California Code of Regulations
Title 9 - Rehabilitative and Developmental Services
Division 1 - Department of Mental Health
Chapter 11 - Medi-Cal Specialty Mental Health Services
Subchapter 1 - General Provisions
Article 3 - Administration
Section 1810.365 - Beneficiary Billing

Universal Citation: 9 CA Code of Regs 1810.365

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

(a) The MHP of a beneficiary, or an affiliate, vendor, contractor, or sub-subcontractor of the MHP shall not submit a claim to, demand or otherwise collect reimbursement from, the beneficiary or persons acting on behalf of the beneficiary for any specialty mental health services provided under this Chapter or related administrative services such as billing for missed appointments or making copies of client records, except to collect:

(1) Other health care coverage pursuant to Title 22, Section 51005.

(2) Share of cost as provided in Title 22, Sections 50657 through 50659.

(3) Copayments in accordance with Section 14134 of the Welfare and Institutions Code and Title 22, Section 51004.

(b) In the event that a beneficiary willfully refuses to provide other current health insurance coverage billing information, as described in Title 22, Section 50763(a)(5), to a provider, including the MHP, upon giving the beneficiary written notice of intent, the provider may bill the beneficiary as a private pay patient.

(c) The MHP or an affiliate, vendor, contractor, or sub-contractor of the MHP shall not hold beneficiaries liable for debts in the event that:

(1) the MHP becomes insolvent,

(2) the State does not pay the MHP for costs of covered services.

(3) the State or the MHP does not pay the MHP provider(s) for covered services.

(4) covered services are provided and paid for under a contract, referral or other arrangement rather than from the MHP,

(5) subsequent screening and treatment is needed to diagnose the specific condition of or stabilize a beneficiary with an emergency psychiatric condition.

1. New section filed 10-31-97 as an emergency; operative 11-1-97 (Register 97, No. 44). A Certificate of Compliance must be transmitted to OAL by 3-2-98 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 3-2-98 as an emergency; operative 3-2-98 (Register 98, No. 10). A Certificate of Compliance must be transmitted to OAL by 6-30-98 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 6-17-98 as an emergency; operative 6-30-98 (Register 98, No. 25). Pursuant to Chapter 324 (Statutes of 1998) Item 4440-103-0001(4), a Certificate of Compliance must be transmitted to OAL by 7-1-99 or emergency language will be repealed by operation of law on the following day.
4. Editorial correction of HISTORY 3 (Register 98, No. 39).
5. Editorial correction extending Certificate of Compliance date to 7-1-2001 pursuant to Chapter 50 (Statutes of 1999) Item 4440-103-0001(4) (Register 99, No. 33). Notwithstanding any other provision of law, emergency regulations adopted pursuant to Welfare and Institutions Code section 14680 to implement the second phase of mental health managed care as provided in this part shall remain in effect until permanent regulations are adopted, or June 30, 2006, whichever occurs first.
6. Editorial correction of HISTORY 5 (Register 2000, No. 42).
7. Editorial correction of HISTORY 5 and repealer and new section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).
8. New subsections (c)-(c)(5) filed 10-18-2010; operative 11-17-2010 (Register 2010, No. 43).

Note: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 14005.9, 14024 and 14134, Welfare and Institutions Code.

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