§ 53857. Medical Director.

(a) Each plan in a designated region shall appoint a physician as medical director whose responsibilities shall include, but not be limited to, the following:

(1) Ensuring that medical decisions are:

(A) Rendered by qualified medical personnel.

(B) Are not influenced by fiscal or administrative management considerations.

(2) Ensuring that the medical care provided meets the standards for acceptable medical care.

(3) Ensuring that medical protocols and rules of conduct for plan medical personnel are followed.

(4) Developing and implementing medical policy.

(5) Resolving grievances related to medical quality of care.

(6) Actively participating in the functioning of the plan grievance procedures.

(7) Actively participating in the functioning of the plan quality improvement program.

HISTORY

1. New section filed 7-1-96 as an emergency; operative 7-1-96. Submitted to OAL for printing only pursuant to Section 147, SB 485 (Ch. 722/92) (Register 96, No. 28).

2. Repealer of section and Note and new section and Note filed 3-4-97; operative 3-4-97. Submitted to OAL for printing only pursuant to Section 147, SB 485 (Ch. 722/92) (Register 97, No. 10).

Note

Note: Authority cited: Sections 10725, 14105, 14124.5 and 14312, Welfare and Institutions Code. Reference: Sections 14087.3, 14087.4, 14450 and 14495, Welfare and Institutions Code; and Section 1367, Health and Safety Code.