California Welfare and Institutions Code

§ 14094.13

WIC § 14094.13 Effective Jan 1, 2017Div. 9 · Part 3 · Ch. 7 · Art. 2.985

Statute text

(a)Each Medi-Cal managed care plan shall establish and maintain a process by which a CCS-eligible child or youth may maintain access to CCS providers that the child or youth has an existing relationship with for treatment of the child’s or youth’s CCS condition for up to 12 months, under the following conditions:

(1)The CCS-eligible child or youth has seen the out-of-network CCS provider for a nonemergency visit at least once during the 12 months immediately preceding the date the Medi-Cal managed care plan assumed responsibility for the child’s or youth’s CCS care under the Whole Child Model program.

(2)The CCS provider accepts the health plan’s rate for the service offered or the applicable Medi-Cal or CCS fee-for-service rate, whichever is higher, unless the CCS provider enters into an agreement on an alternative payment methodology mutually agreed to by the CCS provider and the Medi-Cal managed care plan.

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Legislative history

Added by Stats. 2016, Ch. 625, Sec. 7. (SB 586) Effective January 1, 2017.