Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) A Medi-Cal Managed
Care Plan may apply to register as a Certified Medi-Cal Managed Care Plan according
to the following process:
(1) The entity shall
submit an application containing all information, documentation, and declarations
required in subdivision (b) of this section.
(2) The application shall demonstrate that the
entity is capable of carrying out at least those duties described in section
6906 and has existing relationships, or
could readily establish relationships, with employers and employees, consumers
(including uninsured and underinsured consumers), or self-employed individuals
likely to be eligible for enrollment in a Qualified Health Plan (QHP) or an
insurance affordability program.
(3) The
Exchange shall review the application and, if applicable, request any additional or
missing information necessary to determine eligibility.
(4) Entities who have submitted a completed
application and demonstrated ability to meet the above requirements shall:
(A) Submit the following:
1. An executed agreement conforming to the Roles
and Responsibilities defined in section
6906; and
2. Proof of general liability insurance with
coverage of not less than $1,000,000 per occurrence with the Exchange named as an
additional insured, and workers' compensation
insurance.
(5)
Entities who are eligible based on their completed application and whose designee
completes and passes the training requirements established pursuant to section
6905 shall be registered as a Certified
Medi-Cal Managed Care Plan by the Exchange and assigned a Certified Medi-Cal Managed
Care Plan Number. If the designee fails to complete the training requirements set
forth in section
6905 within 30 calendar days of
completing the requirements in (a)(4)(A) of this section, the applicant shall be
deregistered.
(b) A Certified
Medi-Cal Managed Care Plan application shall contain the following information:
(1) Full name;
(2) Legal name;
(3) Primary e-mail address;
(4) Primary phone number;
(5) Secondary phone number;
(6) Federal Employment Identification
Number;
(7) State Tax Identification
Number;
(8) Identification of
applicant's status as a Medi-Cal Managed Care Plan and a copy of supporting
documentation;
(9) Identification of the
type of organization and, if applicable, a copy of the license or other
certification;
(10) A certification that
the applicant and all of its employees who will be acting pursuant to this Article
comply with section
6907;
(11) An attestation that the entity will serve
families of mixed immigration status;
(12) An attestation that the entity will serve
individuals with disabilities.
(13) For
the primary site and each sub-site, the following information:
(A) Site Location Address;
(B) Mailing Address;
(C) County;
(D) Primary Contact name;
(E) Primary e-mail address;
(F) Primary phone number;
(G) Secondary phone number; and
(H) Hours of operation.
(14) A certification by the Authorized Contact
that the information presented is true and correct to the best of the signer's
knowledge;
(15) For each Enroller to be
affiliated with the applicant:
(A) All information
required by section
6903 that is not already included
elsewhere in the application required by this section; and
(B) An indication of whether he or she is
certified by the Exchange and, if applicable, the certification
number.
1. New section
filed 4-27-2015 as an emergency pursuant to Government Code section
100504(a)(6),
as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 4-27-2015 (Register
2015, No. 18). A Certificate of Compliance must be transmitted to OAL by 4-27-2017
pursuant to Government Code section
100504, or
emergency language will be repealed by operation of law on the following
day.
2. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government Code
section
100504(a)(6)
to change the date upon which a Certificate of Compliance must be transmitted to
OAL. Pursuant to Government Code section
100504(a)(6),
as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of Compliance
must be transmitted to OAL by 4-27-2018 or the language in the emergency order of
4-27-2015 will be repealed by operation of law on the following day (Register 2015,
No. 38).
3. Refiling of 4-27-2015 order on 9-20-2017, including amendment
of subsection (b), as a deemed emergency pursuant to Government Code section
100504(a)(6);
operative 9-20-2017 (Register 2017, No. 38). Senate Bill 833 (stats 2016, c. 30)
modified Government Code section
100504(a)(6)
to extend the date upon which a Certificate of Compliance must be transmitted to
OAL; a Certificate of Compliance must be transmitted to OAL by 4-27-2020 pursuant to
Government Code section
100504(a)(6)
or emergency language will be repealed by operation of law on the following
day.
4. Certificate of Compliance as to 9-20-2017 order transmitted to
OAL 2-5-2020 and filed 3-12-2020 (Register 2020, No.
11).
Note: Authority cited: Sections
100502 and
100504,
Government Code. Reference: Sections
100502 and
100503,
Government Code.
