§ 53884. Assignment System.

(a) The Health Care Options Program shall implement a system within each designated region approved by the department to assign an eligible beneficiary described in section 53845(a), to a plan, in the event the beneficiary does not select a plan pursuant to section 53882(d).

(b) In assigning an eligible beneficiary to a plan, the Health Care Options Program's system shall, at a minimum, consider the following:

(1) Zip code of eligible beneficiary matched to zip codes served by the plan in accordance with the provisions of section 50185.5(f).

(2) Enrollment capacity and availability of the plan.

(3) Plan's ability to render linguistically appropriate services and the eligible beneficiary's need for those services, if made known to the Health Care Options Program.

(4) Assignment of family members to the same plan to the extent possible.

(5)(A) Assignments between plans shall be distributed in accordance with an agreement, approved by the Department, between a local initiative and a commercial plan in a designated region; or

(B) in the absence of an approved agreement, the Department shall determine how assignments shall be distributed in a designated region.

(6) In approving an agreement between a local initiative and a commercial plan, or when the Department determines how assignments shall be distributed, the Department may consider the following factors:

1. The potential for a high level of informed beneficiary choice of plans and providers.

2. The potential for the local initiative to achieve an enrollment level that reasonably allows it to spread financial risk and a reasonable opportunity for it to attain financial viability.

3. Maintaining the level of disproportionate share hospital days and safety net providers in the region so that neither is adversely affected by the mandatory enrollment of Medi-Cal beneficiaries in managed care, when compared to Medi-Cal program levels prior to implementing the two-plan model in the region.

4. The need to assure that a commercial plan is not precluded from receiving default assignments, other than during a limited time period immediately preceding and following local initiative start-up.

5. The ability of the department's enrollment contractor to accurately and timely perform the selected assignment distribution methodology.

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 heading, section and Note and new section heading, 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).

3. Repealer of subsection (b)(5)(A), redesignation and amendment of former subsection (b)(5) to new subsection (b)(5)(A), repealer and new subsection (b)(5)(B) and new subsections (b)(6)-(b)(6)5. filed 10-1-97 as an emergency; operative 10-1-97. Submitted to OAL for printing only pursuant to Section 147, SB 485 (Ch. 722/92) (Register 97, No. 40).

Note

Note: Authority cited: Sections 10725, 14105, 14124.5 and 14312, Welfare and Institutions Code. Reference: Sections 14087.3 and 14087.4, Welfare and Institutions Code.