Medi-Cal Managed Care Plans
Cal. WIC § 14197.1
California Statutes
(
a) The department shall ensure that all covered mental health benefits and substance use disorder benefits, as those terms are defined in
Section 438.900 of Title of the Code of Federal Regulations, are provided in compliance with Parts 438, 440, 456, and of Title of the Code of Federal Regulations, as amended March 30, 2016, as published in the Federal Register (81 Fed. Reg. 18390), and any subsequent amendment to those regulations, and any associated federal policy guidance issued by the federal Centers for Medicare and Medicaid Services. (
b) Notwithstanding
Chapter 3.5 (commencing with
Section 11340) of Part of Division of Title of the Government Code, the department, without taking any further regulatory action, may implement, interpret, or make specific this subdivision by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted. In doing so, the director shall consult with managed care plans and consumer advocates. By July 1, 2022, the department shall adopt regulations, where appropriate, in accordance with the requirements of
Chapter 3.5 (commencing with
Section 11340) of Part of Division of Title of the Government Code. (
c) The department shall make any findings of noncompliance and corrective action plans available on its Internet Web site. (
d) For purposes of this section, “Medi-Cal managed care plan” means any individual, organization, or entity that enters into a contract with the department to provide services to enrolled Medi-Cal beneficiaries pursuant to any of the following:
(1) Article 2.7 (commencing with
Section 14087.3), excluding dental managed care programs developed pursuant to
Section 14087.46.
(2) Article 2.8 (commencing with
Section 14087.5).
(3) Article 2.81 (commencing with
Section 14087.96).
(4) Article 2.82 (commencing with
Section 14087.98).
(5) Article 2.91 (commencing with
Section 14089).
(6) Chapter 8 (commencing with
Section 14200), excluding dental managed care plans.
(7) Chapter 8.9 (commencing with
Section 14700).
(8) A county Drug Medi-Cal organized delivery system authorized under the California Medi-Cal Demonstration, Number 11-W-00193/9, as approved by the federal Centers for Medicare and Medicaid Services and described in the Special Terms and Conditions. For purposes of this subdivision, “Special Terms and Conditions” shall have the same meaning as set forth in subdivision (
o) of