§ 56250. Subcontracts.

(a) A provider or management subcontract entered into by a PCCM plan shall become effective upon submission to and approval in writing by the Department. Departmental approval shall be based on compliance with (b) and (c) below.

(b) A PCCM plan that subcontracts for the provision of any health care service to PCCM plan members shall ensure that the subcontractor meets all requirements of Chapters 3 and 6 related to services a PCCM plan is required to perform.

(c) Each subcontract submitted for Department approval pursuant to subdivision (a), shall contain at least the following:

(1) Specification of the services to be provided.

(2) Specification that the subcontract shall be governed by and construed in accordance with all laws, regulations and contractual obligations incumbent upon the PCCM plan.

(3) Specification that the subcontract or subcontract amendments shall become effective only as set forth in subdivision (a).

(4) Specification of the term of the subcontract, including the beginning and ending dates, as well as methods of extension, renegotiation and termination.

(5) Subcontractor's agreement to submit reports as required by the PCCM plan and the Department.

(6) The subcontractor's agreement to make all of its books and records, pertaining to the goods and services furnished under the terms of the subcontract, available for inspection, examination or copying:

(A) By the Department and by the Department of Health and Human Services.

(B) At all reasonable times at the subcontractor's place of business, or at some other mutually agreeable location in California.

(C) In a form maintained in accordance with the general standards applicable to book or record keeping.

(D) For the term required by section 56310.

(7) Full disclosure of the method and amount of compensation or other consideration to be received by the subcontractor from the PCCM plan.

(8) Subcontractor's agreement to maintain and make available to the Department, upon request, copies of all sub-subcontracts and to ensure that all sub-subcontracts are in writing and require that the sub-subcontractor:

(A) Make all applicable books and records available at all reasonable times for inspection, examination or copying by the Department and by the Department of Health and Human Services.

(B) Retain all books and records pertaining to its PCCM sub-subcontract in accordance with section 56310.

(9) Subcontractor's agreement to notify the Department in the event the agreement with the PCCM plan is amended or terminated. Notice to the Department is considered given when properly addressed and deposited in the United States Postal Service as first-class registered mail, postage attached.

(10) Subcontractor's agreement that assignment or delegation of the subcontract shall be void unless prior written approval is obtained from the Department.

(11) Subcontractor's agreement to hold harmless both the State and PCCM plan members in the event the PCCM plan cannot or will not pay for services performed by the subcontractor pursuant to the subcontract.

HISTORY

1. New section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 7-9-90.

2. New section refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed by operation of law on 11-6-90.

3. Request to readopt section on an emergency basis pursuant to Government Code section 11346.1 granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No. 6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or emergency language will be repealed by operation of law on the following day.

4. Certificate of Compliance as to 11-6-90 order transmitted to OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).

5. New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No. 18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or emergency language will be repealed by operation of law on the following day.

6. Certificate of Compliance as to 3-25-91 order including amendment of section transmitted to OAL 7-19-91 and filed 8-19-91 (Register 92, No. 1).

Note

Note: Authority cited: Sections 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 14088.16 and 14124.1, Welfare and Institutions Code.