§ 55160. Indian Health Service Facility Fee-for-Service Managed Care Plan Reimbursement.

If the Indian Health Service Facility provides services as a fee-for-service managed care plan, the department shall reimburse the facility at the applicable reimbursement rate that would have been received by the Indian Health Service Facility if the service had been rendered to a Medi-Cal beneficiary through the Medi-Cal fee-for-service program for each qualifying visit by a member of the fee-for-service managed care plan. In addition, the department shall pay a monthly case management fee established by the department for each member. If the Indian Health Service Facility qualifies for reasonable cost reimbursement, as provided in federal law, the department shall reimburse or recover from the Indian Health Service Facility at least annually an amount equalling the difference between the payments received from the department, excluding case management fees, and reasonable cost reimbursement, or a percentage of reasonable cost, as provided in 42 U.S.C. 1396a(a)(13)(C).

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, 14087.3, 14087.5, 14088, 14089, 14089.05, 14200 and 14499.5, Welfare and Institutions Code; and Title 25, United States Code, Sections 13 and 1601; and Title 42, United States Code, Sections 1396(b)(m)(2)(A)(ix) and 1396(d)( l)(2).