Cal. Code Regs. Tit. 22, § 55130 - Indian Health Service Facilities as Fee-for-Service Managed Care Plans
(a) If, under the
option provided in Section
55120(d), the
Indian Health Service Facility elects to become a fee-for-service managed care
plan, the Indian Health Service Facility shall act as primary care case manager
for Medi-Cal beneficiaries who are Indians or non-Indians currently receiving
services from the Indian Health Service Facility, once they voluntarily enroll
with the Indian Health Service Facility fee-for-service managed care plan. The
plan shall be responsible to provide or arrange for health care services for
its members as agreed to in the contract between the department and the Indian
Health Service Facility. The department shall inform Medi-Cal beneficiaries who
are Indians or non-Indians currently receiving services from the Indian Health
Service Facility of their option to enroll in the Indian Health Service
Facility fee-for-service managed care plan through the health care options
program.
(b) To participate as a
fee-for-service managed care plan, the Indian Health Service Facility must
demonstrate sufficient resources and capability to implement the
fee-for-service managed care contract, including, but not limited to:
(1) Medical and administrative
staff.
(2) Information
systems.
(3) Organizational
structure.
(4) Financial
solvency.
(5) Quality improvement
system.
(6) Member grievance
system.
Notes
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, 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 14000, 14016.5, 14087.3, 14089 and 14089.05, Welfare and Institutions Code; and Title 25, United States Code, Sections 13 and 1601.
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).
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