certified in writing by the director, of the federal approval necessary for receipt of federal financial participation, as described in subdivision (a) of Section 14199.86 for purposes of assessing the tax under this …

The Legislature finds and declares all of the following: (a) The Legislature continues to recognize that an enrollment-based managed care organization (MCO) provider tax is an essential and necessary source of nonfederal funding for maintaining and improving access to care and re…

For purposes of this article, the following definitions apply: (a) “Base data source” means the quarterly financial statement filings or annual enrollment data submitted by health plans to the Department of Managed Health Care retrieved by the department no later than June 30, 20…

(a) The Medi-Cal Stability Fund is hereby created in the State Treasury. (b) All revenues, less refunds, derived from the taxes provided for in this article shall be deposited in the State Treasury to the credit of the Medi-Cal Stability Fund. (c) Notwithstanding Section 16305.7 …

(a) The department shall determine for each health plan, using the base data source, all of the following: (1) Total cumulative enrollment for the base year. (2) Total Medicare cumulative enrollment for the base year. (3) Total Medi-Cal cumulative enrollment for the base year. (4…

(a) A managed care organization provider tax shall be imposed on each health plan. The tax shall be imposed for the 2027, 2028, and 2029 calendar years. The tax shall be imposed for all periods within a calendar year that the tax is effective and operative as set forth in Section…

(a) (1) For each calendar year in which the managed care organization provider tax authorized by this article is in effect, the tax amount for each health plan shall be eight dollars and eighty-five cents ($8.85) per countable enrollee per month, unless modified in accordance wit…

(a) The tax assessed under this article shall become effective and operative on January 1, 2027, or the effective date, certified in writing by the director, of federal approval if such approval is necessary, whichever occurs later. When such federal approval is necessary and is …

(a) This article shall become operative on July 1, 2026, or the date on which the act that added this article is chaptered, whichever is later. (b) (1) All sections in this article, except for Section 14199.92 to the extent not in conflict with federal law, shall become inoperati…

The following definitions shall apply for purposes of this article: (a) “County” means the County of Los Angeles. (b) “Board of supervisors” means the Board of Supervisors of the County of Los Angeles. (c) “Commission” means the separate public agency established by the board of …

(a) The board of supervisors may, by ordinance, resolution, or other action, establish a commission in order to meet the problems of delivery of publicly assisted medical care in the county and demonstrate ways of promoting quality care and cost efficiency. The health care servic…

Governance of the commission shall be vested in a governing body consisting of 13 members, each of whom shall have a fiduciary duty to act in the best interest of the commission and the local initiative, nominated by the following entities, and appointed by the board of superviso…

(a) The composition of the 13-member governing body of the commission, as prescribed in Section 14087.961, shall be subject to alteration upon a two-thirds vote of the full membership of the governing body, if the action is also concurred in by an affirmative vote of at least fou…

Members of the governing body shall either reside, be employed, or provide services in the geographic area served by the local initiative. Nominees shall be appointed to the governing body by the board of supervisors. The board of supervisors shall not deny appointment to a nomin…

(a) Members of the governing body of the commission shall serve four-year terms. (b) Individuals shall be limited to serving on the governing body for two consecutive four-year terms or a maximum of 10 years. (Amended by Stats. 2004, Ch. 454, Sec. 3. Effective January 1, 2005.)

(a) The governing body of the commission shall establish rules for its proceedings. There shall be at least six meetings per year. (b) (1) Each governing body member shall be entitled to one hundred dollars ($100) remuneration from commission funds for each governing body meeting…

(a) A majority of the members of the governing body shall constitute a quorum for the transaction of business, and all official acts of the governing body shall require the affirmative vote of a majority of the members present and voting. (b) No official act shall be approved wit…

A member of the governing body shall be removed from office if a majority of the members present and voting find that one or more of the following causes for removal exists: (a) The member neither lives in, nor is employed in, the geographic area served by the local initiative. (…