§ 56252. Reinsurance.

(a) The provisions of section 56251 notwithstanding, the PCCM plan may obtain reinsurance for the cost of providing capitated services, subject to the following conditions:

(1) Reinsurance shall not reduce the PCCM plan's liability below the minimum liability per member for any one12-month period, as set forth in the PCCM contract.

(2) Reinsurance may cover both of the following:

(A) The total cost of capitated services provided to members under emergency circumstances by nonplan providers.

(B) Up to 90 percent of all expenditures related to the contract exceeding 115 percent of the PCCM plan's gross income from capitation payments and third-party recoveries under the terms of the contract during any PCCM plan fiscal year.

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 A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 7-9-90.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 A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed by operation of law on 11-6-90.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 A Certificate of Compliance must be transmitted to OAL by 3-6-91 or emergency language will be repealed by operation of law on the following day.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 A Certificate of Compliance must be transmitted to OAL by 7-23-91 or emergency language will be repealed by operation of law on the following day.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 14088.4, Welfare and Institutions Code.