§ 55120. Indian Health Service Facility Participation in Medi-Cal Managed Care Programs.

(a) Indian Health Service Facilities may participate in the Medi-Cal managed care program as a subcontractor with a Medi-Cal managed care plan, if agreement is reached between the parties to the subcontract and the subcontract is approved by the department. Approval by the department shall be based on the subcontract's compliance with standards applicable to all subcontracts held by Medi-Cal managed care plans, including standards relative to appropriate reimbursement rates.

(b) In the two-plan model, the department shall require the local initiative to offer a subcontract to each Indian Health Service Facility located in the designated region served by the local initiative under the two-plan model. If there is no local initiative in a county and the department exercises its option under Section 53800(b)(3), the department shall establish participation standards for Indian Health Service Facilities that provide that at least one of the two Medi-Cal managed care plans participating in the program shall offer a subcontract to each Indian Health Facility located in the designated region served by the plans under the two-plan model. The terms of these subcontracts shall be consistent with the requirements of this chapter and, in other respects, shall be consistent with the terms and conditions offered to other subcontractors providing a similar scope of services.

(c) In counties with mandatory enrollment in Medi-Cal managed care programs other than the two-plan model and county organized health systems, the department shall establish participation standards for Indian Health Service Facilities. These standards shall provide that at least one Medi-Cal managed care plan participating in the program in the county shall offer a subcontract to each Indian Health Facility located in the geographic region served by the program. The terms of these subcontracts shall be consistent with the requirements of this chapter and, in other respects, shall be consistent with the terms and conditions offered to other subcontractors providing a similar scope of services.

(d) In the two-plan model program or in a Geographic Managed Care program, if the Indian Health Service Facility does not participate as a subcontractor, the department shall accept applications to the extent permitted by federal law from an Indian Health Service Facility interested in contracting as a fee-for-service managed care plan under Section 55130. The fee-for-service managed care plan may only enroll Indians and the number of non-Indians receiving services from the Indian Health Service Facility at the time of application to the department. If departmental resources limit the implementation and monitoring of additional fee-for-service managed care plans, the department may discontinue the acceptance of applications and implemention of any additional fee-for-service managed care programs by providing six months written notice of its intent to discontinue acceptance and implementation to the California Area Office, Indian Health Service, Public Health Service, Department of Health and Human Services.

HISTORY

1. New section filed 4-3-98; operative 4-3-98. Submitted to OAL for printing only pursuant to section 147, Senate Bill 485 (Ch. 722/92) (Register 98, No. 15).

2. Change without regulatory effect amending Note filed 4-9-98 pursuant to section 100, title 1, California Code of Regulations (Register 98, No. 15).

Note

Note: Authority cited: Stats. 1992, Ch. 722; Sections 10725, 14089.7, 14105, 14124.5, 14203 and 14312, Welfare and Institutions Code. Reference: Sections 14000, 14016.5, 14087.3, 14087.305, 14087.4, 14087.5, 14088, 14089, 14089.05, 14200 and 14499.5, Welfare and Institutions Code; and Title 25, United States Code, Sections 13 and 1601.