§ 55130. Indian Health Service Facilities as Fee-for-Service Managed Care Plans.

(a) If, under the option provided in Section 55120(d), the Indian Health Service Facility elects to become a fee-for-service managed care plan, the Indian Health Service Facility shall act as primary care case manager for Medi-Cal beneficiaries who are Indians or non-Indians currently receiving services from the Indian Health Service Facility, once they voluntarily enroll with the Indian Health Service Facility fee-for-service managed care plan. The plan shall be responsible to provide or arrange for health care services for its members as agreed to in the contract between the department and the Indian Health Service Facility. The department shall inform Medi-Cal beneficiaries who are Indians or non-Indians currently receiving services from the Indian Health Service Facility of their option to enroll in the Indian Health Service Facility fee-for-service managed care plan through the health care options program.

(b) To participate as a fee-for-service managed care plan, the Indian Health Service Facility must demonstrate sufficient resources and capability to implement the fee-for-service managed care contract, including, but not limited to:

(1) Medical and administrative staff.

(2) Information systems.

(3) Organizational structure.

(4) Financial solvency.

(5) Quality improvement system.

(6) Member grievance system.

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, 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 14000, 14016.5, 14087.3, 14089 and 14089.05, Welfare and Institutions Code; and Title 25, United States Code, Sections 13 and 1601.