§ 56502. Pccm Contract Selection Criteria.

(a) The Department in exercising its discretion to enter into PCCM contracts shall evaluate applications, considering the following:

(a) Provider models that are able to offer the broadest base or reach particular segments of the Medi-Cal population, such as rural areas and Medicare/Medi-Cal beneficiaries. These provider models include, but are not limited to:

(1) Primary care clinics with specialists.

(2) Primary care clinics.

(3) Hospital based clinics.

(4) Group practices.

(5) Individual primary care physicians.

(6) Other models which offer potential for contracting, which shall be considered by the Department on an individual basis.

(b) Applicants who demonstrate sufficient resources to implement the PCCM contract, which include, but are not limited to:

(1) Support staff.

(2) Information systems.

(3) Organizational structure.

(4) Available capital.

(c) Applicants who provide the broadest range of optional services in addition to mandatory services.

(d) Applicants who will cover service areas that:

(1) Are in geographic areas which are free from competition from other PCCM or managed care plans.

(2) Have a significant enrollment pool based on the Department's estimated Medi-Cal beneficiary distribution patterns.

(3) Serve an area where PCCM plans exist or have existed and have not achieved significant enrollment given the service area or where the Department determines the Medi-Cal eligible population can support an additional plan.

(e) Applicants who have managed care or related experience, which includes but is not limited to:

(1) Subcontracting experience with PCCM plans.

(2) PHP experience.

(3) Industrial provider experience.

(4) Preferred provider experience.

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 A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 7-9-90.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 A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed by operation of law on 11-6-90.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 A Certificate of Compliance must be transmitted to OAL by 3-6-91 or emergency language will be repealed by operation of law on the following day.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: Section 14088.16, Welfare and Institutions Code.