Cal. Code Regs. Tit. 22, § 51006 - Out-of-State Coverage
(a)
Necessary out-of-state medical care, within the limits of the program, is
covered only under the following conditions:
(1) When an emergency arises from accident,
injury or illness; or
(2) Where the
health of the individual would be endangered if care and services are postponed
until it is feasible that he return to California; or
(3) Where the health of the individual would
be endangered if he undertook travel to return to California; or
(4) When it is customary practice in border
communities for residents to use medical resources in adjacent areas outside
the State; or
(5) When an
out-of-state treatment plan has been proposed by the beneficiary's attending
physician and the proposed plan has been received, reviewed and authorized by
the Department before the services are provided. The Department may authorize
such out-of-state treatment plans only when the proposed treatment is not
available from resources and facilities within the State.
(6) Prior authorization is required for all
out-of-state services, except:
(A) Emergency
services as defined in Section
51056.
(B) Services provided in border areas
adjacent to California where it is customary practice for California residents
to avail themselves of such services. Under these circumstances, program
controls and limitations are the same as for services from providers within the
State.
(b) No
services are covered outside the United States, except for emergency services
requiring hospitalization in Canada or Mexico.
Notes
2. Change without regulatory effect adding NOTE (Register 86, No. 49).
Note: Authority cited: Sections 10725 and 14125.5, Welfare and Institutions Code. Reference: Section 14122, Welfare and Institutions Code.
2. Change without regulatory effect adding NOTE (Register 86, No. 49).
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