§ 42132. Reasons for Notice of Action.

(a) A written Notice of Action shall be sent to the applicant, client and/or legal guardian, or authorized representative within seven calendar days of the decision by the designated CCS agency when:

(1) The applicant is being denied financial, residential, or medical eligibility following completion of the written application to the CCS program.

(2) A request for a new medical service or program benefit not currently being provided to a client or when continuation of a CCS medical service or program benefit currently authorized is denied.

(3) The client's eligibility for the CCS program is discontinued.

(4) The amount the family must repay the program for treatment services is increased. However, if the family agrees with the new amount and signs a dated statement, which statement may be prepared by either the family or the agency, agreeing to the new amount, the family's copy of the statement constitutes written Notice of Action. No form is required.

(5) The request in subsection (a)(2) is approved, but is modified by the CCS program to reduce the frequency or duration, to change the place or provider of service, or to alter the nature of the medical services or benefit requested.

(b) The reduction, termination, or modification of current services or benefits does not require a written notice of action when:

(1) The reduction, termination, increase, or other modification is ordered by the CCS physician who is providing medical supervision of the client; or

(2) The reduction, termination or modification is with the consent of the client or person legally authorized to consent for the client; or

(3) Services or benefits were authorized for a limited duration as requested by the CCS provider, the client was so advised, and the date the service or benefit is to be terminated is the same as the termination date requested by the provider and approved by the CCS agency; or

(4) The client is in a licensed acute care or subacute medical care facility.

HISTORY

1. Change without regulatory effect pursuant to Section 100, Title 1, California Code of Regulations adding new section filed 3-9-90 (Register 90, No. 13). For prior history, see Title 17, Part I, Subchapter 3, Sections 2890-2923, not consecutive.

2. Change without regulatory effect renumbering former section 42132 to section 41702 and renumbering former section 42701 to section 42132, including amendment of subsection (a) and Note, filed 1-28-2009 pursuant to section 100, title 1, California Code of Regulations (Register 2009, No. 5).

Note

Note: Authority cited: Sections 20, 100275(a) and 123805, Health and Safety Code. Reference: Sections 123805, 123835, 123850, 123865, 123870, 123905 and 123925, Health and Safety Code.