Cal. Code Regs. Tit. 22, § 53913.5 - Medical Director and Dental Director

(a) Each PHP and PCCM plan shall appoint a physician as medical director and each dental plan shall appoint a dentist as dental director, whose responsibilities shall include, but not be limited to, the following:

(1) Ensuring that medical or dental decisions are rendered by qualified medical or dental personnel, unhindered by fiscal or administrative management.

(2) Ensuring that the medical or dental care provided meets the standards for acceptable medical and dental care.

(3) Ensuring that medical or dental protocols and rules of conduct for plan medical or dental personnel are followed.

(4) Developing and implementing medical or dental policy.

(5) Resolving medical or dental quality of care related grievances. The medical or dental director shall refer non-medical or non-dental related grievances, and other grievances that are determined to be appropriately resolved through the grievance procedure, to the grievance coordinator.

(6) Actively participating in the functioning of the plan grievance procedures.

Notes

Cal. Code Regs. Tit. 22, § 53913.5

1. New section filed 3-11-94; operative 3-11-94; Submitted to OAL for printing only pursuant to section 147, SB 485 (Chapter 722, Statutes of 1992) (Register 94, No. 15).

Note: Authority cited: Sections 10725, 14089.7, 14105, 14124.5, 14203 and 14312, Welfare and Institutions Code. Reference: Sections 14088, 14089, 14089.2, 14450 and 14495, Welfare and Institutions Code; and Section 1367, Health and Safety Code.

1. New section filed 3-11-94; operative 3-11-94; Submitted to OAL for printing only pursuant to section 147, SB 485 (Chapter 722, Statutes of 1992) (Register 94, No. 15).