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 1810.436 - MHP Individual, Group and Organizational Provider Contracting Requirements

Universal Citation: 9 CA Code of Regs 1810.436

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

(a) At a minimum, a contract between an MHP and a provider shall meet federal contracting requirements as provided in Title 42, Code of Federal Regulations, Section 438.6 (l), and shall include the following provisions:

(1) Treatment requirements, as a condition for reimbursement, that ensure beneficiaries will receive the same level of services as provided to all other patients served.

(2) Assurances that beneficiaries will not be discriminated against in any manner.

(3) Specifics of how the provider shall make records available for authorized review for fiscal audits, program compliance and beneficiary complaints.

(4) Language specifying that the rate included in the contract is considered to be payment in full, subject to third party liability and beneficiary share of cost, for the specialty mental health services provided to a beneficiary.

(5) Requirements that the provider adhere to Title XIX of the Social Security Act and conform to other federal and State statutes and regulations.

(6) If the contract is in excess of $10,000 and utilizes State funds, a provision that: "The contracting parties shall be subject to the examination and audit of the Auditor General for a period of three years after final payment under contract (Government Code section 8546.7)." The MHP shall also be subject to the examination and audit of the State Auditor General for a period of three years after final payment under contract (Government Code section 8546.7).

(b) For Individual, Group and Organizational Providers that conduct utilization management activities, the MHP must ensure that the compensation arrangements in the contract are not structured so as to provide incentives for the individual or entity to deny, limit or discontinue medically necessary services to any beneficiary.

(c) No provision of a contract shall be construed to replace or conflict with the duties of county patients' rights advocates described in Section 5520 of the Welfare and Institutions Code.

(d) Written policies that address a beneficiary's rights as required by title 42 CFR section 438.100 shall be included in the contracts.

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 (a)(6)-(b) and (d), subsection relettering and amendment of NOTE filed 10-18-2010; operative 11-17-2010 (Register 2010, No. 43).

Note: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Section 8546.7, Government Code; Sections 5777, 5778 and 14684, Welfare and Institutions Code; and Title 42, Code of Federal Regulations, Sections 438.6 and 438.100.

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