(a)
Indian Health Service Facilities may participate in the Medi-Cal managed care
program as a subcontractor with a Medi-Cal managed care plan, if agreement is
reached between the parties to the subcontract and the subcontract is approved
by the department. Approval by the department shall be based on the
subcontract's compliance with standards applicable to all subcontracts held by
Medi-Cal managed care plans, including standards relative to appropriate
reimbursement rates.
(b) In the
two-plan model, the department shall require the local initiative to offer a
subcontract to each Indian Health Service Facility located in the designated
region served by the local initiative under the two-plan model. If there is no
local initiative in a county and the department exercises its option under
Section
53800(b)(3), the
department shall establish participation standards for Indian Health Service
Facilities that provide that at least one of the two Medi-Cal managed care
plans participating in the program shall offer a subcontract to each Indian
Health Facility located in the designated region served by the plans under the
two-plan model. The terms of these subcontracts shall be consistent with the
requirements of this chapter and, in other respects, shall be consistent with
the terms and conditions offered to other subcontractors providing a similar
scope of services.
(c) In counties
with mandatory enrollment in Medi-Cal managed care programs other than the
two-plan model and county organized health systems, the department shall
establish participation standards for Indian Health Service Facilities. These
standards shall provide that at least one Medi-Cal managed care plan
participating in the program in the county shall offer a subcontract to each
Indian Health Facility located in the geographic region served by the program.
The terms of these subcontracts shall be consistent with the requirements of
this chapter and, in other respects, shall be consistent with the terms and
conditions offered to other subcontractors providing a similar scope of
services.
(d) In the two-plan model
program or in a Geographic Managed Care program, if the Indian Health Service
Facility does not participate as a subcontractor, the department shall accept
applications to the extent permitted by federal law from an Indian Health
Service Facility interested in contracting as a fee-for-service managed care
plan under Section
55130. The fee-for-service managed
care plan may only enroll Indians and the number of non-Indians receiving
services from the Indian Health Service Facility at the time of application to
the department. If departmental resources limit the implementation and
monitoring of additional fee-for-service managed care plans, the department may
discontinue the acceptance of applications and implemention of any additional
fee-for-service managed care programs by providing six months written notice of
its intent to discontinue acceptance and implementation to the California Area
Office, Indian Health Service, Public Health Service, Department of Health and
Human Services.
Notes
Cal. Code Regs. Tit. 22, §
55120
1. New
section filed 4-3-98; operative 4-3-98. Submitted to OAL for printing only
pursuant to section
147, Senate Bill 485 (Ch. 722/92)
(Register 98, No. 15).
2. Change without regulatory effect amending
NOTE filed 4-9-98 pursuant to section
100, title 1, California Code of
Regulations (Register 98, No. 15).
Note: Authority cited: Stats. 1992, Ch. 722; Sections
10725,
14089.7,
14105,
14124.5,
14203
and
14312,
Welfare and Institutions Code. Reference: Sections
14000,
14016.5,
14087.3,
14087.305,
14087.4,
14087.5,
14088,
14089,
14089.05,
14200
and
14499.5,
Welfare and Institutions Code; and Title 25, United States Code, Sections
13 and
1601.
1. New section filed
4-3-98; operative 4-3-98. Submitted to OAL for printing only pursuant to
section 147, Senate Bill 485 (Ch. 722/92) (Register 98, No. 15).
2.
Change without regulatory effect amending Note filed 4-9-98 pursuant to section
100, title 1, California Code of Regulations (Register 98, No.
15).