Cal. Code Regs. Tit. 22, § 51002 - Beneficiary Billing
(a) A
provider of service under the Medi-Cal program shall not submit claims to or
demand or otherwise collect reimbursement from a Medi-Cal beneficiary, or from
other persons on behalf of the beneficiary, for any service included in the
Medi-Cal program's scope of benefits in addition to a claim submitted to the
Medi-Cal program for that service, except to:
(1) Collect payments due under a contractual
or legal entitlement pursuant to Section
14000(b)
of the Welfare and Institutions Code.
(2) Bill a long-term care patient for the
amount of his liability.
(3)
Collect copayment pursuant to Welfare and Institutions Code Section
14134.
(b) In the event that a beneficiary willfully
refuses to provide current other health care coverage billing information as
described in Section
50763(a) (5) to a
provider, upon giving the beneficiary written notice of intent, the provider
may bill the beneficiary as a private pay patient. This shall not apply for
beneficiaries covered under Medi-Cal capitated contracting arrangements.
Capitated contractor or subcontractor billing beneficiaries covered under
Medi-Cal capitated contracting arrangements shall be governed by applicable
laws including Welfare and Institutions Code and by; the terms of the
contract.
Notes
2. Amendment filed 8-8-78; effective thirtieth day thereafter (Register 78, No. 32).
3. New subsection (2)(3) filed 11-17-81 as an emergency; effective upon filing (Register 81, No. 47). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 3-17-82.
4. Certificate of Compliance transmitted to OAL 3-16-82 and filed 4-16-82 (Register 82, No. 16).
5. Amendment filed 6-28-89; operative 7-28-89 (Register 89, No. 26).
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions Code; Section 133.5 of Chapter 102, Statutes of 1981; and Section 2 of Chapter 237, Statutes of 1981. Reference: Section 14134, Welfare and Institutions Code.
2. Amendment filed 8-8-78; effective thirtieth day thereafter (Register 78, No. 32).
3. New subsection (2)(3) filed 11-17-81 as an emergency; effective upon filing (Register 81, No. 47). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 3-17-82.
4. Certificate of Compliance transmitted to OAL 3-16-82 and filed 4-16-82 (Register 82, No. 16).
5. Amendment filed 6-28-89; operative 7-28-89 (Register 89, No. 26).
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