Cal. Code Regs. Tit. 22, § 55180 - Indian Health Service Facilities and the Health Care Options Program

(a) In geographic areas served by a Geographic Managed Care program, the two-plan model, or where the health care options program is operating, Indian Health Service Facilities shall be listed as an option in the presentation and informing materials used to advise beneficiaries of their options for receiving Medi-Cal benefits. Indians and non-Indians currently receiving services from an Indian Health Service Facility in such an area may, as an alternative to enrollment in a Medi-Cal managed care plan, and upon request, choose to receive health care services through the Indian Health Service Facility. Such a request shall be made to the health care options program.

(b) In areas covered by subsection (a), if the Indian Health Service Facility provides the department with current information on Indian Medi-Cal beneficiaries and non-Indian Medi-Cal beneficiaries who are currently receiving services from the facility in the form agreed to between the department and the Indian Health Service Facility, the following shall apply:

(1) If an Indian Medi-Cal beneficiary, who is identified by the Indian Health Service Facility as currently receiving services from the facility, does not make a choice of options, that beneficiary shall not be assigned to a Medi-Cal managed care plan, but shall remain in the fee-for-service Medi-Cal program to allow the beneficiary to continue to receive care from the Indian Health Service Facility. This requirement shall apply whether or not the Indian Health Service Facility has subcontracted with a Medi-Cal managed care plan, but shall not apply if the Indian Health Service Facility is a fee-for-service managed care plan.

(2) Non-Indian Medi-Cal beneficiaries may be identified by the Indian Health Service Facility as currently receiving services from the facility. Such beneficiaries who do not make a choice of options shall not be assigned to a Medi-Cal managed care plan, but shall remain in the fee-for-service Medi-Cal program to allow those beneficiaries to continue to receive care from the Indian Health Service Facility. This requirement shall apply whether or not the Indian Health Service Facility has subcontracted with a Medi-Cal managed care plan, but shall not apply if the Indian Health Service Facility is a fee-for-service managed care plan.

(3) If the Indian Health Service Facility is a fee-for-service managed care plan, beneficiaries identified in subdivisions (1) and (2) who fail to make a choice shall be assigned to the Indian Health Service Facility's fee-for-service managed care plan.

Notes

Cal. Code Regs. Tit. 22, § 55180

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, 14089, 14089.05 and 14200, 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).