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 4 - Federal Financial Participation
Article 1 - General
Section 1840.105 - General

Universal Citation: 9 CA Code of Regs 1840.105

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

(a) Except as provided in this Subchapter, FFP for specialty mental health services shall be based on the lowest of the following:

(1) The provider's usual and customary charge to the general public for the same or similar services, unless the provider is a nominal charge provider pursuant to Medicare rules at Title 42, Code of Federal Regulations, Section 413.13.

(2) The provider's reasonable and allowable cost of rendering the services, based on year-end cost reports and Medicare principles of reimbursement pursuant to Title 42, Code of Federal Regulations, Part 413 and as described in HCFA Publication 15-1, for providers not contracting on a negotiated rate basis.

(3) The negotiated rates for providers, including the MHP, contracting on a negotiated rate basis pursuant to Subchapter 2, Article 1, beginning with Section 1820.100; Subchapter 3, Article 1, beginning with Section 1830.100; or Sections 5705 or 5716 of the Welfare and Institutions Code.

(4) The maximum allowances established by Title 22, Section 51516, except that the definitions of individual specialty mental health services shall be the definitions in this Chapter. When crisis stabilization is claimed under this Subchapter, the maximum allowance provided in Title 22, Section 51516, for "crisis stabilization-emergency room" shall apply when the service is provided in a 24-hour facility, including a hospital outpatient department. The maximum allowance for "crisis stabilization-urgent care" shall apply when the service is provided in any other appropriate site.

(b) Reimbursement to the MHP, Short-Doyle/Medi-Cal hospitals, or organizational providers based on negotiated rates shall be subject to retrospective cost settlement that shares equally between the federal government and the legal entity the portion of the federal reimbursement that exceeds actual cost in the aggregate by the legal entity. In no case will payments exceed the established maximum allowances.

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).

Note: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5705, 5716, 5718, 5720, 5724 and 5778, Welfare and Institutions Code.

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