California Code of Regulations
Title 10 - Investment
Chapter 5.8 - Managed Risk Medical Insurance Board Healthy Families Program
Article 5 - Child Health and Disability Prevention Program Payments
Section 2699.6905 - Reimbursement Rates

(a) For the purposes of meeting the requirement of Insurance Code section 12693.41 relating to the Healthy Families Program, well-child health assessments and immunizations provided to persons who subsequently enroll in the Healthy Families Program pursuant to Article 2, shall be reimbursed at the rates specified in Title 17, California Code of Regulations, Section 6868. CHDP health assessment providers shall submit claims for these services in accordance with Title 17, California Code of regulations, Section 6866 to the State Department of Health Services (DHS).

(b) For the purposes of meeting the requirement of Insurance Code Sections 12693.41 relating to the Healthy Families Program, providers shall be reimbursed for initial treatment provided to persons who subsequently enroll in the Healthy Families Program pursuant to Article 2, at the Medi-Cal rate, as specified in Title 22, California Code of Regulations, Sections 51501 et. seq. A county that reimburses a provider at a county-specific rate that is less than the Medi-Cal rate for treatment services for a condition identified in a CHDP health assessment will be reimbursed by the Healthy Families Program at the rate the county reimburses the treatment provider. Providers shall submit claims to the DHS for these services on the Health Insurance Claim Form (HCFA 1500, revised version 12/90), accompanied by a legible copy of any DHS approved version of the Confidential Screening/Billing Report (PM 160).