California Welfare and Institutions Code

§ 14165.51

WIC § 14165.51 Effective Sep 30, 2024Div. 9 · Part 3 · Ch. 7 · Art. 5.15

Statute text

(a)(1) For dates of service commencing no later than January 1, 2026, the department shall establish a Medi-Cal managed care directed payment reimbursement methodology in accordance with Section 438.6(c) of Title 42 of the Code of Federal Regulations applicable to the hospital.

(2)The directed payment reimbursement methodology shall, at minimum:

(A)Provide reimbursement for contracted hospital inpatient services such that aggregate managed care reimbursement to the hospital for hospital inpatient services, exclusive of any payments pursuant to Article 5.230 (commencing with Section 14169.50), is projected by the department to be at least equal to 72 percent of the hospital’s projected Medi-Cal costs for hospital inpatient services associated with the implementation of Section 14182, and other mandatory managed care enrollment provisions implemented subsequent to January 1, 2011.

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Legislative history

Added by Stats. 2024, Ch. 999, Sec. 8. (AB 177) Effective September 30, 2024.