Title WIC, California Welf. & Inst. Code

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 recipients as patients, upon request of the treating physician. (Added by Stats. 1978, Ch. 1327.)

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 of the state, and no county shall employ such consultants. However, if the director finds that it is not reasonable…

(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 payments for categories of services, according to the categories established in the Governor’s Budget. The schedule…

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 persons eligible for medical assistance pursuant to Sections 14005.1, 14005. 4, and 14005.7 by providers in another state in …

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 appropriated to carry out this chapter. (a) (1) The director may suspend a provider of service from further participation under t…

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 provider to meet and confer with the appropriate department officials after the issuance of a …

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 preexisting law, and shall be construed merely as providing a specific statutory basis for suspension. (Added by Stats. 1976, …

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 agency thereof as defined in appropriate state law, that the director determines is for a medical or other item or service t…

(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 or 14171.6, and as the “single state agency” for California vested with authority to administer the Medi-Cal program, th…

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 the appropriate state licensing, certifying or registering authority. The director may in any event provide information o…

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 department or its agents or contractors, shall keep and maintain records of each service rendered under the Medi-Cal prog…

(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 source of payment for the facility’s services that are required to be provided to individuals entitled to servic…

(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 survivors who are enrolled in the Medi-Cal program and assist them in obtaining federal veteran h…

(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 flexibility approved by the federal Centers for Medicare and Medicaid Services related to the COVID-19 public health eme…

(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 any federal grant awarded pursuant to the federal 21st Century Cures Act (Public Law 114-255), any subsequ…

(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. Sec. 290bb-37) to develop a community-based crisis response plan. To the extent consistent with federal grant application r…

(a) Effective January 1, 2023, subject to appropriation by the Legislature, the department shall design and implement a supplemental payment program for emergency medical air transportation services to increase the Medi-Cal reimbursement in an amount not to exceed normal and cust…

(a) (1) Upon appropriation by the Legislature for this purpose, the department shall complete an independent analysis to determine whether network adequacy exists to obtain federal approval for a covered Medi-Cal benefit that provides housing support services. The analysis shall …

(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 of, those identified in paragraphs (2) and (3), that it may deem necessary to carry out the provisions of this chapter or…

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 the department and may be made personally or by mail. If made by mail, service shall be made in the manner prescribed by S…

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 provider, but such review shall be limited to reduction of such penalty. (Added by Stats. 1970, Ch. 1030.)

(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 Division 3 of Title 2 of the Government Code, reasonable rules and regulations as may be necessary or proper to carry out t…

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 11522 of the Government Code, he or she may hear and decide the matter himself or herself or may, in his or her discretion,…

(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, 2002, transfer within the facility, any resident as a result of the resident changing his or her manner of purchasing the …

(a) The regional center or state-operated facility shall send adequate notice, as described in subdivision (a) of Section 4701, to the recipient and, if appropriate, the authorized representative, by standard mail, certified mail, or email at their preference as indicated in thei…

(a) Any applicant for or recipient of services, or authorized representative of the applicant or recipient, who is dissatisfied with a decision or action of the regional center or state-operated facility under this division shall, upon filing a request within 60 days after notifi…

(a) (1) Upon receipt of an appeal request form requesting an informal meeting, the regional center or state-operated facility and the claimant shall determine a mutually agreed-upon date, time, and place for the meeting to be held, which shall be within 10 days of the date the de…

(a) The purpose of the informal meeting is to attempt to resolve the issue or issues that are the subject of the appeal request informally prior to a mediation or fair hearing. (b) The informal meeting shall be conducted by the regional center or state-operated facility director …

(a) At an informal meeting, the claimant shall have the rights stated pursuant to Section 4701. (b) An informal meeting shall be held consistent with Section 4710.6. (c) An informal meeting shall be conducted in the English language. However, if the preferred language of the clai…

(a) If, after the informal meeting, the claimant or their authorized representative is satisfied with all or part of the decision of the regional center or state-operated facility, they shall withdraw the request for an appeal on the matter or matters that have been decided to th…

(a) Upon receipt of an appeal request form requesting mediation or a fair hearing, the hearing office shall immediately notify the claimant and the claimant’s authorized representative, in their preferred language, and the regional center or state-operated facility director in wr…

(a) Upon receipt of an appeal request form requesting mediation, the hearing office shall promptly notify the claimant and their authorized representative, in their preferred language, and the regional center or state-operated facility, of the information applicable to mediation.…

(a) If the issue or issues involved in the mediation are resolved or partially resolved to the satisfaction of both parties, the mediator shall prepare a written resolution. Agreement of the claimant or their authorized representative to the written resolution shall be accompanie…

(a) (1) The fair hearing shall be held within 50 days of the date the appeal request form is received by the department or other agency designated by the department to receive appeal request forms, unless a continuance is granted to the claimant. A claimant’s first request for a …

(a) Two or more claimants with a common complaint, or their authorized representatives, or a regional center or state-operated facility may request the consolidation of appeals involving a common question of law or fact. The hearing officer may grant the request for consolidation…

(a) (1) Within 10 business days of the concluding day of the fair hearing, but not later than 80 days following the date the appeal request form was received by the department or by another agency designated by the department to receive the appeal request form, the hearing office…

(a) If the final decision is unfavorable to the claimant, and the claimant has been receiving the services that have been the subject of the appeal, the decision shall not be implemented until 15 days after receipt of the final hearing decision by the claimant and the authorized …

(a) The regional center shall implement the final hearing decision as soon as practical and not later than 30 days following the date of the final hearing decision, or, if a reconsideration was granted, the regional center shall implement the final corrected decision 30 days foll…

(a) For each appeal request form submitted pursuant to Section 4710.5, the department shall collect information related to the appeal from regional centers or state-operated facilities in a manner and at times determined by the department. The information collected shall include,…

The Medi-Cal Benefits Program comprises a department-administered uniform schedule of health care benefits. Notwithstanding any other provision of this chapter, “health care services” shall be limited to the benefits set forth in this article and in Section 14021. (Amended by Sta…

(a) Notwithstanding any other provision of this chapter or Chapter 8 (commencing with Section 14200), optional hearing aid benefits are subject to per beneficiary benefit cap amounts under the Medi-Cal program. (b) For the purposes of this section, “benefit cap amount” means the …

(a) Notwithstanding this chapter, Chapter 8 (commencing with Section 14200), or Chapter 8.75 (commencing with Section 14591), in order to implement changes in the level of funding for health care services, specific optional benefits are excluded from coverage under the Medi-Cal p…

(a) Notwithstanding any other provision of this chapter or Chapter 8 (commencing with Section 14200), any increase in the amount charged to the Medi-Cal program for patient care or treatment that is directly related to an identifiable provider-preventable condition is excluded fr…

(a) In geographic areas in which Medi-Cal managed care plans contracting under this chapter or Chapter 8 (commencing with Section 14200) are operating with capacity to enroll additional qualifying Medi-Cal beneficiaries, the director may, in the interest of bringing managed care …

The following is the schedule of benefits under this chapter: (a) Outpatient services are covered as follows: Physician, hospital or clinic outpatient, surgical center, respiratory care, optometric, chiropractic, psychology, podiatric, occupational therapy, physical therapy, spee…

(a) Notwithstanding any other provision of law, a community clinic or free clinic licensed pursuant to subdivision (a) of Section 1204 of the Health and Safety Code or an intermittent clinic operating pursuant to subdivision (h) of Section 1206 of the Health and Safety Code, that…