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 3 - Specialty Mental Health Services Other than Psychiatric Inpatient Hospital Services
Article 1 - Fiscal Provisions
Section 1830.105 - Provider Rate Setting Standards and Requirements
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) Except as approved by the Department pursuant to Section 1810.438, the MHP shall reimburse organizational providers that provide services to beneficiaries of the MHP in accordance with Section 1840.105.
(b) The MHP shall reimburse individual and group providers that contract with the MHP in accordance with the terms of the contract.
(c) The MHP shall reimburse individual or group providers that provide services to beneficiaries of the MHP and that do not have a contract with the MHP at the rates established by the Medi-Cal program in Title 22, Division 3, Subdivision 1, Chapter 3, Article 7, unless a different rate is agreed to between the MHP and the provider, except as provided in Subsection (d).
(d) The MHP shall reimburse individual or group providers that provide psychiatric inpatient hospital professional services to a beneficiary of the MHP with an emergency medical condition and that do not have a contract with the MHP at the rates established by the Medi-Cal program in Title 22, Division 3, Subdivision 1, Chapter 3, Article 7.
(e) Individual and group providers shall bill the MHP the provider's usual and customary charges for the specialty mental health service rendered to the beneficiary. The rate paid by the MHP to individual and group providers less third party liability and beneficiary share of cost shall be considered payment in full for the specialty mental health services provided to the beneficiary.
(f) Organizational providers shall bill the MHP in accordance with the cost settlement requirements described in Section 1840.105 that apply to the provider.
(g) The MHP shall not be responsible to reimburse providers who deliver Medicare covered services to a beneficiary for any Medicare coinsurance and deductible payments due to the provider from the Medi-Cal program pursuant to Title 42, United States Code, Section 1396 a(a)(n), unless the provider is an organizational provider contracting with or otherwise authorized by the MHP of the beneficiary.
1. New article
1 (sections 1830.105-1830.115) and 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 article 1
(sections 1830.105-1830.115) and 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 article 1
(sections 1830.105-1830.115) and 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).
Note: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 5778 and 14684, Welfare and Institutions Code; and Title 42, United States Code, Section 1396 a(a)(n).
