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 4 - Standards
Section 1810.425 - Hospital Selection Criteria

Universal Citation: 9 CA Code of Regs 1810.425

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

An MHP shall establish a hospital selection process that meets the following criteria:

(a) The MHP shall require that each hospital:

(1) Comply with federal Medicaid laws, regulations and guidelines and State statutes and regulations and not violate the terms of the contract between the MHP and the Department.

(2) Sign a provider agreement with the Department.

(3) Provide psychiatric inpatient hospital services, within its scope of licensure, to all beneficiaries who are referred by the MHP, unless compelling clinical circumstances exist that contraindicate admission, or the MHP negotiates a different arrangement with the hospital.

(4) Refer beneficiaries for other services when necessary.

(5) Not refuse an admission solely on the basis of age, sex, race, religion, physical or mental disability, or national origin.

(b) In addition to the specified conditions in Subsection (a), an MHP may consider but is not limited to any or all of the following in selecting hospitals:

(1) History of Medi-Cal certification, licensure and accreditation.

(2) Circumstances and outcomes of any current or previous litigation against the hospital.

(3) The geographic location(s) that would maximize beneficiary participation.

(4) Ability of the hospital to:
(A) Offer services at competitive rates.

(B) Demonstrate positive outcomes and cost effectiveness.

(C) Address the needs of beneficiaries based on factors including age, language, culture, physical disability, and specified clinical interventions.

(D) Serve beneficiaries with severe mental illness and serious emotional disturbances.

(E) Meet the quality improvement, authorization, clinical and administrative requirements of the MHP.

(F) Work with beneficiaries, their families and other providers in a collaborative and supportive manner.

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 A Certificate of Compliance must be transmitted to OAL by 3-2-98 or emergency language will be repealed by operation of law on the following day.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. Amendment of subsection (a)(1) filed 10-18-2010; operative 11-17-2010 (Register 2010, No. 43).
9. Change without regulatory effect amending subsection (a)(2) and NOTE filed 8-24-2015 pursuant to section 100, title 1, California Code of Regulations (Register 2015, No. 35).

Note: Authority cited: Sections 10725, 14680 and 14700, Welfare and Institutions Code. Reference: Sections 14684, 14714 and 14718, Welfare and Institutions Code.

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